Dermatology Training Programs Research Articles

How to develop entrustable professional activities in a training dermatology program; practical tips for dermatology educators.

Entrustable professional activities (EPAs) are units of professional practice that could be observed, assessed, monitored, documented, and entrusted. EPAs when entrusted, outline the physician's qualifications, and shape the scope of practice. This insight highlights the importance of development of EPAs in all medical specialties including dermatology to ensure the best standards for patient's care. Development of EPAs-based training program is considered a challenge for clinical educators. In this paper, we describe practical tips and reflections on our experience in developing EPAs in dermatology doctoral training program that could be a guide for dermatology educators to implement EPAs in dermatology training programs.

Steps to improve the teaching of clinical reasoning in dermatology: A scoping review and proposal.

Clinical reasoning (CR) is an area of active interest since faults in the diagnostic process can result in errors and possibly delays in care or even patient harm. The purpose of this scoping review was to collect information from the medical literature on approaches utilized to teach and assess CR in dermatology, identify gaps, and prepare a proposal on how to enhance the speciality's ability to develop trainee CR skills. We conducted a review of the published literature (1990-2020) from four databases. The initial search yielded 780 papers, and 42 relevant CR publications met inclusion criteria. Demographic, thematic content, theoretical frameworks, continuum of authenticity, competency/milestone, and assessment/educational intervention data were recorded by two screeners. Trainees at different educational levels from 17 different countries have been assessed in the dermatology literature. Most publications were of a single intervention, appeared underpowered, and had small sample sizes. Only two publications examined work-based assessments (use real patients/stimuli). Knowledge-based studies were the dominant theoretical framework with no studies exclusively focused on process-based CR interventions. Simulation was well represented with 23 (55%) investigations. Rigorous studies that examine CR teaching and assessment in dermatology are lacking. Evidence-based best practices for use of work-based assessments, especially direct observation, need to be developed/adapted for dermatology and validated. Dermatology training programs would benefit from longitudinal data on trainee CR development, process-based CR educational programs, metacognition CR exploration specific to skin disease diagnosis, and studies that yield practical recommendations on how to structure multi-faceted assessments that assess CR.

A national survey comparing practice patterns and residency training satisfaction for categorical dermatology versus combined internal medicine and dermatology trained physicians.

Combined internal medicine and dermatology (med-derm) training programs were created to advance complex medical dermatology and inpatient dermatology care. A prior study demonstrated that compared to categorical dermatology residents, med-derm residents had less program satisfaction, yet indicated a stronger desire to pursue careers in academia. No follow-up data on practice patterns after training has been reported. We aimed to characterize differences in residency program satisfaction and practice patterns between physicians trained in categorical dermatology compared to med-derm residency programs. We surveyed physicians who graduated from combined med-derm programs along with their counterparts, from six institutions, that either currently or historically had a combined med-derm training, from 2008-2017. Fifty-five percent of med-derm and forty-one percent of categorical-trained physicians responded. The practice patterns between the two groups were similar. A quarter of med-derm physicians continued to provide general internal medicine services. Categorical trained physicians were significantly more satisfied with their training (P=0.03) and performed more excisions on the head/neck (P=0.02). The combined graduates had significantly greater confidence in multidisciplinary care (P=0.003), prescribed more biologic (P<0.001) and non-biologic immunosuppressive agents (P=0.002), and volunteered more for the underserved patients in their communities (P=0.04). Although few differences in overall practice patterns between categorical and med-derm trained graduates were appreciated, med-derm graduates seem more comfortable with multidisciplinary care and may care for more medically complex patients requiring immunosuppression.

Burnout phenomenon in Saudi dermatology residents: a national assessment of prevalence and contributing factors.

A cross-sectional study was conducted between March and August 2021; an electronic survey was administered to all dermatology residents (n=79) in all centers with the Saudi Board Dermatology Training Program in the western, eastern and southern regions. Participation was voluntary, and written informed consent was obtained before the study. The survey was completed by 70 dermatology residents, for an 88.61% response rate. All the participants were aware of the study's aims, and their informed consent was obtained. The study design complied with the Declaration of Helsinki ethical standards and was approved by the Institutional Review Board at Imam Muhammad Ibn Saud Islamic University in Saudi Arabia. A total of 70 respondents completed the questionnaire. High emotional exhaustion (EE) was present in 47.1% of respondents, low personal accomplishment (PA) was present in 65.7%, and high depersonalization (DP) was the least prevalent (24.3%) across all burnout dimensions of dermatology residents. Overall burnout was present in 21.4% of the dermatology residents. Multivariate analysis showed that the odds of EE were significantly lower in males than females [odds ratio (OR)=0.2, P=0.016] and the higher number of patients seen per clinic (OR=1.09, P=0.032) was associated with higher odds of having a high risk of EE, while higher satisfaction with work-life balance was associated with lower odds of a high risk of EE (OR=0.47, P=0.005). A higher number of study hours/week was associated with lower odds of low PA (OR=0.95, P=0.02). Similarly, higher satisfaction with career was associated with lower odds of low PA (OR=0.35, P=0.042). Multivariate analysis showed that only exercise (OR=0.21, P=0.05) and satisfaction with work-life balance (OR=0.42, P=0.008) were associated with a lower risk of burnout. Our study adds the burnout rates among dermatology residents in Saudi Arabia, in addition to possible risk factors that can predict burnout, to the literature. These findings can be applied to improve training programs and reduce the burnout rate among residents.

Measuring h-index and scholarly productivity in academic dermatology in Canada.

Promotion in academia heavily relies on research productivity. The h-index is a standardized metric used to quantify research productivity at the individual level. We evaluated factors associated with h -index in dermatology across select Canadian academic centers with special focus on sex and academic rank. Medical academic centers throughout Canada with dermatology training programs were included. For each faculty member, we extracted the following data from public sources: sex, graduate degree, academic rank, years since the Fellow of the Royal College of Physicians and Surgeons of Canada (FRCPC) certification or equivalent, recent Canadian Institutes of Health Research (CIHR) funding and H-index (based on Scopus author profile). Log-linear univariate and multivariate regression analyses were performed to evaluate the association between h-index and these factors. An ordinal logistic regression was performed to explore sex differences in academic ranking. Our results showed that out of 300 faculty members across Canada, 155 were females (51.67%) and 145 were male (48.33%). H-index was available for 279 dermatologists. The average h-index was 8.35 (SD 11.53) and the median was 4.00 (1st quartile = 2.00, 3rd quartile = 10.00). Higher h-index was associated with more years since dermatology certification, successive academic rank, graduate degree and recent CIHR funding, but not with sex. In conclusion, h-index was not associated with sex when controlling for potential confounders. These results could reflect recent demographic changes in the field with an increase in newly appointed female dermatologists. Longitudinal assessment of academic productivity in dermatology is needed to assess the impact of continued efforts to promote equal opportunities in the field.

Home Programs, Mentor Relationships, and Research Productivity Influence Successful Matching Into Dermatology Training Programs.

Home Programs, Mentor Relationships, and Research Productivity Influence Successful Matching Into Dermatology Training Programs.

Analysis of the Content and Comprehensiveness of Dermatology Residency Training Websites in Taiwan

With a growing trend in the popularity of web-based resources, it is important to evaluate residency program websites for providing accurate information for dermatology residency applicants. Little is known about the quality of dermatology residency websites in Taiwan. The aim of the study is to assesses the quality of official websites of dermatology training programs in Taiwan. A literature search for all related studies from inception to 31 July 2020 was performed using PubMed without restriction on language. We used criteria that had 6 domains and 25 items to evaluate 23 official websites of the dermatology training programs in Taiwan from August to September 2020. Of the 23 training programs, only 6 (26%) of the websites met more than half of the criteria. Notably, the items “features of the department” and “comprehensive faculty listing” were included in all websites. The criteria for interview process, board pass rates, social activities and information on the surrounding area were not met by all websites. Evidently, there is much room for improvement for the dermatology training program websites in Taiwan.

Drivers and sequelae of burnout in U.S. dermatology trainees.

BackgroundBurnout is a health care epidemic. Although burnout has been shown to affect dermatologists in multispecialty studies, there are no such studies in dermatology trainees.ObjectiveWe conducted a survey-based study of burnout in U.S. dermatology trainees to identify its drivers and sequelae.MethodsAll residents enrolled in a U.S. dermatology training program were eligible. The 45-question survey included the Maslach Burnout Inventory, a validated quality of life index, and 31 questions based on known drivers of burnout and new research questions. No identifying data were collected.ResultsA total of 180 residents responded, for a response rate of 14.4%. Notably, an analysis of the cohort showed that our sample was not statistically different from the national complement of trainees based both on proportion of female respondents and mean age (p = .9449 and .2376, respectively). Of the respondents, 59% were female. The average age was 30.6 years. Sixty-nine percent of trainees (124 of 180) met the criteria for burnout. On univariate analysis, age, sex, training year, and relationship status were not associated with burnout. Good work–life balance (p = .032), autonomy in the workplace (p = .0027), intradisciplinary respect (p = .022), and increased work hours (p = .0110) were protective. On multivariate analysis, autonomy in the workplace (odds ratio: 3.580; confidence interval, 1.32–9.71; p = .012) and good work–life balance (odds ratio: 0.262; confidence interval, 0.095–0.722; p = .0097) remained significant.ConclusionImproving control over working environment, as evidenced by the impact of work–life balance and autonomy, may lessen burnout in trainees. Further studies analyzing regional and program-specific variations will help improve trainee experience.

Skin Malignancy in the Military: A Number Needed to Biopsy Analysis.

Skin malignancy has increased in prevalence over the last 15 years and effective diagnosis is required for adequate treatment. Retrospective data analysis of skin biopsy data has shown correlation between various independent variables, but no studies have been shown to directly assess skin malignancy risks for military personnel. Assessing correlation could lead to more effective, targeted screening programs that could lead to decreased mortality from skin malignancies. We present a 1-year analysis of the number needed to biopsy (NNB) to detect skin cancer and analysis of military-specific risk factors in a military dermatology training program. The present study aims to (1) compare skin biopsy yields to civilian institutions and patient populations and (2) determine significance of exposure variables including age, gender, military beneficiary status, branch of service, and military rank. We performed a retrospective observational study over 1 year by identifying all skin biopsies performed in the Walter Reed National Military Medical Center dermatology clinic from August 2015 to July 2016. Utilizing the pathology reports, we manually excluded biopsies performed for the purpose of ruling out inflammatory/immunologic conditions or cosmeses and focused only on encounters performed to rule out basal cell carcinoma, squamous cell carcinoma, or melanoma. We decided to exclude malignant diagnoses that were exceedingly rare or could mimic inflammatory conditions, such as cutaneous T-cell lymphoma. For uncertain diagnoses with vague context per pathology report, previous office clinic notes and pre-biopsy differential were referenced and included only if melanoma or non-melanoma skin cancer (NMSC) diagnosis was the intended indication. A total of 3,098 biopsies were included in the study, diagnostic for 1,084 total skin malignancy and 54 melanoma diagnoses. Melanoma comprised 4.98% of all skin malignancy diagnosed. The NNB for all skin malignancy was 2.86 (95% CI 2.76-2.96) and NNB for melanoma and NMSC was 20.93 (95% CI 19.70-22.15) and 1.91 (95% CI 1.83-2.00), respectively. Patient age, gender, and military rank significantly impacted NNB values (P < .001). The proportion of melanoma skin cancers is notably increased in our population compared to published population statistics with comparable total biopsy yields. Skin biopsy for purpose of screening for malignancy should be performed in the military population and consideration should be made for gender, age, and rank. Our findings can further expand on military risk factors for skin cancer and aid in further multivariant modeling.

An Observational Survey to Appraise the Influence of COVID-19 Pandemic on Dermatology Training Programs in India: Residents' Standpoint.

Background:Given the all-encompassing foothold of COVID-19, it is plausible that the pandemic would have a long-lasting impact on medical training programs, including dermatology. We conducted a survey amongst the residents of dermatology (across India) to assess the impact of COVID-19 pandemic on their teaching and education programs.Materials and Methods:An online semi-structured English questionnaire was prepared on the Google-forms platform and the link was circulated among the residents. The questionnaire comprised of five sections (demographic details, impact on clinical training, procedural training, academic curriculum, and research activities). Appropriate statistical tests were carried out to analyze the data obtained.Results:Three-hundred and seventy-eight responses were taken into consideration. A majority of the respondents (63.5%) were engaged in both COVID-19-related duties and departmental work (out-patient and in-patient duty). Around two-thirds of the trainees (65.1%) claimed a reduction in patient footfall (greater than 50% compared to pre-COVID times). Sixty-nine percent reported a decline of more than 50% in in-patient admission; 47.6% felt that the discontinuity in patient care had severely affected their residency training; 50.8% highlighted that no procedures were being performed in their department; 54.5% opined that academic activities were relatively unhampered as regular seminars were being conducted through online web-based applications; and 65.1% of the trainees were not able to devote any time to their thesis-related work.Conclusion:Since the after-effects of this pandemic will last long, it is advisable that residents and faculties adapt themselves to web-based learning programs in the academic curriculum so that the training of the future consultants does not get jeopardized. Our survey, being the first of its kind in dermatology, will throw some light on the perspective of residents and the way forward to combat the untoward consequences on their training programs.

Psychodermatology fellowship: is it time?

The fields of dermatology and psychiatry have overlap in the patient populations and diseases they treat. However, there are not currently fellowship opportunities for dermatologists or psychiatrists specifically interested in gaining expertise in psychodermatology. We discuss the logistics of a one-year psychodermatology fellowship, open to residents after completing either dermatology or psychiatry residencies, and the potential benefits that it could bring to both dermatology and psychiatry training programs across the county.

Bonds and Bridges: The Role of Social Capital in Building a More Diverse Dermatology Workforce

Several calls to action have been made in response to the lack of racial diversity in dermatology, but we have yet to explore how differences in social capital perpetuate homogeneity in dermatology training programs and the workforce. Herein, the concept of social capital is applied to this problem in dermatology and is used as a scaffold to suggest interventions that may ameliorate the systemic barriers faced by underrepresented-in-medicine (UIM) students.

Psoriasis in patients of color: differences in morphology, clinical presentation, and treatment.

Psoriasis is a chronic inflammatory skin disease affecting 2% to 3% of individuals worldwide. However, the majority of clinical data are in white patients, with limited data in patients of color. We present 3 cases of psoriasis representative of patients presenting to an urban and racially diverse hospital-based dermatology clinic in Toronto, Ontario, Canada, to illustrate the differences in psoriasis in patients of color compared to white patients. We review the differences in the morphology, presentation, treatment, and psychosocial impact of psoriasis in this population. We also discuss the importance of early diagnosis, treatment considerations, and education in dermatology training programs regarding psoriasis in patients of color.

Assessing Quality of Reporting of Herbal Dermatology Trials from the Philippines using the hCONSORT Checklist: a Systematic Review

Background. Herbal medicine is a growing and innovative field in Philippine dermatology. There is a need to assess the quality of reporting of published herbal randomized controlled trials (RCTs) in dermatology since these will serve to guide rational development and use of medicinal plants in the Philippines.&#x0D; Objective. The study aimed to assess the quality of reporting of published herbal RCTs in dermatology from the Philippines based on the hCONSORT checklist.&#x0D; Methods. We searched MEDLINE, CENTRAL, HERDIN (from inception to 20 September 2018), and other secondary sources for published randomized controlled trials that used any herbal preparation as intervention for the treatment or prevention of a dermatologic disease or for maintenance of healthy skin, hair, or nails. We determined the percentage of reported items based from the hCONSORT checklist.&#x0D; Results. We included 41 trials, majority of which were on infections, infestations, and bites (66%). The three most common families of herbs used were Fabaceae/Leguminosae (22%) (Gliricidia sepium (Jacq.) Walp. [kakawati]; Senna alata (L.) Roxb. / Cassia alata (L.) [akapulko]); Arecaceae (12%) (Cocos nucifera L. [coconut]); and Myrtaceae (12%) (Eucalyptus sp [eucalyptus], Psidium guajava L.[guava], and Melaleuca alternifolia (Maiden &amp; Betche) Cheel [tea tree]). Most of the trials (27/41, 66%) were conducted in accredited dermatology training programs of the Philippine Dermatological Society. Only 11 trials (27%) were published in PubMED-indexed journals. More than half of articles were published after the CONSORT publication in 2006 (59%). The mean percentage of reported hCONSORT checklist items in included studies was 39.6% (SD 9.9), with only seven studies reporting more than 50% of the hCONSORT checklist items.&#x0D; Conclusion. Published herbal RCTs in dermatology from the Philippines are poorly reported based on the hCONSORT checklist. There is a need for dissemination of the hCONSORT to local researchers and journal editors to ensure thorough and quality reporting.

Fungal Skin Infections.

1. Aditya K. Gupta, MD, PhD, FRCP(C), FAAD*,† 2. Melissa A. MacLeod, MSc† 3. Kelly A. Foley, PhD† 4. Gita Gupta, MD‡ 5. Sheila Fallon Friedlander, MD§ 1. *Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada 2. †Mediprobe Research, Inc, London, Ontario, Canada 3. ‡Wayne State University, Detroit, MI 4. §Dermatology and Pediatrics, Pediatric Dermatology Training Program, University of California at San Diego School of Medicine, Rady Children’s Hospital, San Diego, CA * CMC: : Chronic mucocutaneous candidiasis HIV: : Human immunodeficiency virus id: : Dermatophytid KOH: : Potassium hydroxide MC: : Mucocutaneous candidiasis PCR: : Polymerase chain reaction PV: : Pityriasis versicolor TP: : Tinea pedis Most pediatricians appear to be familiar with candidal diaper dermatitis, but there is a lack of knowledge about other, less common fungal infections in children. After completing this article, readers should be able to: 1. Recognize the clinical presentations of different fungal infections in children. 2. Know the differential diagnosis of various fungal skin infections. 3. Know what diagnostic tests can be used to confirm infection. 4. Be aware of available treatment options and how to manage the infections appropriately. Candidal diaper dermatitis is the most common fungal infection of childhood. This yeast infection almost always secondarily invades diaper-area skin that has been damaged by an irritant contact dermatitis from maceration, urine, and/or stool. Children in the preschool-age group who no longer wear diapers are more likely to develop tinea infections, particularly tinea capitis. Tinea refers to dermatophyte infections in the epidermis and areas high in keratin, such as the hair and nails. In prepubertal children, tinea capitis and tinea corporis are most common; in adolescence, tinea pedis (TP), tinea cruris, and tinea unguium (onychomycosis) are more common. (1) Yeast infections other than candidal diaper dermatitis, including pityriasis versicolor (PV) (formerly known as tinea versicolor) and mucocutaneous candidiasis …

Development of a curriculum in molecular diagnostics, genomics and personalized medicine for dermatology trainees.

Results of molecular studies are redefining the diagnosis and management of a wide range of skin disorders. Dermatology training programs maintain a relative gap in relevant teaching. To develop a curriculum in molecular diagnostics, genomics and personalized medicine for dermatology trainees at our institution. The aim is to provide trainees with a specialty-appropriate, working knowledge in clinical molecular dermatology. The Departments of Dermatology and Pathology and Laboratory Medicine collaborated on the design and implementation of educational objectives and teaching modalities for the new curriculum. A multidisciplinary curriculum was developed. It comprises: (i) assigned reading from the medical literature and reference textbook; (ii) review of teaching sets; (iii) two 1 hour lectures; (iv) trainee presentations; (v) 1-week rotation in a clinical molecular pathology and cytogenetics laboratory; and (vi) assessments and feedback. Residents who participated in the curriculum to date have found the experience to be of value. Our curriculum provides a framework for other dermatology residency programs to develop their own specific approach to molecular diagnostics education. Such training will provide a foundation for lifelong learning as molecular testing evolves and becomes integral to the practice of dermatology.

The importance of dedicated dermoscopy training during residency: A survey of US dermatology chief residents

Studies have shown low satisfaction levels among dermatology residents with respect to dermoscopy training. Many desire additional instruction. We surveyed graduating chief residents to assess current education practices among US dermatology training programs with respect to the role of dermoscopy as an aid in the management of pigmented lesions. An online survey was sent to 139 chief residents of US dermatology training programs. A 59% response rate was achieved. Of responding chief residents, 94% use dermoscopy. Although 92% of chief residents received dermoscopy training, only 48% trained with a pigmented lesion specialist. Among those training without a specialist, less than half received classroom or bedside teaching compared with 77% of those who trained with a specialist. Of those who trained with a specialist, 77% were satisfied with their training compared with only 30% who trained without a specialist (P < .0001). Those who trained with a specialist were more likely to agree that dermoscopy can help differentiate melanoma from benign lesions (77% vs 47%; P = .0065). Response bias and limiting the survey to chief residents potentially limits our ability to generalize these results to all US dermatology trainees. Although many residents use dermoscopy as a diagnostic tool, the lack of dedicated dermoscopy training remains a potential barrier to increasing residents' diagnostic confidence in the management of pigmented lesions. Increasing the amount of dedicated instruction on this topic is one possible approach to enhance resident satisfaction, potentially increasing their competency in the management of atypical nevi.

Quality Assurance in Postgraduate Medical Education: Implications for Dermatology Residency Training Programs

In the past few years, quality assurance has become an increasingly important part of medical education for both Canadian and American training programs. Since this emphasis on quality assurance in residency programs is recent, most faculty members involved in teaching residents in dermatology training programs would not themselves have had experience with quality assurance. As a result, satisfying this requirement may be a challenge. In this article, we review published reports in which various residency training programs have satisfied this requirement and propose projects in which dermatology residency training programs may satisfy quality assurance requirements. Using the key words residency, training, project, quality, assurance, improvement, medical errors, and safety, a literature search was conducted of English-language articles published after January 1990. There are many innovative and effective ways program directors in dermatology training programs should be able to develop projects that improve patient care, enhance resident education, and fulfill accreditation requirements.

Use of and beliefs about total body photography and dermatoscopy among US dermatology training programs: An update

Total body photography (TBP) and dermatoscopy are imaging techniques used to treat patients with pigmented lesions. We sought to describe use, training, logistics, and beliefs about these tools among residency programs and to assess changes during a 10-year period. Surveys were sent to all directors (n = 111) and chief residents (n = 109) of US dermatology training programs. A total of 83 (74.8%) attendings answered the questionnaire. In all, 59 (71.1%) reported using TBP, an 11.9% increase (P = .2484) over the past decade. Reasons for using TBP included: reduces patient anxiety (81.4%), helps detect early melanoma (78.0%), and leads to fewer biopsies (66.1%). Logistical (79.2%) and financial (45.8%) constraints were reasons for not using TBP. Seventy respondents (84.3%) reported using dermatoscopy, a 40.0% increase (P = .0001) over the 10-year period. Reasons for dermatoscopy use were consistent over time: helps find melanoma in curable stage (75.7%), reduces patient anxiety (61.4%), and leads to fewer biopsies (57.1%). The most common reason for not using dermatoscopy remained lack of training (38.5%). A total of 92 (84.4%) residents completed their survey, of which 41 (44.6%) and 81 (88.0%) reported using TBP and dermatoscopy, respectively. In all, 62 (67.4%) and 79 (85.9%) respondents would prefer additional training in TBP and dermatoscopy, respectively. Results may not be applicable to the general dermatology community. Use of dermatoscopy among residency programs has increased significantly during the last decade. A more modest increase in the use of TBP was observed. Barriers to diffusion of these technologies into practice persist, including insufficient logistics and training.

The current state of dermatopathology education: a survey of the association of professors of dermatology

Dermatology training programs develop program-specific dermatopathology (DP) curricula. We summarize the current state of DP education in dermatology residency programs and identify opportunities for DP education resource development. A 27-question survey was emailed to members of the Association of Professors of Dermatology (APD). Fifty-two of 109 programs responded for a response rate of 48%. Results were calculated using a non-response adjustment. Thirty per cent of the overall education time during residency is spent in DP-specific education. Lever and Weedon are the texts most often cited as primary texts utilized for DP education. Three-quarters of programs have third year residents spend three or more weeks on the DP service. The majority of dermatology residency programs have a specific DP service rotation at some point during residency. The majority of training programs use a variety of resources and mechanisms for teaching DP to dermatology residents. Some programs list barriers to DP education including lack of cases, microscopes, resident education time for DP-related teaching and availability of educators. We conclude that a greater depth and breadth of resources for DP education would be of benefit to dermatology residency programs.