Dermatology Training Research Articles

Surgical Training of Dermatologists

Surgical Training of Dermatologists

Marginal traction alopecia severity score: development and test of reliability

Traction alopecia (TA) is common in African females. Although hairstyles are thought to be causal, the contribution of individual hairstyling variables to TA severity has not been quantified. The aim of the current study was to develop a severity scoring system (M-TAS score) for marginal TA, the commonest form of this disorder, and to test its reliability. The margins of the scalp were divided into anterior and posterior with an imaginary line joining the tips of both ears. The anterior and posterior hairlines were further divided into three using the temporalis muscles and mastoid processes at the hairline as landmarks, respectively. Each examiner assessed each of the six areas. If any were found to have TA, the severity was scored using an examiner assessed system (tested once) or a picture matched score (tested twice). Ten and eight female patients with TA of varying severity were assessed by 11 and 9 examiners (dermatologists, dermatology trainees, and nurses), respectively. The intraclass correlation coefficient (ICC) for interobserver agreement was larger with photograph-matched scores than with examiner estimated scores reaching substantial (0.61-0.80) and excellent (0.81-100) agreement for both anterior and posterior scores irrespective of level of skill of examiner. The ICC for intraobserver agreement with the photograph matched scores was 0.99. The diagnosis of normal margin was excellent for the anterior yet poor for the posterior margin with photograph scores. The M-TAS score is not for diagnosis but to assess severity. The photograph-based M-TAS score requires validation with larger samples but could be a useful research tool for elucidating disease prevalence and determinants of TA as well for monitoring response to treatment.

Skin phototypes of a Maltese sample population

Skin phototyping is a clinical classification system based on a patient's historical reporting of the acute skin response to sunlight. We carried out a simple study to estimate the skin phototypes of the Maltese people in order to acquire more information on the relative risk of the general Maltese population to sun burning and to the more chronic effects of sun exposure, including photoaging and skin cancers. A consultant dermatologist and dermatology trainees determined the skin phototype of patients seen with skin infections or skin tags at dermatology outpatients in Malta by carrying out a short interview. Data were collected on 756 patients. The commonest reported skin phototype in both sexes was type III (48.0% overall; 52.4% in males, 43.8% in females); this was followed by type IV in males (30.4%) and type II in females (32.3%). Only 1.2% of the total was of skin type I. Approximately one half of the Maltese population is at moderate risk of sun damage; about one quarter is at low risk; and the other quarter is at high risk, the latter group needing more thorough sun avoidance and better surveillance for skin tumours. Social desirability can influence responses to such questionnaires and might have contributed to the difference between males and females noted in our study.

Independent extended nurse prescribing for patients with skin conditions: a national questionnaire survey

To examine the prescribing practices of independent extended nurse prescribers for patients with skin conditions. Nurse-led services are one means of improving healthcare provision for dermatology patients. The advent of nurse prescribing should optimize the role of the nurse in these situations. Medicines for skin conditions constitute a significant category within the Nurse Prescribers Extended Formulary. The impact and activity of independent extended nurse prescribing for patients with skin disease has yet to be evaluated. A convenience sample of 638 qualified independent extended nurse prescribers self completed a written questionnaire. spss and splus were used for data entry and analysis. The majority of nurses (89.7%) were based in primary care and worked in general practice. Four hundred and seventy-six (75%) participants held a degree level qualification or higher. Forty-four (6.9%) held a diploma, degree or master's level module/s in dermatology, 433 (67.9%) had undertaken study day/s in dermatology. Five hundred and sixty (87.8%) had more than 10 years postregistration nursing experience. A significantly broader range of skin conditions, and more items for these conditions, were prescribed by nurses with higher academic qualifications, nurses with specialist dermatology training (i.e. a diploma, degree or master's level module in dermatology or dermatology study days), nurses over 45 years and nurses in general practice. A small number of nurses felt unconfident in their prescribing practice. The majority of nurses treating skin conditions work in general practice, are highly qualified, and have a wealth of clinical experience. Nurses' dermatology training is inconsistent A small number of nurses feel unconfident in their prescribing practice. Nurses prescribing for skin conditions must be provided with appropriate dermatological training in order to treat the enormous numbers of patients with skin conditions treated in primary care.

Supplementary nurse prescribing for patients with skin conditions: a national questionnaire survey

To examine the prescribing practices of supplementary nurse prescribers (working in both primary and secondary care) who prescribe medicines for patients with skin conditions and the factors that facilitate or inhibit this mode of prescribing. Nurses work in a variety of roles, with varying levels of expertise, are involved in the treatment management of a broad range of skin diseases. Skin conditions are those for which independent nurse prescribers prescribe most frequently. The role of the nurse, limitations of the formulary and inter-professional relationships influence the prescribing practices of these nurses. There is no evidence currently available examining the impact and activity of supplementary nurse prescribing for patients with skin conditions. A convenient sample of 580 nurses who prescribed for skin conditions and were qualified supplementary nurse prescriber, self-completed a written questionnaire. Five hundred and twenty (89.7%) nurses were based in primary care and worked in general practice. Four hundred and thirty-six (75%) held a degree level qualification or higher, 41 (7%) had specialist dermatology training and 512 (88.3%) had more than 10 years postregistration nursing experience. Supplementary prescribing was used by a minority of nurses. Nurses who had specialist dermatology training used this mode of prescribing most frequently. Doctor and pharmacists lack of understanding of supplementary prescribing, lack of peer support and clinical management plans prevented the implementation of this mode of prescribing. Supplementary prescribing is used by a minority of nurses to treat skin conditions. A number of factors prevent nurses from using this mode of prescribing including lack of specialist training and lack of support in practice. Specialist dermatology training, an understanding of supplementary prescribing by the members of the healthcare team, and support in practice are required if supplementary prescribing is to be implemented effectively for the treatment of skin conditions.

News from the International Foundation for Dermatology: Regional Dermatology Training Center -Guatemala

News from the International Foundation for Dermatology: Regional Dermatology Training Center -Guatemala

News from the International Foundation for Dermatology: Reception in New York City for Ambassadors to the United Nations of Countries Involved with the Regional Dermatology Training Centers of the International Foundation for Dermatology

International Journal of DermatologyVolume 30, Issue 8 p. 603-603 News from the International Foundation for Dermatology: Reception in New York City for Ambassadors to the United Nations of Countries Involved with the Regional Dermatology Training Centers of the International Foundation for Dermatology Alfred W. Kopf M.D., Alfred W. Kopf M.D. New York, New YorkSearch for more papers by this author Alfred W. Kopf M.D., Alfred W. Kopf M.D. New York, New YorkSearch for more papers by this author First published: August 1991 https://doi.org/10.1111/j.1365-4362.1991.tb02661.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume30, Issue8August 1991Pages 603-603 RelatedInformation

A single educational intervention aiming to improve dermatology care in western Nepal

There is limited dermatologic training available for healthcare workers in Nepal. We visited a rural area of western Nepal to set up a pilot program of dermatologic teaching. This consisted of 2 days of interactive lectures, followed by 2 days of practical dermatology in the clinic. After the theoretical training, the overall accuracy of the diagnoses made by the attendees was high at 79%. All trainees felt that the program had been useful. The most common conditions seen were eczema and skin infection. We aim to expand this dermatologic training program in western Nepal in the future.

Maintaining the condition of ageing skin

Ageing skin is more vulnerable to damage and infection. Effective skin and dermatology training can prevent problems from occurring and improve quality of care.

Dermatoethics: A curriculum in bioethics and professionalism for dermatology residents at Brown Medical School

Both American and Canadian residency accreditation bodies have formal requirements in core competencies that include training in ethics and professionalism without prescribing content. A structured seminar series in medical ethics and professionalism relating to dermatology practice was started at Brown Medical School's dermatology residency in 2001. Methods of instruction include discussion groups, review of medical and lay literature, book review, didactic teaching, case presentation, and informal e-mail exchange. Some of the topics that have been covered include basic medical ethics, research ethics, physician-industry relationships, truth telling, privacy and confidentiality, duty to treat, and ethical and legal issues in cosmetic dermatology, dermatologic surgery, dermatologic genetics, occupational dermatology, and pediatric dermatology. The main goals of the curriculum are to fulfill the core competency requirement in professionalism of the specialty certifying boards, introduce trainees to the cross-disciplinary literature of biomedical ethics and current ethical controversies, and encourage dialogue on ethics and professionalism among faculty, colleagues in other specialties, and dermatology trainees.

What are the chances of getting a dermatology training post if I have also got an MSc in dermatology in Wales?

Have a career or related problem that needs answering? Can9t find the right person to point you in the right direction? Log on to the Advice Zone for reliable medical careers advice. You can post a question or see if one of our 300 advisers has already answered a similar question. Here is a selection of questions and answers posted on the site <b>www.bmjcareers.com/advicezone</b>

Perspectives on Training and Future Prospect of a Dermatology Resident

According to Spanish Royal Decree 127/84, dermatology is defined as a “complete medical and surgical organ specialty involving the skin, cutaneous appendages, papillary mucosa, and associated external elements.” The official definition covers several different dermatology knowledge areas, including dermatopathology, immunodermatology, dermatological surgery and physical therapy. Medical resident training for dermatologists in Spain also includes venereology. The definition provided above has, for many years, guided the National Commission for Medical Specialties in terms of designing programs for resident dermatology training in Spain. For many residents, tutors, and specialists participating in medical resident training, however, this definition excludes important aspects of dermatology. Cosmetic dermatology, for example, although clearly an important area in dermatology, is excluded from the training program for dermatologists. Nonetheless, it has to be conceded that the time available for training is limited, and, despite the well-reasoned proposals of the National Commission for Medical Specialties, the dermatology resident training period in Spain has not as yet been increased from 4 to 5 years. This raises a number of doubts and problems in regard to medical residents acquiring suitable training in all areas of dermatology. Since hospitals belonging to the public health system do not provide cosmetic dermatological treatment, trainees have no opportunity to learn about and practice cosmetic dermatology. A 2-day course taken in the third year of residence is assumed to provide adequate training in this area. To this can be added the training provided by the annual meeting of the Spanish Cosmetic and Therapeutic Dermatology Group—accessible, however, only to residents lucky enough to have a superior who will allow them to attend. In my opinion, it is a futile exercise to complain of the intrusion of pseudo-specialists operating in the cosmetic dermatology field as long as there is a failure to provide proper training to specialists with a

A brief review of the “vulgaris” lesions of the skin

Medical students and the trainees in dermatology and pathology have a curiosity about the names, such as, acne vulgaris or verruca vulgaris. The word “vulgaris” sounds like vulgar, commonly meaning crudely indecent, coarse, or obscene. However, the word “vulgar” is derived from the Latin word “vulgaris”, meaning “of or belonging to the common people”. In medical terminology, the word “vulgaris” means common or ordinary. A search through the indexes in Dermatology and Pathology text books revealed seven dermatologic conditions with “vulgaris” in their names. These included very common diseases, such as, acne vulgaris and verruca vulgaris as well as now rarely diagnosed disease, such as, lupus vulgaris. We are briefly reviewing the seven “vulgaris” diseases of the skin.

Use of ionizing radiation in dermatologic training centers

Use of ionizing radiation in dermatologic training centers

Wound Care in Tanzania at the Regional Dermatological Training Centre

Wound Care in Tanzania at the Regional Dermatological Training Centre

Role of Dermatologists in Treating Melanoma

Melanoma is a major focus of dermatology training and practice, with dermatologists playing a central role in managing melanoma through primary prevention, secondary prevention, diagnosis, and treatment of thinner tumors. Dermatologists have led public health efforts to raise melanoma awareness, promulgate the early warning signs of melanoma, and promote melanoma prevention through sun protection. Dermatologists have unique expertise in melanoma risk assessment and the clinical diagnosis of melanoma through visual inspection and the use of diagnostic aids, including dermoscopy and photographically assisted follow-up. Increasing incidence of melanoma, earlier melanoma detection, narrower excision margins, and improved surgical training in dermatology have recently combined to enhance the role of dermatologists in melanoma care. For patients with thin primary melanomas, dermatologists are increasingly assuming complete care, including wide local excision and long-term surveillance for both disease recurrence and detection of new primary melanoma. Conversely, the advent of sentinel lymph node biopsy and adjuvant therapy has made melanoma management more complex and has intensified the need for a multidisciplinary approach to the disease. In this context, dermatologists contribute significantly to the formation, administration, and implementation of multidisciplinary melanoma programs.

Preparing nurses to prescribe medicines for patients with dermatological conditions

From Spring 2006, independent extended nurse prescribers in the United Kingdom will be able to prescribe any licensed medicines except controlled drugs. Supplementary nurse prescribers are currently able to prescribe any medication. No other country in the world has such extended prescribing rights for nurses. Aspects of prescribing viewed positively by nurses include continuity of care, increased satisfaction, and the belief that patients receive improved information about prescriptions. There is some evidence, however, that nurses feel ill-prepared to prescribe due to poor understanding of pharmacology, physical assessment and diagnosis. This paper reports a study assessing the extent to which independent extended supplementary nurse prescribers feel prepared to prescribe medicines for patients with dermatological conditions. A convenience sample of 1187 qualified independent extended supplementary nurse prescribers was sent a postal questionnaire. A total of 868 completed questionnaires was returned, and 638 of these nurses prescribed medicines for skin conditions. The data were collected in 2005. A total of 605 (94.8%) participants used independent extended prescribing and 234 (36.7%) supplementary prescribing. The majority were highly experienced and worked in primary care. In general, their prescribing programme had met their needs when prescribing medicines for patients with dermatological conditions. However, the needs of those who had undertaken a diploma-level module in dermatology and/or dermatology study days, and those working in both primary and secondary care, were met to a statistically significantly greater extent during the programme than for those nurses without this preparation, or those working in either primary or secondary care. Independent extended supplementary prescribing has extended the role that nurses in the United Kingdom are able to play in the management of skin disease. Specialist dermatology training is a prerequisite for nurses adopting this role. Further evaluative work on patient-focused outcomes, i.e. accessibility and convenience of care, and satisfaction with quality of care, is required.

Diagnosing and managing cutaneous pigmented lesions: Primary care physicians versus dermatologists

Primary care physicians (PCPs) are often expected to screen for melanomas and refer patients with suspicious pigmented lesions to dermatologists. To assess whether there is a difference between dermatologists and PCPs in accurately diagnosing melanoma and appropriately managing (based on decisions to refer/biopsy) suspicious pigmented lesions. A survey based on a random sample of 30 photographs of pigmented lesions with known pathology was administered to 101 dermatologists and 115 PCPs from October 2001 to January 2003. Likelihoods that a photographed lesion was melanoma and that the lesion should be biopsied/referred were scored on a 1 to 10 scale. Accuracy of melanoma diagnosis and appropriateness of pigmented lesion management were compared between dermatologists and PCPs by using the areas under (AUC) the receiver operating characteristic (ROC) curves. Dermatologists were superior to PCPs in diagnosing melanomas (AUC 0.89 vs 0.80, P<.001) and appropriately managing pigmented lesions (AUC .84 vs 0.76, P<.001). PCPs who tended to biopsy lesions themselves did better at managing pigmented lesions than PCPs who did not perform biopsies. Dermatology training during residency did not significantly improve the diagnostic accuracy of PCPs nor their management of pigmented lesions. Dermatologists have both better diagnostic accuracy and ability to manage pigmented lesions than PCPs. Yet, there is a shortage of dermatologists to meet the demand of accurate melanoma screening. More innovative strategies are needed to better train PCPs and enhance skin cancer screening.

Who benefits from calling a solar keratosis a squamous cell carcinoma?

Conflicts of interest None declared. Why didst thou promise such a beauteous day, And make me travel forth without my cloak... 1 At the end of 2004 a tidal wave swept through the Asian Pacific Region. By mid‐January it became clear that around 300 000 people had died, and millions more were devastated by loss of home and environment. The after‐effects will be felt in this area for at least a generation. In mid‐January I visited the Regional Dermatology Training Centre of the International Foundation for Dermatology in Moshi, Tanzania as part of my responsibilities in the International League for Dermatological Societies. I used the opportunity to visit the ward where a small proportion of the dermatology patients is admitted for more intensive care. There was a young man who had been admitted with severe progressive pyoderma gangrenosum of both legs which was unresponsive to the limited systemic therapy available. He was unable to be sent home to his village in rural Africa because of the high risk of secondary infection, which was likely to be lethal under these conditions. Consequently, he agreed to amputation of both legs, which was performed. By a miracle, he recovered well and the wounds healed.

Rising educational debt levels in recent dermatology trainees and effects on career choices

Educational debt levels are outpacing inflation. To determine whether debt levels influence career choices of graduating dermatology residents. Anonymous surveys of graduating dermatology residents. The presence of debt was associated negatively with pursuing fellowship training in 1999 and 2004 (P < .05) but did not affect choices about entering solo practice or job dissatisfaction levels. This study relies on self-reported data, and some surveys were incomplete. Debt levels do not appear to significantly influence the career choices of dermatology residents.