Dermatology Training Research Articles

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.

Dermatologic Health Disparities

Although significant data highlight the extent of health disparities, data regarding dermatologic health disparities are limited. Ethnic minorities, people of low socioeconomic status, the less educated, elderly, and uninsured have poorer melanoma and nonmelanoma skin cancer outcomes. Atopic dermatitis is more prevalent among ethnic minorities, but whether morbidity is also increased in these populations is unclear. Given the current dermatology workforce shortage, increased patient load from health care reform may have an adverse effect on access to dermatologic care. Additional concerns include status of dermatologic training, insufficient research involving ethnic minorities, and lack of investigation of dermatologic health disparities.

Procedural dermatology training during dermatology residency: A survey of third-year dermatology residents

Procedural dermatology training during dermatology residency: A survey of third-year dermatology residents

Liposuction – a surgical procedure in dermatology

Liposuction is an integral part of the wide range of surgical procedures in dermatology. Dermatologists established tumescent local anesthesia in combination with the use of micro-cannulas; especially dermatologists from Germany and Austria actively designed and developed these new techniques. In this position paper, we discuss the history, various interdisciplinary aspects, the significance, and the treatment indications for this procedure as well as its role within dermatologic training programs and research. For quality reasons, members of the Germany Society of Dermatologic Surgery and the Austrian Society of Dermatologic Surgery discuss several fundamental professional aspects as well as the historical development of liposuction.

Efficacy of Peer-Assisted Learning Across Residencies for Procedural Training in Dermatology

With new care models such as the medical home, there is an expanding need for primary care providers to be trained in dermatologic procedures. Yet, many internal medicine residency program graduates feel unprepared to perform these procedures. The aim of this study was to evaluate the effect of a structured peer-assisted learning approach to improve residents' knowledge and skills related to common dermatologic assessment techniques. Eight medicine-dermatology resident educators, with a faculty member, facilitated dermatologic procedure workshops for 28 internal medicine and medicine-pediatrics resident learners. Learners completed preworkshop and postworkshop surveys, assessing their knowledge and skill levels as well as the efficacy of the resident educators and the educational value of the workshop as a whole. All learners were able to properly demonstrate the techniques at the workshop's conclusion. The median sum score of self-reported knowledge increased from 3 to 9.5 (scale, 0-10; P < .001). The median sum score of self-reported skills increased from 10 to 16 (scale, 4-20; P < .001). Resident educators were favorably evaluated by their peers, and 96% of participants rated the experience as being of high educational value. Peer-assisted learning is effective in teaching dermatologic procedures in graduate medical education. Resident learners found peer-assisted learning to be beneficial and rated their peer teachers highly. Further studies should focus on outcomes in practice, looking at the number of dermatologic procedures performed by learners, as well as the effects on resident educators.

Teledermatology: a tool for remote supervision of a general practitioner with special interest in dermatology

Teledermatology (TD) has been developed as an alternative to face-to-face (FTF) dermatology care in remote areas. To assess the feasibility of TD in remote supervision and education of a general practitioner with special interest (GPwSI), to reduce FTF consultations with the consultant dermatologist, and to provide appropriate diagnosis and care. Our secondary aim was to evaluate patient satisfaction with this mode of consultation. A TD service in Aberdeen was set up to augment supervision of a remote rural GP training in dermatology. This service was audited over a 2-year period to assess its usefulness in the education of the remote GP. Prospective data on 230 selected referrals was analysed. Store-and-forward TD provided a high level of patient satisfaction, and was effective in remote supervision and education of a GPwSI in dermatology. FTF consultations with the consultant were avoided in 69% of consultations, and diagnostic agreement was considered high (61%). Educational feedback was given to the GP in 66% of consultations. TD can supplement infrequent specialist dermatology service in remote areas, as in this case. We conclude that for selected patients, TD was a useful training tool for supervising the GPwSI, and ensuring clinical governance and quality assurance in clinics in a remote rural area. However, this model of care was limited by cost and the inherent limitations of TD.

Pigmented spindle cell naevus of Reed: A controversial diagnostic entity in Australia

The Reed naevus or pigmented spindle cell naevus of Reed (PSCN) was previously considered a pigmented variant of the spindle cell-type of Spitz naevus. It is now considered a distinct entity and may overlap with cutaneous melanoma in both clinical and dermatoscopic features. We hypothesised that PSCN is an under-recognised entity in Australia and present a typical case. To test our hypothesis, we performed a clinically based survey of Australian dermatology trainees (Registrars). A further aim of our study was to determine the approach of dermatology trainees in this country to the management of this type of lesion. A web-based survey questionnaire based on the presented case was circulated to trainees of the Australasian College of Dermatologists. Responses, including level of training and initial approach to management, were collated and form the basis of the results presented herein. Of 39 respondents, 13 (33%) diagnosed the lesion as PSCN. The majority (33/39; 84.6%) indicated they would biopsy the lesion, with most of these (91%) preferring excisional biopsy. The results support our hypothesis that PSCN is under-recognised in Australia. The results also show that despite difficulty distinguishing this lesion, management of these lesions by dermatology trainees in Australia is consistent and parallels current recommendations.

Linear and whorled nevoid hypermelanosis

The Correspondence Section serves as a forum for opinion exchange about subjects of general interest such as dermatologic training, relations between dermatologists and pharmaceutical houses, governmental control of dermatology and medical practice in general, peculiarities of dermatology related to geographic, climatic, or racial factors, the flow of information and publications, as well as other concerns the readership might have. Contributions are welcome and should conform to the usual format for correspondence. Manuscripts will undergo standard editorial procedures. Submit all correspondence to Mauricio Goihman-Yahr, M.D., Ph.D., Editor, Jet International M-154, P.O. Box 020010, Miami, FL 33102.

Dermatology referrals in an East Asian tertiary hospital: a need for inpatient medical dermatology

Within hospitals, there is a need for dermatological expertise, as hospitalized patients have a wider spectrum of severe and serious dermatological conditions, associated with significant morbidity. To characterize the patient profile and referral pattern of inpatient dermatology consultations, and to evaluate the diagnostic accuracy of non-dermatologists. This was a retrospective study reviewing all inpatient referrals for dermatology consultations during a 1-year period from July 2005 to June 2006 (inclusive), at the largest multi-disciplinary tertiary hospital in Singapore. Of the 731 referrals made for dermatology consultations, 26.9% of patients had ≥ 3 important underlying comorbidities. Eczema/dermatitis (33.1%; n = 242) and cutaneous infections (23.4%; n = 171) accounted for over half of the dermatological consultations, followed by cutaneous adverse drug reactions (12.3%; n = 90). The provisional diagnoses of the referring doctors agreed with the final diagnoses confirmed by dermatologists in only 30.2% of all referrals; incorrect diagnoses were made in 35.2% of cases, and no provisional diagnoses were made in the remaining 34.6% of cases. Most misdiagnosed skin diseases were in fact common dermatoses (such as eczemas, cutaneous infections, drug rash) that required only standard treatment. Our study reiterates the importance of inpatient medical dermatology in terms of both service and education. There should be continual efforts to ensure that dermatologists have the highest level of training and experience in medical dermatology, to provide collaborative optimum care for hospitalized patients with dermatological diseases.

Nanotechnology and dermatology education in the United States: Data from a pilot survey

Nanotechnology is a rapidly growing discipline with important implications for consumers, patients, physicians and investigators. In an era when nanotechnology is being both incorporated into educational requirements for medical fields such as radiology and oncology and vigorously pursued and developed by cosmeceutical companies, dermatology is falling behind. A survey was conducted to ascertain knowledge, attitudes and perception of nanotechnology in dermatology teaching programs.To ascertain baseline knowledge, attitudes and preceptions regarding nanotechnology among dermatology trainees, dermatology investigators and dermatology faculty in US academic medical centers, an online survey was sent out to random members of the dermatology community and data analyzed (100 participants, 23% response rate). Participants responded to a questionnaire on a five-point scale ranging from strongly disagree, disagree, uncertain, agree, to strongly agree. Due to the low response rate, strongly disagree/disagree and strongly agree/agree values were combined and compared to uncertain responses.Approximately equal numbers of faculty vs. chief residents responded to the survery (52% vs. 47.75%, respectively). The majority of respondents had not previously attended any educational activity on nanotechnology (69.57%). The majority of participants agreed that more education on nanotechnology for dermatologists is needed (78.26% agreed vs. 21.74% uncertain) and that it should be incorporated into the residency training curriculum (60.87% agree vs. 13.04% disagree). Participants mostly agreed that nanotechnology research can contribute to better fundamental understanding of skin disease (78.26%), to advances in the diagnosis of skin disease (73.91%) and to therapies (78.26%). Participants mostly agreed that more research is needed (82.60%) and that this research should be funded (78.26%). Not surprisingly, respondents were uncertain with respect to issues of nanotechnology safety both in the pharmaceutical realm (60.87%) and cosmeceutical realm (69.57%). Furthermore, the overwhelming majority responded that research is also needed to evaluate nanomaterial safety (86.96%).Both the populations size and response rate were low, possibly affecting the power and significance of the results in this study.The survey results indicate a significant gap in dermatology training. Participants indicated a need for more training and education in the area of nanotechnology, and called for more research to evaluate the potential pitfalls associated with nanomaterials as well and to seek new advances in diagnostic and therapeutic modalities.

Skin diseases among children attending the out patient clinic of the University of Nigeria teaching hospital, Enug.

The prevalence of skin diseases varies worldwide and information regarding local prevalence of its various causes may help the development of policies towards better management. To document the types of skin disorders seen among children attending the University of Nigeria Teaching Hospital, Enugu( UNTH). The medical register from the children out patient clinic was used to obtain information on pattern and outcome of skin diseases seen from January 1996 to December 2005. Of the 16,337 children seen in children.s out patient clinic (CHOP), 1506 (1.3%) had a skin disease. Age range was one week to 16 years with a mean ± SD of 3.89 ± 3.8 years. Children aged 0 - 5 years constituted 70.24% of patients with skin diseases. The commonest skin condition was pyoderma (29.81%) seen mainly in those below 5 years, followed by scabies (13.55%). Approximately 1/3 (33.3%) of the patients were referred to the dermatology clinic. Infectious skin diseases constitute a high percentage of skin disorders encountered in paediatrics. Almost half (48.4%) of the skin problems were diagnosed as non-specific dermatitis suggesting the need of better dermatological training of the paediatric residents.

Procedural dermatology training during dermatology residency: A survey of third-year dermatology residents

Given the expanding role of multiple surgical procedures in dermatology, resident training in procedural dermatology must be continually assessed to keep pace with changes in the specialty. We sought to assess the third-year resident experience in procedural dermatology during residency training. This survey study was mailed to third-year dermatology residents at 107 Accreditation Council for Graduate Medical Education (ACGME)-approved dermatology residency programs in 2009. A total of 240 residents responded (66%), representing 89% of programs surveyed. Residents assume the role of primary surgeon most commonly in excisional surgery (95%) and flap and graft reconstruction (49%) and least often in Mohs micrographic surgery (18%). In laser and cosmetic procedures, the resident role varies greatly. Residents believed they were most prepared in excisional surgery, botulinum toxin, and laser surgery. Residents believed it was sufficient to have only knowledge of less commonly performed procedures such as hair transplantation, tumescent liposuction, and ambulatory phlebectomy. Of responding residents, 55% were very satisfied with their procedural dermatology training during residency. Individual responses from residents may be biased. Neither residency program nor dermatologic surgery directors were surveyed. This survey confirms dermatology residents received broad training in procedural dermatology in 2009, in keeping with ACGME/Residency Review Committee program guidelines. The results provide feedback to dermatology residency programs and are an invaluable tool for assessing, modifying, and strengthening the current procedural dermatology curriculum.

The perceived influence of cosmetic dermatology on dermatology resident education

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.

2-Week wait referrals in suspected skin cancer: Does an instructional module for general practitioners improve diagnostic accuracy?

The two-week wait (2WW) scheme in the United Kingdom for suspected skin cancer has been criticised for having low pick up rates, with a high proportion of clinically benign lesions being referred as suspicious. We studied the referral patterns of skin cancer to our hospital under the 2WW initiative, and aimed to quantify the effect of a targeted continuing medical education (CME) module on improving diagnostic accuracy. All referrals to our hospital (dermatology and plastic surgery) under the 2WW rule were audited between July and September 2006. A targeted CME module was sent to GPs describing and illustrating common lesions. After 11 months, all 2WW referrals were prospectively studied between August and October 2007. The main outcome measure was the percentage of correctly referred squamous cell carcinomas (SCCs) and melanomas. 237 referrals were made between July and August 2006, and 223 referrals between August and October 2007. The proportion of appropriately referred skin cancers (SCCs and melanomas) was 23.2% before CME, and 20.6% after CME. There were no differences in pick up rates before and after the CME amongst suspected SCCs (21.1% vs. 29.7%) or melanomas (24.6% vs. 15.1% respectively). Referrals to Plastic Surgery were more likely to be confirmed histologically as melanomas or SCCs (23.6% and 33.7% respectively) than those made to Dermatology (17.5% and 15.3% respectively). The proportion of correctly suspected skin malignancies under the 2WW initiative remains low despite education. A targeted CME module sent to GPs fails to improve pick up rates. There is a need for continuing dermatology training amongst referring physicians.

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.

Www.dermatoweb.net. Una web docente para el aprendizaje de la Dermatología en el pregrado

Dermatoweb is a website to aid undergraduate dermatology training. It includes the dermatology program of the Lerida Faculty of Medicine, and is based principally on clinical presentations, tables with the differential diagnosis of the 20 most common reasons for dermatologic consultation, about 200 clinical test cases to stimulate self-training, and a subject list with the 32 topics that make up the dermatology syllabus in many faculties of medicine. Thanks to this website, some of our students achieve high marks in dermatology despite hardly coming to classes. In addition, therapeutic guidelines for the common dermatoses can be found on the site, and an atlas with more than 5,300 photographs and almost 100 videos on the more common dermatological procedures; these can serve as a visual aid for family doctors, residents in dermatology in the initial years, and practicing dermatologists.

Use of www.dermatoweb.net to Support Undergraduate Teaching of Dermatology

Dermatoweb is a website to aid undergraduate dermatology training. It includes the dermatology program of the Lerida Faculty of Medicine, and is based principally on clinical presentations, tables with the differential diagnosis of the 20 most common reasons for dermatologic consultation, about 200 clinical test cases to stimulate self-training, and a subject list with the 32 topics that make up the dermatology syllabus in many faculties of medicine. Thanks to this website, some of our students achieve high marks in dermatology despite hardly coming to classes. In addition, therapeutic guidelines for the common dermatoses can be found on the site, and an atlas with more than 5,300 photographs and almost 100 videos on the more common dermatological procedures; these can serve as a visual aid for family doctors, residents in dermatology in the initial years, and practicing dermatologists.

Guidelines for management of atopic dermatitis

Atopic dermatitis (AD) is a chronic relapsing eczematous skin disease characterized by pruritus and inflammation and accompanied by cutaneous physiological dysfunction (dry and barrier-disrupted skin). Most of the patients have atopic diathesis. A standard guideline for the management (diagnosis, severity classification and therapy) of AD has been established. In our guideline, the necessity of dermatological training is emphasized in order to assure diagnostic skill and to enable evaluation of the severity of AD. The definitive diagnosis of AD requires the presence of all three features: (i) pruritus; (ii) typical morphology and distribution; and (iii) chronic and chronically relapsing course. For the severity classification of AD, three elements of eruption (erythema/acute papules, exudation/crusts and chronic papules/nodules/lichenification) are evaluated in the most severely affected part of each of the five body regions (head/neck, anterior trunk, posterior trunk, upper limbs and lower limbs). The areas of eruption on the five body regions are also evaluated, and both scores are totaled (maximum 60 points). The present standard therapies for AD consist of the use of topical corticosteroids and tacrolimus ointment as the main treatment for the inflammation, topical application of emollients to treat the cutaneous physiological dysfunction, systemic antihistamines and anti-allergic drugs as adjunctive treatments for pruritus, avoidance of apparent exacerbating factors, psychological counseling and advice about daily life. Tacrolimus ointment (0.1%) and its low-density ointment (0.03%) are available for adult patients and 2-15-year-old patients, respectively. The importance of the correct selection of topical corticosteroids according to the severity of the eruption is also emphasized. Furthermore, deliberate use of oral cyclosporine for severe recalcitrant adult AD is referred.

Needs assessment survey of psychocutaneous medicine

Psychocutaneous medicine studies the boundaries between skin and mind, and takes the unique approach of examining the patients in their biopsychosocial context. It can help patients with chronic skin problems cope with anxiety and the social stigma of their disease. Decreased psychologic stress can contribute to better treatment outcomes and be an important key to patient care. In addition, some primary psychiatric disorders may be expressed in the skin, such as delusions of parasitosis. A psychocutaneous specialist is well placed to treat these disorders. To assess the need for psychocutaneous medicine in dermatology, eighty-five attendees of the Wisconsin Dermatological Society (WDS) meeting were asked to complete a needs assessment survey. Forty-two percent of respondents felt that 30% of their patients would benefit from psychiatric interventions. In addition, 43% of respondents did not routinely inquire about mental health issues. When they did recognize psychiatric needs in a patient, 83% of responders did not feel comfortable prescribing psychotropic medications. Our data showed that about one-half of the members of WDS attending the meeting believed that a high percentage of their patients would benefit from psychocutaneous intervention. Moreover, it was found that the training during medical school and dermatology residency was insufficient for professionals to confidently prescribe psychotropic medications. Considering the fact that studies have shown psychiatric comorbidity in 30% of dermatologic diseases, and that many of the respondents who felt that their patients would not benefit from psychocutaneous intervention did not inquire about psychologic effects of skin disease in their patients, we conclude that psychocutaneous medicine is an under-recognized field in dermatology. Further evaluation of the demand for psychocutaneous clinics and their integration into daily dermatologic practices and residency training programs is needed.

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.