The perceived influence of cosmetic dermatology on dermatology resident education

Abstract

To the Editor: Over the past decade, an increased focus on cosmetic products and procedures has increased the demand for cosmetic dermatology. Dermatology residents consistently report inadequate exposure to cosmetics.1Freeman S.R. Greene R.E. Kimball A.B. Freiman A. Barzilai D.A. Muller S. et al.US dermatology residents' satisfaction with training and mentoring: survey results from the 2005 and 2006 Las Vegas Dermatology Seminars.Arch Dermatol. 2008; 144: 896-900Crossref PubMed Scopus (36) Google Scholar, 2Freiman A. Barzilai D.A. Barankin B. Natsheh A. Shear N.H. National appraisal of dermatology residency training: a Canadian study.Arch Dermatol. 2005; 141: 1100-1104Crossref PubMed Scopus (49) Google Scholar, 3Reid D.C. Kimball A.B. Ehrlich A. Medical versus surgical dermatology: how much training do residents receive?.Dermatol Surg. 2006; 32: 597Crossref PubMed Scopus (7) Google Scholar It is unknown if residency programs have increased training in cosmetics and, if so, if this change has compromised interest or expertise in other areas of dermatology. To investigate this, we surveyed those responsible for resident education: dermatology residency program directors and department chairmen. In May 2008, an electronic survey was e-mailed to 171 dermatology residency program directors and chairmen who are members of the Association of Professors of Dermatology. Responses were anonymous. Seven Likert scale questions assessed the perceived influence of cosmetics on dermatology training. The Likert scale was scored from 1 (no) to 9 (definitely). Fifty-three members completed the survey (31% response rate). Eighty-five percent of respondents believed that cosmetics have become a more prominent part of resident training over the past decade (average Likert score, 8.1 out of 9). Fifty-three percent believed that this increase has resulted in decreased expertise and interest in medical dermatology (average, 5.6). Respondents felt that it was less important for residents to gain expertise in cosmetics than in other areas of dermatology (92-100% said it was “very important” to gain experience in medical dermatology, noncosmetic surgery, and dermatopathology during residency, compared with only 36% for cosmetics). Despite this perception, few respondents believed the Residency Review Committee or American Board of Dermatology should formally limit time spent learning cosmetics (average, 4.6), require case logs for medical dermatology (average, 3.3), or reserve cosmetics training for postresidency fellowships (average, 3.0). Notably, they felt, despite the increased prominence of cosmetics in resident training and the perceived inadequacy of cosmetics training by residents, that residents are not more motivated to gain expertise in cosmetics compared with other areas of dermatology (average, 7.2-8.0). Our results confirm previous data that program directors and chairmen believe that training in cosmetics is less important during residency than training in noncosmetic areas of dermatology.1Freeman S.R. Greene R.E. Kimball A.B. Freiman A. Barzilai D.A. Muller S. et al.US dermatology residents' satisfaction with training and mentoring: survey results from the 2005 and 2006 Las Vegas Dermatology Seminars.Arch Dermatol. 2008; 144: 896-900Crossref PubMed Scopus (36) Google Scholar, 2Freiman A. Barzilai D.A. Barankin B. Natsheh A. Shear N.H. National appraisal of dermatology residency training: a Canadian study.Arch Dermatol. 2005; 141: 1100-1104Crossref PubMed Scopus (49) Google Scholar, 4Reichel 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 (41) Google Scholar, 5Todd M.M. Miller J.J. Ammirati C.T. Dermatologic surgery training in residency.Dermatol Surg. 2002; 28: 547-550Crossref PubMed Scopus (26) Google Scholar The important new findings in our survey are that 85% of respondents feel cosmetics has become more prominent in residency training, and 53% believe the increased emphasis on cosmetics has lessened residents' interest and expertise in medical dermatology. Limitations of this study are that it assessed a subpopulation of dermatologists who may be biased toward medical dermatology—yet these are the people charged with educating residents, so we believe their opinions are important. Second, the response rate of 31%, although well within the accepted range for survey studies of physicians, may have affected the data.6Asch D.A. Jedrziewski M.K. Christakis N.A. Response rates to mail surveys published in medical journals.J Clin Epidemiol. 1997; 50: 1129-1136Abstract Full Text PDF PubMed Scopus (1788) Google Scholar Lastly, responders may have stronger feelings about the role of cosmetic dermatology than nonresponders, introducing bias. Our study raises the concern that residents may have less interest and expertise in medical dermatology as a result of increased emphasis on cosmetics. As the field of dermatology expands, it is vitally important that residency programs consider how to offer comprehensive training in all areas of dermatology, including cosmetics, without compromising expertise in traditional aspects of dermatology such as medical dermatology. We are indebted to Dr Sarah O'Brien for her assistance in statistical analysis. Dr O'Brien is affiliated with the Center for Innovation in Pediatric Practice at Nationwide Children's Hospital, Columbus, OH.