387 Teledermatology-based inpatient consult rotations engender autonomy for trainees

Abstract

Preparation for independent practice is essential for graduation from residency yet promoting resident autonomy without compromising faculty supervision is a challenge. In our program, senior residents gain independence during a unique inpatient consult service where attending oversight is provided via teledermatology (TD), with in-person back up available. We surveyed recent graduates of our program to compare levels of perceived autonomy between the TD-based staffing against a traditional in-person model. We also explored perceptions of potential TD-based staffing for inpatient pediatric consults. Of the 29 graduates queried, 66% responded; 7 practice in an academic setting and 12 provide inpatient consultation. Most graduates felt that both the TD-based rotation and in-person patient consult rotations overall were “extremely helpful” in preparing them for future practice (74% for each). Most graduates strongly agreed that TD-based oversight provided greater autonomy in comparison to in-person attending oversight (74%) and that being the only dermatology provider physically present on the TD-based rotation helped cultivate independence for future practice (84%). The majority agreed that more senior dermatology rotations should provide TD-based attending oversight (“strongly agree”=32%;”agree”=26%). Interestingly, 58% either disagreed (21%) or felt neutral (37%) about having a similar TD-based model for inpatient pediatric dermatology consultation. Free text comments expressed concern for the complex nature of pediatric dermatologic conditions that were felt to necessitate in-person attending oversight for every consult. Overall, we found TD-based attending oversight for inpatient dermatology consultation to be of great benefit to dermatology residents. We believe that this unique educational opportunity engenders autonomy for residents as they prepare for future practice. The discrepant comfort level with TD-based staffing for adult versus pediatric dermatology consultation warrants further investigation.