Dermatology Training Research Articles

Computer-Based Video Instruction for Training Medical Students on Skin Biopsies.

The development of procedural skills is necessary for medical students. Computer-based video instruction (CBVI) increases knowledge and procedural skills. This pilot study's aim was to investigate the usefulness of CBVI in dermatologic procedure training for medical students and secondarily assess students' overall perception of the field of dermatology. Twenty-nine first- and second-year medical students were randomly assigned to the CVBI group or control group, in addition to in-person instructor demonstration of shave and punch biopsies using fresh cadaver tissue. Blinded evaluators graded student performances using a five-point Likert scale immediately after demonstration, and 1 week later to assess knowledge retention. In overall performance, the CBVI group demonstrated higher scores both in shave (3.54 vs 2.59, p = .01) and punch biopsies (3.63 vs 2.88, p = .01) at immediate recall and knowledge retention (3.68 vs 2.67, p = .01; 4.00 vs 2.99, p < .001, respectively). Approximately 33.3% of the students stated that the experience increased their interest in the field of dermatology. Incorporation of CBVI into the dermatology curriculum augments medical students' procedural skills. The CBVI group performed significantly better in all 7 grading categories for shave biopsy and in 5 of 7 categories for punch biopsy. Integration of procedural laboratory tests raises students' interest in dermatology.

GRAPPA Trainees Symposium 2018: A Report from the GRAPPA 2018 Annual Meeting

The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) held a trainee symposium at its 2018 annual meeting in Toronto, Ontario, Canada. Rheumatology and dermatology trainees engaged in psoriasis or psoriatic arthritis research presented their work. This report briefly reviews 5 oral presentations and 21 posters presented at the meeting.

Dermatologic Training and Practice in Canada: A Historical Overview.

The specialty of dermatology is constantly changing to meet the medical needs of our society. The discipline is in flux because of a variety of factors such as growing population needs, technological advancements, fiscal restraint, and demographic changes. As part of an in-depth review of the specialty, the Dermatology Working Group (DWG) for the Royal College of Physicians and Surgeons of Canada sought to determine whether the current training configuration is suitably preparing graduates to meet the societal health needs of dermatology patients. In this first of a 2-part series, the authors conducted comprehensive literature and historical reviews and a jurisdictional analysis to understand the current state of dermatology practice in Canada. Herein, they explore trends in the dermatology workforce, population needs, accessibility, and wait times, as well as issues in undergraduate and postgraduate medical education. In a subsequent publication, the DWG will utilize information gained from this historical analysis and jurisdictional review, stakeholder perspectives, and a national survey to shape the future of dermatology training in Canada.

Dermoscopic Features of Psoriasis, Lichen Planus, and Pityriasis Rosea in Patients With Skin Type IV and Darker Attending the Regional Dermatology Training Centre in Northern Tanzania.

BackgroundPapulosquamous skin diseases can be challenging to diagnose, especially in dark skin. Dermoscopy is reported to be helpful, but few data are available on its use in skin type IV or darker.ObjectiveTo describe dermoscopic features in plaque-type psoriasis (PP), lichen planus (LP), and pityriasis rosea (PR) patients attending the Regional Dermatology Training Centre in Moshi, Northern Tanzania, and to compare findings with published data.MethodsA descriptive cross-sectional study was conducted at a tertiary hospital from October 2016 to June 2017. Fifty-six patients with PP, 25 with LP, and 9 with PR were enrolled consecutively. Clinical diagnosis was confirmed with histopathology in 74.4%. Dermoscopic vascular and nonvascular features from 225 lesions were analyzed.ResultsOf the 90 patients enrolled, 58.9% were male and the median age was 50 (interquartile range 32.8–60.0) years. In PP lesions, red dots were found in 64.2% and white scale in 45.5%. In LP lesions the background was violet in 45.5% and 58.2% revealed Wickham striae. In PR lesions a dull red background was found in 50.0%, white scale in 83.3%, but no vessels were detectable.ConclusionDermoscopy features in PP, LP, and PR in dark skin are mostly similar to those in light skin.

Impact of medical scribes on dermatology trainee and attending experience

Medical scribe integration into academic dermatology practices results in decreased attending documentation time, improved physician efficiency, and positive patient satisfaction. However, scribes' impact on dermatology education has not been explored. We conducted a cross-sectional survey at the Brigham and Women's Hospital Dermatology Department and its associated residency program assessing trainee and attending perceptions of scribe impact on documentation time, teaching time, and quality of teaching. Thirty-nine surveys (67% of eligible population) were analyzed. The majority of faculty and trainees perceived that scribes decreased documentation time (92% attendings, 88% trainees), increased attendings' direct teaching time (57% attendings, 76% trainees), increased attending availability to answer questions (57% attendings, 68% trainees), and improved overall education (57% attendings, 80% trainees). Trainees generally perceived educational benefits of scribes more strongly than attendings. Trainees and attendings had discordant views regarding number of patients that the trainee sees (29% attendings, 72% trainees, P&lt;0.05) and the amount of supervision provided for procedures (43% attendings, 56% trainees). The positive impact of scribes on dermatology education is consistent with results in other disciplines. Although hospitals typically invest in scribes to increase physician efficiency, this study suggests that scribes can also improve the educational experience.

Do primary care physicians require training in core clinical dermatology? A cross sectional needs assessment study from Western India.

Primary care physicians play a crucial role in managing patients with common skin disorders who form around one-third of outpatient attendees. This study aimed to assess the need for dermatology training among primary care physicians by assessing their knowledge, self-perception of ability to diagnose and manage skin disorders, and their difficulties in managing these patients. A descriptive, cross-sectional, needs assessment study was done among primary care physicians (n = 61) of rural (n = 34) and urban (n = 27) areas of Vadodara district. A pre-validated semi-structured questionnaire (for self-rating of the ability to diagnose/manage skin disorders and difficulties faced in managing patients) was used along with a photo-quiz (for knowledge assessment) while approaching primary care physicians during their monthly review meeting with prior permission. Data were analyzed by Epi InfoTM software and manual content analysis. The mean score on the photo-quiz was 4.1/10. Forty-three (70.5%) participants rated their ability to diagnose/manage skin disorders as 'average' on a five-point Likert scale. Various difficulties (n = 89) narrated by participants were related to their knowledge/skill, disease factors, patients and administrative aspects. Three-fourths of the participants managed difficulties by referring patients to dermatologists. One-third suggested conducting training in common skin disorders. The study population included primary care physicians from the government healthcare setup only. Knowledge assessment was done using a short ten-item photo-quiz instead of actual patients. Primary care physicians had poor knowledge of skin disorders, and a majority overrated their own ability for clinical management of these disorders. Most common difficulties faced were related to clinical management. There is a need for training on common skin disorders.

Evaluation of a Hybrid Undergraduate Dermatology Training workshop during Family Medicine clerkship

Evaluation of a Hybrid Undergraduate Dermatology Training workshop during Family Medicine clerkship

Where are we in cosmetics and esthetics practices in educational clinics in Turkey?

Objective: Cosmetic dermatology has recently gained importance with the recent increase in demand. The aim of this study is to identify cosmetic dermatology training in Turkey and to assess instructors' attitudes toward cosmetic dermatology training during residency and current cosmetic dermatology practices. Methods: This is a cross-sectional questionnaire study conducted with instructors to investigate the practice of cosmetics dermatology, the technical equipments, number of patients, and their ideas in the clinics that provide dermatology specialty education in Turkey. Results: At least one cosmetic procedure was found to be performed in 69% of the clinics that participated in the study (n = 55), and no cosmetic procedure was performed in 31% of the clinics. The mean number of application was 13.2 ± 12.3 weekly in the clinics that performed cosmetics procedure. The most common procedures were botulinum toxin injection with 63.6% (n = 35), chemical peeling with 60% (n = 33), and platelet-rich plasma with 60% (n = 33), respectively. The most common laser application was neodymium-doped yttrium aluminum garnet (28/55). The mean time spent for cosmetic procedures was 1–5 h weekly in the clinics which performed cosmetic procedures. Seventy-six percent (n = 42) of the participants felt inadequate for performing cosmetics procedures, and 95% (n = 52) reported that cosmetic dermatology education was required. Conclusions: Both theoretical and practical education must be given in educational clinics, and the infrastructure must be created, and the educational schedule must be standardized.

Digital Problem-Based Learning: An Innovative and Efficient Method of Teaching Medicine.

Background:The breadth of knowledge assimilated by undergraduates is substantial. Time must be utilised to impart knowledge and skills to ensure optimal training. Dermatology comprises a large portion of work in primary care; yet UK undergraduate dermatology training is short. Digital problem-based learning (PBL) is an innovative teaching method incorporating clinical images into intense, interactive teaching sessions.Aim:To determine the efficacy of digital PBL sessions in teaching UK medical students during their dermatology module.Methods:In total, 59 second-year medical students at Norwich Medical School during their dermatology secondary care attachment completed two 2.5-h digital PBL sessions. One session was focused on lesions and the second on inflammatory diseases. During each session, students assessed 60 clinical cases each comprising an image with a brief history. In small groups, students discussed the cases, described the images, and agreed a diagnosis followed by a group discussion with the supervising clinician who provided feedback. Following each session, students completed a feedback questionnaire.Results:In total, 117 sets of feedback were received; 60% of students considered they learnt a great amount in a short time. The majority of students reported feeling more confident to make a dermatological diagnosis and more motivated in clinics as a result of the digital PBL; 64% of students found digital PBL more useful than real patient clinics. The most frequent negative comment was that 2.5 h was too long to concentrate.Conclusions:Digital PBL was a popular, effective, and efficient teaching method. Digital PBL sessions should be introduced alongside clinics and other teaching methods for undergraduates.

Clinical spectrum of dermatological disorders in children referred from pediatrics department

Background: Worldwide, limited studies have been done to study the spectrum of dermatological referrals in children. Aims and Objectives: The aim of this study was to analyze the spectrum of dermatological disorders in children referred from pediatrics department. Materials and Methods: It was a hospital-based observational study. Five hundred twenty-five children of either sex or age ≤18 years, in whom, parents had given written informed consent, and referred to Dermatology from Pediatric medicine department were included in this study. The diagnosis was made based on clinical features supported by necessary investigations. Working hours were considered as routine and emergency. Nelson' severity scoring system was used to classify children as sick. Results: Most of the children were referred during routine hours (85.7%), maximally from inpatient department (46%) followed by outpatient department (37%). Most common diagnosis was viral infections (21.2%), closely followed by eczematous disorders (17.6%) and disorders due to arthropods (17.1%). Majority of patients were not sick (83.61%). Pediatricians did not suggest any diagnosis in 70.85% of referrals followed by doubtful diagnosis in 26.85% and definitive diagnosis in 2.28% of patients. Conclusion: Majority of referrals were done during routine hours in nonsick patients. As many common easily treatable dermatoses were observed in all the referrals reiterating the fact that these referrals should be sought as early as possible to prevent unnecessary delays in the diagnosis and patient management. Furthermore, a robust dermatological training should be provided to undergraduates and interns to better equip the nondermatologists to diagnose common dermatological disorders.

Social media in dermatology: clinical relevance, academic value, and trends across platforms

Social media encompasses multiple sites for online communication that reach a large proportion of the global population. While the increase in number of publications investigating dermatology content on social media has paralleled the growth of social media in the past decade, there has not yet been an extensive review of past literature on this topic. Our objective is to summarize and analyze publications on the role of social media within the field of dermatology. Social media is frequently used by patients to solicit advice related to cutaneous concerns and even when seeking out a dermatologist, but it is underutilized among both clinicians marketing their practices and academicians collaborating with colleagues in the field. Social media has the potential to advance instruction for trainees in dermatology and facilitate new research methods. Patient-centered perspectives and advocacy groups have a larger presence overall on social media platforms than stakeholders in academic dermatology. Furthermore, specific platforms like Facebook, YouTube, and Twitter vary in originators of material, messaging strategies, and reliability of information with regards to certain dermatologic conditions and behaviors.

A clinicoepidemiological study of topical corticosteroid misuse at a tertiary care center

Background: Misuse of topical corticosteroids (TCS) has become a burning issue in many countries across the globe. Nonprescriptional sale, lack of awareness, and nonavailability of qualified dermatologist are some of the contributing factors.Aim: To assess the clinicoepidemiological profile of patients misusing TCS and assess various factors contributing to it.Methods: All the patients presenting to the dermatology OPD of a tertiary care center were screened by asking for application of any topical medication. Those patients who were found to be using TCS inappropriately as per clinical diagnosis were included in the study.Results: A total of 324 out of 8621 (3.76%) patients were included in the study. Maximum number of patients belonged to the age-group of 21–30 years. The most common steroid was clobetasol followed by mometasone and beclomethasone. The most common primary dermatosis was dermatophytosis followed by acne vulgaris and melasma. Unavailability of dermatologist was the most common reason cited by the patients for the use of these preparations.Conclusion: Nonprescriptional sale of TCS is the major factor responsible for TCS abuse in India. Creating awareness (both amongst patients and prescribers) and adequate dermatology training to undergraduate medical students is the need of the hour.

Male Genital Dermatology: A Primer for the Sexual Medicine Physician.

The dermatologic conditions affecting the male genitalia are diverse and range from normal variants and benign growths to overt malignancy. Unfortunately, there is a dearth of urologic dermatology training in most residency programs, and many dermatologic lesions with a classic appearance on other areas of the body may have atypical presentations on the genitalia. Patients may present to a variety of physicians without receiving a definitive diagnosis, which can be highly distressing to the afflicted individual. To provide sexual medicine physicians tools to aid in the evaluation and diagnosis of urologic dermatology lesions, whether they are limited to the genitalia or part of a widespread systemic disease. Comprehensive review of the literature pertaining to genital dermatology in men. We stratify each condition into 1 of 5 groups (normal variants and benign lesions, inflammatory lesions, transmissible lesions, premalignant lesions, and malignant lesions) and focus on presentation and prevalence of these conditions. Sexual medicine physicians should emphasize the non-pathologic nature of normal variants of genital anatomy (ie, penile hyperpigmentation, pearly penile papules) and stress that removal of these lesions is only appropriate for cosmetic purposes. Benign genital growths (ie, sebaceous cysts, seborrheic keratoses) may not require intervention, but they should be monitored for atypical features and infection. In contrast, transmissible (ie, herpes, syphilis) and inflammatory (ie, psoriasis) lesions may necessitate prompt intervention to reduce transmission and complications of late-stage disease. Premalignant and malignant lesions may mimic many of the aforementioned conditions; it is important that patients receive routine follow-up after treatment. All suspicious non-healing or ulcerating lesions should undergo pathologic evaluation to rule out malignancy. Urologic dermatology can be a diagnostic challenge for sexual medicine physicians. This review simplifies the diagnostic approach and emphasizes pathologic features of each condition to guide management. Gabrielson AT, Le TV, Fontenot C, etal. Male genital dermatology: A primer for the sexual medicine physician. Sex Med Rev 2019;7:71-83.

Aesthetic Dermatologic Surgery Training in Canadian Residency Programs.

The public and other physicians expect dermatologists to be experts on aesthetic dermatology services. In Canada, current challenges may limit residents from achieving competency in aesthetic dermatology during their training. This may adversely affect patient safety, create medicolegal risks, and deter graduates from offering aesthetic procedures. The objective of this article is to characterize the curriculum, hands-on learning opportunities, and perceptions of aesthetic dermatologic training in Canadian dermatology residency training programs. An online survey of faculty and residents within Canadian dermatology residency programs was performed. The main outcome measures were the hours of formal aesthetic dermatology teaching, the frequency of hands-on dermatology resident training with injectables and devices, and comparing faculty and resident perspectives regarding resident aesthetic dermatology training. Thirty-six faculty members (40%) and 47 residents (34%) responded to the survey. Lasers, fillers, neuromodulators, and mole removal were most commonly taught in the 10 hours or fewer of formal instruction. Residents commonly observed rather than performed procedures. High dissatisfaction among residents was reported with the quality and quantity of aesthetic dermatology training. Faculty and resident respondents supported increasing aesthetic dermatology education, and approximately 70% of residents plan to offer aesthetic services. Discounted pricing or resident-led clinics were felt to be ways to increase resident hands-on experience. The standardization of core competencies in aesthetic dermatologic procedures is essential to ensure patient safety and practitioner competence. At present, formal aesthetic dermatology training in residency may be insufficient for hands-on training. The majority of dermatology faculty and resident respondents support increasing aesthetic dermatology training.

Projecto Angolano de Formação e Desenvolvimento da Dermatologia: Avanços e Desafios

Introdução: Apesar do fardo e das repercussões físicas, psicológicas e sociais que as doenças da pele representam, o desenvolvimento da Dermatologia e a formação de técnicos nessa disciplina defrontam em Angola sérios desafios, com repercussões no acesso e na qualidade dos serviços e cuidados prestados a população.Metodologia: Foi realizado um estudo retrospectivo do Projecto de Formação e Desenvolvimento da Dermatologia, iniciado em 2010 com o apoio do Ministério da Saúde e do Colégio Angolano de Dermatologia e Venereologia (CADV). O projecto tem por objectivo a formação de mais dermatologistas e de aumentar o acesso dos doentes a Serviços de referência. São apresentados dados sobre a formação dos internos, bem como outros ganhos e limitações do Projecto.Resultados: Até 2013, o internato médico complementar em Dermatologia estava reservado apenas a um Serviço de Dermatologia em Luanda, tendo formado oito dermatologistas desde 1975. Em 2013, cinco novos Serviços Regionais, abertos em Cabinda, Malange, Huambo, Benguela e Huíla, iniciaram a formação de especialistas, aumentando em 2017 a 26 o número total de internos em formação.Conclusão: No contexto de Angola, a descentralização dos serviços clínicos de formação, a afinação periódica do programa de pós-graduação e a promoção activa de atitudes e actividades de pesquisa são elementos chave no desenvolvimento da Dermatologia e na prestação de serviços de referência mais próximos das populações.

Cosmetic Dermatology Training During Residency: Outcomes of a Resident-Reported Survey.

As the demand for cosmetic treatments increases, it is important for dermatology residents to be educated about and achieve proficiency in dermatologic cosmetic procedures. To assess dermatology residents' educational exposure to cosmetic dermatology. An anonymous 18-question survey was sent electronically to 1,266 dermatology residents requesting information about cosmetic dermatology training during residency. Two hundred sixty-eight residents responded to the survey (21% response rate). Most residents receive didactic instruction (94%) and hands-on training (91%) on cosmetic dermatology topics during residency. Survey participants in residency programs perceived as supportive of cosmetic dermatology training are more frequently provided lectures (70% vs 31%, p < .001) and procedural training (100% vs 69%, p < .001) in cosmetic dermatology as compared to residents in unsupportive programs. Eighty-nine percent of respondents reported hands-on training as the most effective method for developing proficiency in cosmetic procedures. Providing safe and competent patient care should serve as the impetus for expanding cosmetic dermatology education and training for residents.

Olivia Marie-Virginie Mine Schofield

Olivia Marie-Virginie Mine Schofield was a dedicated and well respected consultant dermatologist who enhanced dermatology services in Scotland, particularly in paediatric dermatology. She was appointed as a consultant dermatologist to...

Examining trainee awareness of dermatoses and dermatological assessments during acute admissions (A quality improvement project)

Studies demonstrate 67% of elderly patients can have dermatoses, which could result in functional and psychological consequences. Elderly presentations are further complicated by comorbidities and polypharmacy. This combined with limited dermatology training at undergraduate and postgraduate levels creates diagnostic challenges. This project investigated dermatology assessments by trainees using the Trust’s acute medical admissions proforma. 100 proforma were reviewed for skin assessments alongside nursing skin care bundles. Subsequently, a skin survey was conducted amongst trainees evaluating knowledge and confidence when diagnosing and managing common dermatoses. Successively, a dermatology teaching series was delivered. Post-intervention the above were reassessed, demonstrating improvements in most areas. The dermatology teaching series will continue alongside a Trust hospital guideline to sustain improvements in dermatological care on admission.

GRAPPA Trainees Symposium 2017: A Report from the GRAPPA 2017 Annual Meeting.

At the 2017 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) in Amsterdam, the Netherlands, a trainees symposium was held. Rheumatology and dermatology trainees engaged in psoriasis or psoriatic arthritis research presented their work. This report briefly reviews 6 oral presentations and 25 posters presented at the meeting.

Pattern of skin diseases amongst children attending a dermatology clinic in Lagos, Nigeria.

IntroductionSkin diseases constitute a major health problem affecting a large proportion of the population including children causing distress and disability. This study aimed to document the spectrum and frequency of skin diseases of children who attended the dermatology outpatient clinic of the Lagos University Teaching Hospital (LUTH) Lagos, Nigeria.MethodsA cross-sectional study of children (18 years old and below) who attended the dermatology clinic between January 2004 and December 2016. Data obtained from the medical records of the patients included age, gender, clinical features, laboratory features and diagnosis. Skin diseases were classified into various groups.ResultsThere were 6373 children included in the study with a male to female ratio of 1:1.13. The most common disease categories were infections 1795 (26.1%), Eczematous conditions 1711 (24.9%), Infestations 936 (13.6%), papulosquamous disorders 547 (8.0%) and Bullous disorders 254 (3.7%). With respect to individual skin diseases, atopic dermatitis (AD) 1042 (15.1%) was the most common skin condition followed by papular urticaria 705 (10.2%) and tinea capitis 554 (8.1%). Infections were most common among infants and adolescents. Acneiform eruptions were common among adolescents while eczematous disorders were most common among children less than 5 years.ConclusionThe study highlights the common dermatoses seen in children in a specialized dermatology clinic in a developing country such as Nigeria. Most of the skin diseases observed can be controlled by proper environmental sanitation, adequate nutrition, reducing overcrowding, and promoting good health-seeking behavior among parents and caregivers. Information obtained from the study may guide training in dermatology especially among pediatricians.