Educational video improves dermatology residents' understanding of Mohs micrographic surgery: A survey-based matched cohort study

Abstract

To the Editor: Dermatology resident experience with Mohs micrographic surgery is highly variable,1Lee E.H. Nehal K.S. Dusza S.W. Hale E.K. Levine V.J. Procedural dermatology training during dermatology residency: a survey of third-year dermatology residents.J Am Acad Dermatol. 2011; 64: 475-483Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar,2Reichel J.L. Peirson R.P. Berg D. Teaching and evaluation of surgical skills in dermatology: results of a survey.Arch Dermatol. 2004; 140: 1365-1369Crossref PubMed Scopus (37) Google Scholar and it has been reported that surgical training is often underemphasized in the course of dermatology training compared with other proceduralists.3Alam M. Dermatologic surgery training during residency: room for improvement.Dermatol Surg. 2001; 27: 508-509PubMed Google Scholar In surgery, especially dermatologic surgery, there is a need to quickly and intuitively transmit complex information to a wide physician audience, and various creative methods have been attempted, including YouTube4Koya K.D. Bhatia K.R. Hsu J.T. Bhatia A.C. YouTube and the expanding role of videos in dermatologic surgery education.Semin Cutan Med Surg. 2012; 31: 163-167Crossref PubMed Scopus (27) Google Scholar and metaphor.5Lee E. Wolverton J.E. SomaniAK A simple, effective analogy to elucidate the Mohs micrographic surgery procedure – the peanut butter cup.JAMA Dermatol. 2017; 153: 743-744Crossref PubMed Scopus (6) Google Scholar We created a mixed live-action and animated video demonstrating an introduction to Mohs micrographic surgery in an effort to improve residents' basic understanding of how, why, and when Mohs micrographic surgery is performed, with additional information on special considerations for Mohs micrographic surgery performed on unique anatomic locations. Although it was never intended to replace any part of a formal Mohs micrographic surgery fellowship, we hoped that residents' confidence with the basic concepts of Mohs micrographic surgery would improve with this approachable educational method. In this survey-based, matched-cohort study, 83 dermatology resident physicians were recruited by contacting Accreditation Council for Graduate Medical Education program coordinators and requesting dispersal within their programs through the Association of Professors of Dermatology LISTSERV (L-Soft International, Bethesda, MD). The residents were asked to complete a preliminary survey to self-rate their comfort level of Mohs micrographic surgery. The survey consisted of 5 basic Mohs competencies, and participants were asked to rate their comfort with each competency as 1 (low) through 5 (high). They were then asked to view 2 short, educational video modules on Mohs micrographic surgery. The first video demonstrates the excision of a sample and its histologic preparation—and how uniquely in Mohs micrographic surgery this allows for evaluation of complete margins with accurate reference to surrounding surface anatomy. The second video demonstrates special anatomic considerations for excising and preparing samples taken from the eyelids, lips, and nails. After viewing the 2 modules, residents reanswered the same survey questions (Fig 1). The combination of premodule and postmodule answers were presented in a cross-tabulation table for each of the 5 questions. Values above the descending diagonal represented higher responses on the postsurvey, and values below this diagonal indicated higher responses on the presurvey. Owing to non-normal distributions for the survey questions, a nonparametric Wilcoxon signed rank test was used to compare the paired responses. This analysis was performed using SAS 9.4 software (SAS Institute Inc, Cary, NC), and a P value of <.05 was considered statistically significant. Our results demonstrated that the video modules significantly improved residents' self-rated comfort in all survey questions (P < .05) (Fig 2). After viewing the video modules, residents assessed themselves as more comfortable with how the layer is taken by the surgeon, how the layer is inked by the surgeon, how the tissue is positioned on the slide, how 100% of the margin is cleared by the surgeon, and unique issues for specific anatomic locations. With wide variation in Mohs micrographic surgery experience among dermatology residents, an approachable medium for resident exposure to Mohs micrographic surgery is needed, and a module conveying 3-dimensional content may fill that need. Our Mohs micrographic surgery video modules improved residents' self-rated confidence with the basics of Mohs micrographic surgery.