From novice to proficient: Comparing veterinary student learning curves of tonometry using TonoPen, TonoVet and TonoVet Plus

Abstract

Our aim was to compare learning curves of final year veterinary students using three commonly-used tonometers for measuring intraocular pressure (IOP) in dogs: TonoPen XL (TP), TonoVet (TV), and TonoVet Plus (TVP). Students were randomly assigned to use one of the tonometers, and their performance metrics (IOP readings, number of attempts and time required to obtain a valid reading) were recorded over a one-week period and compared to those of experienced clinicians. Tonometry data were analyzed using linear mixed-effects models, and student-clinician IOP agreement was assessed using intraclass correlation coefficients (ICC). In the TVP group (n = 39), students took the longest to measure (+9.1 s compared to clinicians, p < 0.001), showed a non-significant trend toward time improvement (reduction ≤0.5 s/test, p ≥ 0.095), and demonstrated the highest agreement with clinicians (ICC = 0.71). In the TV group (n = 38), students took longer to measure than with TP and less time than with TVP (+6.9 s, p < 0.001) but had significant improvement in measurement time (reduction of 1.03 s/test, p = 0.023) and moderate agreement (ICC = 0.68). In the TP group (n = 37), students were fastest (+5.7 s, p < 0.001) and required fewer attempts to obtain valid readings (reduction of 0.056 attempts/eye, p = 0.015), though this group had the lowest student-clinician agreement (ICC = 0.53). Our results show that student performance improved with all tonometers. TP demonstrated the shortest learning curve but had the poorest agreement with clinician measurements. TVP yielded the best agreement but required a longer learning curve. TV offered a balance between learning curve and measurement consistency. These findings highlight the distinct learning characteristics of each device and can improve targeted training strategies in veterinary education.