Dermatology Training Research Articles

34101 Pilot survey project on methods used to assess dermatology resident clinical reasoning

Background: Clinical reasoning (CR) is a core competency that all residents must acquire prior to entering clinical practice. No data exist regarding what methods are used to assess dermatology trainees. Our group developed and piloted a Dermatology Residency Program Director (DRPDs) survey to determine what methods are used to assess CR skills.

32793 How can we teach clerkship medical students the multidisciplinary aspects of dermatology? A medical education initiative

Background: Canadian medical schools offer minimal clinical dermatology training for clerkship students. The limited available educational resources for them usually focus on primary skin conditions, therefore it is challenging for students to understand the multidisciplinary nature of dermatology in a clinical setting. The study objective was to develop case-based educational resources to help bridge this gap and assess their effectiveness.

Global Awareness, Knowledge, and Practice Patterns of Psychocutaneous Medicine: A Primary Care Perspective.

Objective: To report findings generated from an analysis of available literature on psychodermatology knowledge, awareness, and practice patterns among dermatologists worldwide to better elucidate their educational needs and referral practices. Data Sources: To identify literature from inception to December 23, 2020, the following search strategy was used within PubMed and Google Scholar databases: psychodermatology OR psychocutaneous disorders OR psychodermatology practice patterns OR psychodermatology awareness OR psychodermatology attitudes OR psychodermatology knowledge. Non-English studies were excluded. Studies were included if they were identified as having collected data from a survey instrument assessing psychodermatology awareness, knowledge, and practice patterns of dermatologists and dermatology trainees. Study Selection and Data Extraction: Of 1,347 records screened, a total of 12 cross-sectional studies were identified as having collected data from 2,466 dermatologists in 18 countries worldwide. Individual study and overall response frequencies were extracted for each variable of interest by an independent reviewer. Results: Although most respondents provided weekly psychodermatologic care, only 13% reported feeling very comfortable treating patients with psychocutaneous concerns. Only 19% of respondents had a clear understanding of psychodermatology, and almost two-thirds of participants had no formal training in psychodermatology. Seventy-three percent of dermatologists reported interest in continuing medical education. Conclusions: A considerable number of patients present to their physician with a psychocutaneous concern. As such, dermatologists, psychiatrists, and primary care providers may benefit from an understanding of the presentations and management of the most common psychodermatology complaints. Incorporation of psychodermatology curriculums into training programs and educational activities should be considered.

DT01: Technology‐enhanced learning interventions on skin‐of‐colour dermatology for dermatology trainees and fellows: are they effective or sustainable?

DT01: Technology‐enhanced learning interventions on skin‐of‐colour dermatology for dermatology trainees and fellows: are they effective or sustainable?

BT23: The impact of the COVID ‐19 pandemic and use of teledermatology in specialty training: experience at two UK dermatology training centres

BT23: The impact of the <scp>COVID</scp> ‐19 pandemic and use of teledermatology in specialty training: experience at two <scp>UK</scp> dermatology training centres

Skin conditions among pediatric dermatology outpatients in Botswana

An understanding of the prevalence patterns of skin diseases in children in Botswana is needed to guide national dermatological policy development, training, and resource allocation to improve patient care. To describe local skin disease patterns in children aged 0-18 years presenting for dermatologic care in Botswana. A retrospective review of records from 1st January 2011 to 31st December 2016 was conducted at the outpatient dermatology clinic of Princess Marina Hospital (PMH) in Gaborone, Botswana and outreach clinic sites. There were 4413 pediatric visits constituting 18.6% of all dermatology visits. There was a slight male predominance of 1.2:1. The majority of disorders were noninfectious 80.1% (3537/4413) versus infectious 14.6% (645/4413), with 5.2% (231/4413) unclassified. In the noninfectious category, two-thirds were inflammatory, followed by disorders of nails, skin appendages, and pigmentary disorders. Atopic dermatitis was the most common inflammatory disorder. Over half of infectious skin diseases were viral, followed by fungal and bacterial disorders. In the HIV-related disorders, the majority were verrucae 94% (108/115) followed by Kaposi sarcoma. The nine most common skin diagnoses accounted for close to 70% of all skin diseases seen at the clinic, and these included atopic dermatitis (almost half of all cases), followed by verruca, acne, and vitiligo. There is a high burden of skin disorders in children in Botswana. In our cohort, a small number of skin conditions made up the vast majority of pediatric diagnoses. This information can be used to guide dermatology training and resource allocation to better manage these common diseases.

Impact of the COVID-19 pandemic on dermatology residency education in the United States: A cross-sectional survey

To the Editor: The COVID-19 pandemic has resulted in unprecedented disruptions to dermatology residency education.1,2 Following the novel disruptions of COVID-19 on medical training, it is imperative to support residents. However, there has been limited research evaluating the impact of the COVID-19 pandemic on US dermatology training as perceived by dermatology residents.3 This survey analyzes the impact of the COVID-19 pandemic on dermatology trainees. With new SARS-CoV-2 variants arising and the possibility of future public health crises, these reflections are of particular importance.

Celebrating 20 years of the UK Dermatology Clinical Trials Network. Part 2: education, training and capacity building.

SummaryIn Part 1 of this 2‐part review of the 20th anniversary of the UK Dermatology Clinical Trials Network (UK DCTN), we described its role in developing and supporting clinical trial proposals, elaborating on structure, process and clinical trials activity. This review describes the diverse educational and training activities that the UK DCTN supports. Although not primarily set up as an educational organization, an education and training function emerged organically as the network grew. Education and training also embodies the democratization principle that drove the formation of the UK DCTN, allowing participation from a much wider group of individuals than just senior academics. Far from being a sideline, education and training has now become a major component of the UK DCTN that evolves constantly through changing training curricula and trial methodology developments. Formal UK DCTN training opportunities started in 2007 with competitively awarded annual fellowships for dermatology trainees, followed by similar schemes for general practitioners, Staff and Associate Specialist clinicians and dermatology nurses. These were followed in 2013 by larger groups of trainees who work up specific trial proposals with senior mentors. Finally, a virtual journal club emerged during the pandemic in 2020 in order to reach trainees with little access to academic training. Focused activities with dermatological nurses and patients/carers also take place. Such activities require considerable organization and volunteerism from the co‐ordinating centre and former fellows. Education and training has become an essential component for capacity building to develop clinical trials and succession planning for the UK DCTN.

Impact of trainee experience on shave biopsy specimen size.

Skin biopsies are crucial for the diagnosis of many cutaneous pathologies, yet specimen adequacy is essential for definitive diagnosis. Recent literature has noted a trend in decreasing biopsy size over time, which has created concern over implications regarding adequacy for diagnosis. This study sought to evaluate if clinician training length or type of residency training impacted the average biopsy size and sample adequacy. Dermatopathology reports for shave biopsies between January 1, 2021, and June 30, 2021, at Penn State Health were queried through PathNet, the software application for pathology reports in this health system's electronic medical record system. Biopsy dimensions, volume, diagnosis, location, clinician training level, and descriptions of evaluation of deeper sections (recuts) and superficial sampling were recorded for each biopsy. Basic statistical calculations were performed to assess the mean and standard deviation for biopsy sizes per clinician group. Differences in biopsy size between training levels were statistically significant despite qualitatively similar biopsy locations and final diagnosis categories for each clinician training group. After evaluating measures for sample adequacy, our data showed significantly smaller biopsies; however, overall frequencies were minimal. Additionally, more inadequate specimens were noted for clinician groups with the least amount of dermatology experience. The results of this study identify a correlation with decreasing biopsy size amidst increased experience in dermatology training but find no evidence to support that this trend currently threatens sample adequacy.

Dermatological care of elderly people with psoriasis before and after entering a nursing home : A qualitative analysis from the perspective of medical providers

HintergrundDemografische Veränderungen bewirken einen steilen Anstieg der Anzahl der über 65-Jährigen. Damit verbunden ist die Zunahme der Anzahl pflegebedürftiger, multimorbid Erkrankter. National wie auch international gibt es keine Informationen insbesondere zur Versorgung von Psoriasiserkrankten im Setting Pflegeheim und zur Frage, wie diese durch den Eintritt in ein Pflegeheim beeinflusst wird.FragestellungZiel war es, anhand von Interviews bzw. Fokusgruppen die Ergebnisse vorausgehender Routinedatenanalysen zur Versorgung Psoriasiserkrankter in Pflegeheimen mit medizinischen Versorgern (Dermatologen, Allgemeinmediziner, Pflegedienstleitungen und Pflegekräfte) zu diskutieren, Schwierigkeiten der Versorgung aufzudecken und abschließend Handlungsempfehlungen für eine zukunftsfähige gerontodermatologische Versorgung abzuleiten.Material und MethodenDurchgeführt wurden qualitative Leitfaden-gestützte Interviews und Fokusgruppen mit Dermatologen (n = 5), Allgemeinmedizinern (n = 7), Pflegekräften (n = 7) und Pflegedienstleitungen (n = 2). Die Daten wurden inhaltsanalytisch ausgewertet.ErgebnisseDie Auswertung ergab insgesamt 344 Aussagen, die insgesamt 14 Hauptkategorien zugeordnet werden konnten. Die Ergebnisse zeigen, dass für die Versorgungsqualität von Menschen mit Hautkrankheiten, insbesondere Psoriasis, in Pflegeinrichtungen ein Verbesserungsbedarf besteht. Dieser zeigt sich sowohl auf ärztlicher als auch auf pflegerischer Ebene. Laut der Versorger (N = 21) kann dies insbesondere durch eine verstärkte digitale Versorgung, dermatologische Schulungen für Hausärzte und Pflegefachkräfte sowie engere Kooperationen zwischen den einzelnen Disziplinen adressiert werden.SchlussfolgerungDigitale Pflegekonsile, aber auch eine spezifische Leitlinie zur „Haut des alternden Menschen“ können von Nutzen sein, um die dermatologische Versorgungssituation im Pflegeheim zu verbessern und somit das Wohlbefinden der Betroffenen zu steigern.

Challenges in the Diagnosis and Assessment of Psoriatic Arthritis.

Each year, the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) holds a trainee symposium adjacent to the GRAPPA annual meeting. The target audience for this meeting includes trainees in rheumatology, dermatology, and related fields. The 2021 GRAPPA Trainee Symposium focused on challenges in the diagnosis and assessment of psoriatic arthritis (PsA). During the meeting, speakers focused on identification of psoriasis (PsO), the differential diagnosis for both PsO and PsA, diagnostic errors and pitfalls, physical examination in PsA, patient-reported outcomes and composite measures in the assessment of PsA, and the patient perspective on diagnosis and assessment, followed by a panel discussion. This paper summarizes the content discussed at the meeting.

2021 GRAPPA Trainee Symposium: A Summary of Oral and Poster Presentations.

The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) held a trainee symposium at its 2021 virtual meeting. Dermatology and rheumatology trainees presented their work on psoriasis and psoriatic arthritis (PsA). This report briefly reviews 5 oral presentations: prediction of cardiovascular events in psoriatic disease (PsD), correlation between spine abnormalities and clinical findings, biomechanical stress as a trigger for PsA, differences in DNA methylation among twins with PsD, and critical proteins associated with induction of PsD. In addition, we highlight 22 posters broadly discussing clinical and molecular implications of PsD.

Trends in dermatology resident applicant experience and training time in the United States, 2015-2020

To the editor: Medical schools have launched programs to reduce students’ length of training and debt burden, such as 3-year “accelerated” pathways and tuition exemptions.1,2 However, little has been reported regarding the trends that may extend medical school training for students applying to dermatology, which is a competitive specialty for both US and international medical students. The aim of this study was to evaluate the trends in medical school training time for dermatology applicants.

Dermoscopy use in primary care: a qualitative study with general practitioners

BackgroundSkin assessments constitute a significant proportion of consultations with family physicians (commonly called general practitioners or GPs in the UK), and referrals to hospital dermatology departments have risen significantly in recent years. Research has shown that dermoscopy use may help GPs to assess and triage skin lesions, including suspected skin cancers, more accurately. However, dermoscopy is used by a small minority of GPs in the UK. Previous questionnaire studies have aimed to establish in a limited way some perceptions of dermoscopy among GPs: this study aimed to explore more deeply the factors influencing the use of dermoscopy among GPs.MethodsThis was a qualitative interview study set in UK general practice. A purposive sample was taken of GPs who were established dermoscopy users, GPs who had recently adopted dermoscopy, and those who did not use dermoscopy. A total of twelve semi-structured interviews were conducted. Audio-recordings were transcribed verbatim and analysed using a thematic analysis (Braun and Clarke).ResultsGPs’ capability to use dermoscopy necessitated receiving adequate training, while previous dermatology experience and support from colleagues were also considered factors that enabled dermoscopy use. The impact of dermoscopy on patient consultations about skin complaints was generally considered to be positive, as was having an ‘in-house’ dermoscopy user within a GP practice to refer patients to. However, training in dermoscopy was not considered a priority for many GPs either due to other more pressing concerns within their practices or the perceived complexity of dermoscopy, alongside barriers such as equipment costs. Significant ethical concerns with posting patient photographs online for training and teaching purposes were also highlighted.ConclusionsBoth GPs who use dermoscopy, and those who do not, consider it to have an important role in improving skin assessments within primary care. However the need for adequate training in dermoscopy and dermatology more generally was highlighted as a key barrier to its wider use. The development of competency standards for the use of dermoscopy could allow the adequacy of training to be assessed and developed.

Testing Artificial Intelligence Algorithms in the Real World: Lessons From the SMARTI Trial

Background A number of studies have shown promising performance of artificial intelligence (AI) algorithms for diagnosis of lesions in skin cancer. To date, none of these have assessed algorithm performance in the real-world setting. Objective The aim of this project is to evaluate practical issues of implementing a convolutional neural network developed by MoleMap Ltd and Monash University eResearch in the clinical setting. Methods Participants were recruited from the Alfred Hospital and Skin Health Institute, Melbourne, Australia, from November 1, 2019, to May 30, 2021. Any skin lesions of concern and at least two additional lesions were imaged using a proprietary dermoscopic camera. Images were uploaded directly to the study database by the research nurse via a custom interface installed on a clinic laptop. Doctors recorded their diagnosis and management plan for each lesion in real time. A pre-post study design was used. In the preintervention period, participating doctors were blinded to AI lesion assessment. An interim safety analysis for AI accuracy was then performed. In the postintervention period, the AI algorithm classified lesions as benign, malignant, or uncertain after the doctors’ initial assessment had been made. Doctors then had the opportunity to record an updated diagnosis and management plan. After discussing the AI diagnosis with the patient, a final management plan was agreed upon. Results Participants at both sites were high risk (for example, having a history of melanoma or being transplant recipients). 743 lesions were imaged in 214 participants. In total, 28 dermatology trainees and 17 consultant dermatologists provided diagnoses and management decisions, and 3 experienced teledermatologists provided remote assessments. A dedicated research nurse was essential to oversee study processes, maintain study documents, and assist with clinical workflow. In cases where AI algorithm and consultant dermatologist diagnoses were discordant, participant anxiety was an important factor in the final agreed management plan to biopsy or not. Conclusions Although AI algorithms are likely to be of most use in the primary care setting, higher event rates in specialist settings are important for the initial assessment of algorithm safety and accuracy. This study highlighted the importance of considering workflow issues and doctor-patient-AI interactions prior to larger-scale trials in community-based practices. Acknowledgments This research was supported by the Victorian Medical Research Acceleration Fund, with 1:1 contribution from MoleMap Ltd. VM is supported by the National Health and Medical Research Council Early Career Fellowship. CF is supported by the Monash University Research Training Program Scholarship. Conflicts of Interest SM is head of clinical research and regulatory affairs at Kahu.ai Ltd, a subsidiary of MoleMap Ltd. MH was the chief medical officer and a director of MoleMap Ltd, and holds shares in MoleMap Ltd. Trial Registration ClinicalTrials.gov NCT04040114; https://clinicaltrials.gov/ct2/show/NCT04040114

Cosmetic dermatology training perspectives during residency: A survey‐based report from Jordan

There has been an evident increase in the number of cosmetic dermatologic procedures performed by dermatologists. Those procedures vary from a simple office-based one to more complex procedures requiring general anesthesia. Therefore, it is essential to assess the adequacy of cosmetic dermatology training among dermatology residents to meet patients' expectations. We sought to assess dermatology residents' educational exposure to cosmetic dermatology and identify the practices and educational gaps of esthetic dermatology residency programs in Jordan. An online cross-sectional study targeted almost all dermatology residents in Jordan from April to June 2021. Forty-two dermatology residents completed an English online questionnaire that involved sociodemographic data, the resident's educational exposure to cosmetic dermatology, and the resident's opinion regarding the training programs. Out of the 42 participants, 16 (38.1%) were males, and 26 (61.9%) were females. More than half (54.8%) of the participants reported that cosmetic procedures were done in the department they are attending. The majority (64.3%) did not attend cosmetic training or procedures. The majority strongly agree that hands-on training is the most beneficial way of cosmetic residency training (88.1%). More than 85% believe that cosmetic dermatology training should be practical and that final-year residents should perform cosmetic procedures independently. Only 2.4% and 4.8% of the residents were very satisfied or satisfied, respectively, with the current level of cosmetic procedural training. The dermatology residents in Jordan are dissatisfied regarding the current level of cosmetic procedural training. Therefore, infrastructure must be improved; educational training quality must be improved by providing theoretical and practical education in clinics.

A study of attitudes among Polish dermatologists and dermatology trainees regarding modern technologies in medicine.

IntroductionDermatology offers great potential for the use of modern technologies such as remote online consultations, initial diagnostics via smartphone and computer applications, and artificial intelligence (AI)-based support for doctors.AimTo investigate the attitude of dermatologists to such technologies.Material and methodsThe participants completed a paper questionnaire comprising 16 questions regarding data such as age, gender and advancement in specialization, as well as views on the safety, benefits and future role of technologies such as AI and telemedicine in the future of medicine. The participants were chosen by snowball sampling. In total, 140 questionnaires were obtained; this was reduced to 90 by removing 50 respondents who were not familiar with term “telemedicine”. The obtained data were subjected to statistical analysis.ResultsThe prevailing opinion was that while AI will not be able to replace doctors in the future, it could be used to improve the skills of medical personnel. Among the possible applications of these technologies in medicine, most of the responses indicated disease prevention (32%) and education (26%). None of the participants indicated that telemedicine could completely replace the traditional visit to the doctor’s office.ConclusionsWhile the connection between medicine and modern technology is becoming stronger, most respondents believe that it is not possible for technologies such as AI or telemedicine to replace the work of human doctors.

Dermatology in the Tropics; a Trend Analysis of the Effects of Inadequate Undergraduate Dermatology Training on the Frequency of Dermatology Cases, a Study Based in 5 Ghanaian Public Facilities

After contact with a case of transmissible tuberculosis (TB), some of the exposed individuals may be infected and develop an immune reaction against Mycobacterium tuberculosis (Mtb), the causative agent of the disease. The replication of mycobacteria is usually stopped within cellular structures called granulomas, whose integrity relies on a complex interplay between cells and cytokines, the most prominent of them being TNF. In case of deficiency or inhibition of the activity of TNF, the granulomas may disrupt and release the surviving mycobacteria which may multiply, disseminate and lead to active TB disease. Several immune-mediated inflammatory diseases, among which rheumatoid arthritis, Crohn’s disease, ankylosing spondylitis and psoriasis can be treated by biological therapies acting by the inhibition of TNF or cytokines like IL-17 and IL-23. If these therapies, in particular TNF-inhibitors, are administered to people infected by Mtb, there is a risk of decreasing the integrity of granulomas and increasing the probability of mutiplication of mycobacteria and TB reactivation. Therefore, in persons with rheumatological, gastro-enterological and dermatological diseases candidate to biological therapies there is a general recommendation of screening for TB infection (TBI) at baseline. The screening should include also a search for history of prior TB or contact with TB, a test for the presence of TBI, and if scored positive, a chest X-Ray

Representing Black, Asian and Minority Ethnic Skin in Dermatology Education Amidst the COVID-19 Pandemic: An Evaluation of an E-learning Resource.

BackgroundRecently published literature has shed light on the lack of representation and exposure to Black, Asian and Minority Ethnic (BAME) skin types in dermatology education and training. This may lead to diagnostic uncertainty and impact the overall quality of care delivered. Thus, this paper discusses the design and development of an e-learning resource as an innovative solution to address this educational need during the pandemic.MethodsA focus group was conducted to assess the learning needs of trainees on cutaneous manifestations of BAME patients. An e-learning resource was created using instructional design, educational and multimedia principles such as the ADDIE (Analysis, Design, Development, Implementation, Evaluation) model and Gagne’s nine steps. The e-learning was disseminated to trainees across a one-month period. Feedback on the content and relevance of the e-learning was collected on the completion of the module.ResultsOverall, 84% (n=42) of trainees reported that the module improved their confidence and knowledge acquisition of common skin conditions in BAME skin types (p<0.0001 when compared to pre-course confidence). 94% (n=47) of trainees agreed or strongly agreed that the e-learning met their learning needs as an educational tool. Of 50 trainees, the results show that trainees agreed or strongly agreed that the resource was accessible (94%, n=47), reusable (94%, n=47) and promotes a sustainable way of teaching in dermatology (96%, n=48).ConclusionA well-structured virtual learning module can be an effective tool to deliver teaching remotely whilst complying with public health measures to prevent the spread of COVID-19. This e-learning also highlights the need for further BAME representation in published dermatological resources.

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.