Knowledge Of Dermatology Research Articles

Undergraduate dermatology education in Ireland: a survey of interns.

Dermatological conditions are the fourth most common of all diseases affecting humans, and affect almost one third of the world's population, necessitating effective undergraduate dermatology education. 1. To enquire about the self-perceived confidence of newly qualified junior doctors in recognising and diagnosing dermatological conditions. 2. To ascertain information pertaining to newly qualified junior doctors' undergraduate dermatology education. A mixed-methods survey on undergraduate dermatology education and self-perceived confidence levels of interns in relation to dermatological conditions was distributed to interns working within two Irish intern networks. Mann-Whitney U testing was used to test for differences between those who had a dermatology placement versus those who did not. Qualitative thematic analysis was used to analyse reflections and comments. Fifty-seven interns completed our survey. A total of 60% of respondents were female (n = 34). The median age range of respondents was 25-29years. Fifty-eight percent of interns had a clinical dermatology undergraduate placement (n = 33). Forty-nine percent of interns were dissatisfied with their undergraduate dermatology education (n = 28), while 26% (n = 15) were satisfied and 25% (n = 14) indicated neutral feelings. Confidence levels reported were reasonable where inflammatory and malignant dermatoses were concerned. Statistical significance was established across several areas in dermatology between those who had a dermatology placement versus those who did not. Thematic analysis revealed themes of ineffective dermatology education, of a basic knowledge of dermatology, and of dermatology knowledge via other specialties. This study demonstrates that undergraduate dermatology education is not standardised across various universities in Ireland. It also revealed several areas within dermatology within which there was a statistically significant difference in confidence levels between those who had a clinical undergraduate dermatology placement versus those who did not. This raises the question: "Would mandating a dermatology clerkship may be beneficial to interns?".

Inpatient Dermatology referrals: What is the burden? A retrospective review of 14 years of dermatology inpatient referrals.

The lack of dermatological knowledge by non-dermatologists is exposed by the increasing number of requests made for inpatient dermatological consultations. Patients have been commenced on inappropriate treatment because of poor dermatology training. To determine the burden and accuracy of inpatient dermatology referrals. A retrospective cohort study using paper inpatient dermatology referrals from one Health Board between June 2007 and July 2021. Data analysis included timing of referrals; referring speciality; diagnosis and treatment. Descriptive statistics, using Excel, were used for analyses. The average number of referrals per year was 106 (79-166). The most frequent day of referral was Monday (26%). Most referrals were from medical teams (73%).Differential diagnosis was suggested by the referring team in 59% of referrals. In only 29% of referrals the dermatology team agreed with the differential diagnosis. There was discrepancy in the correctness of diagnosis in all categories, however the paediatricians were most likely to offer a correct differential (44%). In 44% of referrals treatment was commenced by the referring team, most commonly antibiotics. There is an extra burden on dermatology teams to cover inpatients. Our figures highlight two important issues - the need for better dermatological education in medical schools to improve diagnosis accuracy and management of conditions as well as the need to recognise the need for an inpatient dermatology service to review inpatient referrals and advise in diagnosis and management of dermatology cases on the wards, and to protect the service from being uncoupled from the main hospital.

Dermatological Knowledge and Image Analysis Performance of Large Language Models Based on Specialty Certificate Examination in Dermatology

Large language models (LLMs) are trained using large datasets and may be applied to language-based tasks. Studies have demonstrated their ability to perform and pass postgraduate medical examinations, and with the increasingly sophisticated deep learning algorithms and incorporation of image-analysis capabilities, they may also be applied to the Specialty Certificate Examination (SCE) in Dermatology. The Dermatology SCE sample questions were used to assess the performance of five freely available and high-performance LLMs. The LLMs’ performances were recorded by comparing their output on multiple-choice questions against the sample answers. One hundred questions, four of which included photographs, were entered into the LLMs. The responses were recorded and analysed, with the pass mark set at 77%. The accuracies for Claude-3.5 Sonnet, Copilot, Gemini, ChatGPT-4o, and Perplexity were 87, 88, 75, 90, and 87, respectively (p = 0.023). The LLMs were generally capable of interpreting and providing reasoned responses to clinical scenarios and clinical data. This continues to demonstrate the potential of LLMs in both medical education and clinical settings.

Abstract C012: Evaluation of skin cancer screening education provided by dermatologists with The Sun Bus for medical students

Abstract Introduction: Medical student curriculum is lacking in standardized training of skills for conducting the skin cancer screening examination. Dermatology is not a standard clinical rotation during medical school, and many medical students do not have much exposure to the specialty of dermatology for hands-on training in skin examinations by dermatologists. We sought to create an event in conjunction with the Sun Bus that included education about dermatology and skin examination for medical students. Objectives We sought to assess how the effects on knowledge of dermatology and skin cancer prevention and screening among participating medical students changed from participating in the educational event. Methods: The Health Education and Awareness Team of Texas Tech University Health Sciences Center El Paso collaborated with The Sun Bus to organize a training event for medical students. During this event, students had the opportunity to listen to a panel about dermatology as well as the basics of skin cancer screening from working dermatologists. Students also received a brief training on skin cancer screening provided by The Sun Bus and conducted screenings alongside dermatologists during a free skin cancer screening event. Students completed voluntary pre-event and post-event surveys. Results The vast majority of students did not feel confident in their ability to screen for skin cancer prior to attending the event. This research showed improved student confidence in providing skin cancer screenings and identifying suspicious skin lesions from the intervention. Conclusion: Medical students lack standardized training in dermatology and in the dermatologic skin cancer screening examination. This student educational event represents a meaningful intervention that improved medical students’ confidence in providing skin cancer screenings and identifying suspicious skin lesions. Bibliography The Sun Bus. https://www.thesunbus.org/about-us Accessed 11 Dec 2023. Compres E, Holzem K, Ibler E, Bierman JA, Rademaker AW, Kundu RV. A Brief Dermatology Curriculum in Skin Cancer Detection and Prevention to Improve Medical Student Knowledge and Confidence. MedEdPORTAL. 2020;16:11049. Published 2020 Dec 29. doi:10.15766/mep_2374-8265.11049 Moore MM, Geller AC, Zhang Z, et al. Skin cancer examination teaching in US medical education. Arch Dermatol. 2006;142(4):439-444. doi:10.1001/archderm.142.4.439 Ivanov NN, Swan A, Guseman EH, Whipps J, Jensen LL, Beverly EA. Medical Students' Knowledge, Attitudes, and Behaviors With Regard to Skin Cancer and Sun-Protective Behaviors. J Am Osteopath Assoc. 2018;118(7):444-454. doi:10.7556/jaoa.2018.098 Ivanov NN, Swan A, Guseman EH, Whipps J, Jensen LL, Beverly EA. Medical Students' Knowledge, Attitudes, and Behaviors With Regard to Skin Cancer and Sun-Protective Behaviors. J Am Osteopath Assoc. 2018;118(7):444-454. doi:10.7556/jaoa.2018.098 Citation Format: Elian A. Martin Lopez, Hannah Riva, Shravya Kichena Kichena, Daniel Lovasz, Brian Kan, Tannis Hogg, Jessica Chacon. Evaluation of skin cancer screening education provided by dermatologists with The Sun Bus for medical students [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C012

Brief Teaching Intervention Improves Medical Students' Dermatology Diagnostic Skills and Comfort in Performing Dermatology Exams.

Skin disease is a significant contributor to the global disease burden, with dermatologic health disparities adding to this burden. Internists, general practitioners, and other medical professionals often manage skin disease with limited exposure to dermatologic education in medical school. This study evaluated a brief educational intervention for medical students to improve dermatologic knowledge, diagnostic and communication skills, and comfort in performing dermatology-focused physical exams. A secondary focus of the intervention was to promote awareness of skin disease, detection, and prevention for patients with a variety of skin tones. Sixty-five first through fourth-year students at Rutgers RWJMS participated in a pre-test-post-test within-subject study. Students described images using open-ended responses followed by multiple-choice identification questions. Students watched a one-hour self-paced module created by a licensed dermatologist and completed a follow-up assessment. At pre-test, descriptions were brief and often inaccurate but significantly improved post-intervention to include descriptors such as primary morphology and demarcation. Accuracy on diagnostic and management questions significantly improved and comfort in advising patients and performing dermatologic exams significantly increased. A low-cost, brief, self-paced module can augment dermatologic education for medical students while increasing exposure to multiple skin tone presentations of lesions.

Skin Disease Recognition Based on Deep Learning Algorithms: A Review

The sharp increase in cases of melanoma and other skin cancers worldwide highlights the urgent need for improved diagnostic methods. Because skin lesions vary widely and access to dermatological knowledge is limited in resource-poor areas, traditional methods - which rely on visual inspection and clinical experience - have difficulty identifying diseases accurately. This situation requires innovative approaches to improve accessibility and diagnostic accuracy. To address these issues, this work uses deep learning (DL) and convolutional neural networks (CNNs). This paper is trying to transform skin cancer diagnosis through the use of large databases of dermoscopic images and advanced artificial intelligence algorithms. In order to evaluate the effectiveness of CNNs and DL in identifying skin diseases, we conducted a comprehensive analysis of the literature, focusing on the accuracy of skin cancer type classification. Our approach focused on model architectures, data preparation methods, and performance indicators while examining existing research using AI algorithms to diagnose skin cancer. With the ultimate goal of improving patient outcomes through early detection and accurate classification of skin conditions, this approach not only underscores the great potential of DL and CNN in transcending traditional diagnostic limitations, but also highlights the continued development of AI-based tools in pathology. Dermatology. Diagnosis.

The American Academy of Dermatology's "Good Skin Knowledge" program enhances children and adolescents' confidence regarding dermatologic knowledge.

The American Academy of Dermatology (AAD) has resources meant to be used by children. Herein, we discuss the Good Skin Knowledge (GSK) curriculum, which was created to educate youth aged 8-13 about common dermatologic conditions to promote healthy skin habits, build self-confidence, and encourage careers in science and medicine. To assess participants' confidence regarding understanding and retention of GSK materials, the authors developed a pre- and post-training survey consisting of 10 questions. Results of our survey demonstrate a significant improvement in participants confidence regarding knowledge of skin function and care with at least two thirds of youth surveyed indicating understanding across all areas, with the largest gains centered around knowledge of the three skin layers, knowing what a dermatologist does, and appreciating the causes of acne.

The NLR SkinApp: Testing a Supporting mHealth Tool for Frontline Health Workers Performing Skin Screening in Ethiopia and Tanzania.

Background: The prevalence of skin diseases such as leprosy, and limited dermatological knowledge among frontline health workers (FHWs) in rural areas of Sub-Saharan Africa, led to the development of the NLR SkinApp: a mobile application (app) that supports FHWs to promptly diagnose and treat, or suspect and refer patients with skin diseases. The app includes common skin diseases, neglected tropical skin diseases (skin NTDs) such as leprosy, and HIV/AIDS-related skin conditions. This study aimed to test the supporting role of the NLR SkinApp by examining the diagnostic accuracy of its third edition. Methods: A cross-sectional study was conducted in East Hararghe, Ethiopia, as well as the Mwanza and Morogoro region, Tanzania, in 2018-2019. Diagnostic accuracy was measured against a diagnosis confirmed by two dermatologists/dermatological medical experts (reference standard) in terms of sensitivity, specificity, positive predictive value, and negative predictive value. The potential negative effect of an incorrect management recommendation was expressed on a scale of one to four. Results: A total of 443 patients with suspected skin conditions were included. The FHWs using the NLR SkinApp diagnosed 45% of the patients accurately. The values of the sensitivity of the FHWs using the NLR SkinApp in determining the correct diagnosis ranged from 23% for HIV/AIDS-related skin conditions to 76.9% for eczema, and the specificity from 69.6% for eczema to 99.3% for tinea capitis/corporis. The inter-rater reliability among the FHWs for the diagnoses made, expressed as the percent agreement, was 58% compared to 96% among the dermatologists. Of the management recommendations given on the basis of incorrect diagnoses, around one-third could have a potential negative effect. Conclusions: The results for diagnosing eczema are encouraging, demonstrating the potential contribution of the NLR SkinApp to dermatological and leprosy care by FHWs. Further studies with a bigger sample size and comparing FHWs with and without using the NLR SkinApp are needed to obtain a better understanding of the added value of the NLR SkinApp as a mobile health (mHealth) tool in supporting FHWs to diagnose and treat skin diseases.

Fundamental dermatology education of medical doctors at a regional hospital in Johannesburg, South Africa.

dermatology is a prevalent field of global health and dermatological conditions are amongst the most frequent complaints affecting communities, yet dermatology has become an overlooked aspect of the medical school curricula and many medical schools have failed to provide doctors with training to manage these conditions confidently and adequately. This study aimed to determine the baseline dermatological knowledge of medical doctors and determine the influence of fundamental dermatology education on hospital medical staff at a regional hospital in Johannesburg, South Africa. the knowledge and confidence of 33 medical doctors were tested using a pre-test and post-test quasi-experimental design. Participants completed an online questionnaire followed by an image-based test consisting of 20 questions to determine their level of confidence in diagnosing and managing common dermatological conditions. The participants then attended a sixty-minute educational session based on common dermatological conditions. Following this, their level of confidence and knowledge on the subject was re-assessed using the same online test. Pre and post-intervention confidence and test scores were compared. the pre-intervention test mean score was 67.11%. The post-intervention mean score was 92.50%. The difference between means (post-intervention - pre-intervention) ± SEM was 25.39 ± 4.81. The intervention significantly improved overall test scores (p-value < 0.0001). Many participants felt that their undergraduate training was insufficient in preparing them for the management of common dermatological conditions. the baseline knowledge and confidence of medical doctors in managing common dermatological conditions was poor and such educational interventions have significant value in improving the ability of medical doctors in managing common dermatological conditions. More time should be dedicated to dermatology training at an undergraduate level.

Skin of Color Is Underrepresented on Instagram: Assessing South Jersey Skin Talk as an Educational Tool to Increase Awareness.

Background Instagram, a widely used social media platform with over two billion active users, has the potential to propagate dermatologic health information within the public sphere. However, there is a lack of representation of people of color (POC), making it crucial to share accurate and inclusive posts to increase awareness about dermatologic conditions. It is also necessary to address the misconceptions about skin diseases and other hereditary conditions within various ethnic groups. To combat this, a group of medical students created South Jersey Skin Talk (SJST), an initiative aimed to improve dermatologic health literacy in skin-of-color communities, particularly in underserved areas like Camden County, NJ. Using reliable sources to prevent the spread of misinformation, SJST's accessible Instagram page explains skin conditions, especially emphasizing appearances and manifestations in POC. The hypothesis being investigated bythis group is that the implementation of SJST as a community intervention is expected to improve dermatologic health literacy in POC. Methods A 13-question survey was conducted via Qualtrics (Seattle, Washington) and was distributed on social media (Instagram, Facebook, Reddit, Twitter, TikTok, and GroupMe). It remained open for eight weeks during which users 18 years or older were invited to participate. The survey was divided into four sections: demographics, Instagram usage, knowledge of dermatology, and inclusion and diversity on SJST's page. A total of 184 total responses were collected, which were compared using chi-squared analyses on Qualtrics software. Results POC felt less represented on social media compared to White respondents prior to visiting SJST on Instagram (p < 0.00001). However, after viewing SJST, 87.5% of White participants and 88% of POC reported feeling represented on the page. Additionally, both groups of respondents indicated that they felt more knowledgeable about their primary skin concern after viewing the SJST's posts. Furthermore, 86.8% of POC reported that they would feel more confident participating in a conversation with their dermatologist regarding their primary dermatologic concern. Conclusion SJST is a community outreach organization focused on improving health literacy for POC and bridging the gap in healthcare disparities between White and POC populations. The results from this survey confirm the hypothesis and illustrate that community interventions targeted at education for POC increase health literacy and patient autonomy. These results also show that there is a need for more representation and diversity in medical dermatology on social media. Further studies should be done to investigate other disparities affecting adequate representation for POC.

A life for autoimmune blistering diseases: in memoriam Detlef Zillikens.

Detlef Zillikens, MD, director and chair of the Department of Dermatology at the University of Lübeck, Lübeck, Germany, died in September 2022, aged only 64. He dedicated his professional life to autoimmune blistering diseases (AIBDs) and built his department into one of the world's leading centers for these diseases. Herein, his professional life and the impact on the field of AIBDs and the research landscape at the University of Lübeck are addressed. With his warm, integrative, open-minded, ever-optimistic attitude, he was a highly reliable colleague, mentor, and friend to many in the field including each of the authors. Combined with his in-depth knowledge of dermatology, interest in many fields of life science, and hard work, Detlef Zillikens initiated the founding of two independent research institutes, the Lübeck Institute of Experimental Dermatology and the Institute and Comprehensive Center for Inflammation Medicine. He was also instrumental in establishing the Center for Research on Inflammation of the Skin, where in a new research building, over 140 scientists pursue research questions related to skin inflammation. By inviting numerous researchers and clinicians to his department and hosting two large international meetings, he brought the field of AIBDs much closer together and inspired multiple national and international research initiatives. His ideas will live on and grow in many of his colleagues and mentees.

Application of a flipped classroom teaching model based on micro-videos in the standardized training of dermatological residents in China.

To explore the effects of a micro-video-based flipped classroom teaching model on the standardized training of dermatological residents in China. A total of 78 residents who had received standardized training at the Department of Dermatology of the First Affiliated Hospital of Anhui Medical University were selected and randomly divided into an experimental group (39 residents) and a control group (39 residents). The experimental group received micro-video-based flipped classroom teaching, whereas the control group received traditional lecture-based classroom teaching. Scores relating to theoretical knowledge of dermatology, clinical practice skills, and the results of a questionnaire survey were used to evaluate the teaching effects. The average score of the experimental group in the theoretical knowledge test (88.56 ± 5.80) was significantly higher than that of the control group (81.90 ± 7.45). Similarly, the average score of the experimental group in the clinical practice skills test (85.44 ± 5.97) was also significantly higher than that of the control group (78.46 ± 5.94). The results of the questionnaire survey showed that the experimental group exhibited significant improvements in learning interest, mastery of teaching content, communication skills, expression skills, clinical practice skills, autonomous learning, clinical thinking, clinical application, and team cooperation. Flipped classroom teaching based on micro-videos helped to improve the teaching effects of theoretical knowledge, clinical practice skills, and residents' comprehensive ability during dermatological residents' standardized training.

Students bridging the diversity gap in dermatology—A mixed methods study of medical education

AbstractBackgroundAfter noticing a lack of diversity in pictures for skin conditions and dermatology teaching, seven medical students applied for funding from the University of Exeter to design a project with the aim of expanding their dermatology knowledge through developing diverse teaching resources and assessing knowledge using innovative evaluation methods. Students then tested their project by raising awareness about common skin conditions and their presentation on different skin colours to the public in Exeter.ObjectivesThis paper aims to reflect on and evaluate the experience of medical students in developing and implementing this project, with a focus on the significant positive impact it had on their dermatological knowledge and practical ability to assess skin conditions on diverse skin tones.MethodsEach team member was asked to complete a survey to self‐assess critical skills before and after participating in the project and write a post‐event reflective piece. The responses to the survey and reflective pieces were further analysed for specific themes.ResultsAll members perceived a significant improvement in three common themes: (i) bridging the knowledge gap, (ii) gaining confidence in designing innovative resources and (iii) enhancing communication skills. The survey and reflective pieces also identified areas of improvement in the project.ConclusionsBeyond expanding the dermatology knowledge of medical students, the project encouraged critical thinking and proactiveness as future clinicians. Medical students perceived improvements in key skills such as effective communication, public speaking and developing innovative teaching resources. Medical schools must create opportunities to enable such student‐led projects and embed inclusion and diversity in the medical curriculum so that future clinicians are well‐equipped to serve a rapidly diversifying population. This project has now received further funding and is being expanded to create a digital resource pack for all medical school educators and students.

ChatGPT-3.5 and ChatGPT-4 dermatological knowledge level based on the Specialty Certificate Examination in Dermatology.

The global use of artificial intelligence (AI) has the potential to revolutionize the healthcare industry. Despite the fact that AI is becoming more popular, there is still a lack of evidence on its use in dermatology. To determine the capacity of ChatGPT-3.5 and ChatGPT-4 to support dermatology knowledge and clinical decision-making in medical practice. Three Specialty Certificate Examination in Dermatology tests, in English and Polish, consisting of 120 single-best-answer, multiple-choice questions each, were used to assess the performance of ChatGPT-3.5 and ChatGPT-4. ChatGPT-4 exceeded the 60% pass rate in every performed test, with a minimum of 80% and 70% correct answers for the English and Polish versions, respectively. ChatGPT-4 performed significantly better on each exam (P < 0.01), regardless of language, compared with ChatGPT-3.5. Furthermore, ChatGPT-4 answered clinical picture-type questions with an average accuracy of 93.0% and 84.2% for questions in English and Polish, respectively. The difference between the tests in Polish and English were not significant; however, ChatGPT-3.5 and ChatGPT-4 performed better overall in English than in Polish by an average of 8 percentage points for each test. Incorrect ChatGPT answers were highly correlated with a lower difficulty index, denoting questions of higher difficulty in most of the tests (P < 0.05). The dermatology knowledge level of ChatGPT was high, and ChatGPT-4 performed significantly better than ChatGPT-3.5. Although the use of ChatGPT will not replace a doctor's final decision, physicians should support the development of AI in dermatology to raise the standards of medical care.

Practices and Perceptions of Community Pharmacists in the Management of Atopic Dermatitis: A Systematic Review and Thematic Synthesis.

Understanding the contributions of community pharmacists as first-line health providers is important to the management of atopic dermatitis, though little is known about their contribution. A systematic review was carried out to examine practices and perceptions of the role of community pharmacists. A literature search was conducted in five different databases. Full-text primary research studies, which involved practices and perceptions of the role of community pharmacists in the management of atopic dermatitis, previously published in peer reviewed journals were used. Critical appraisal of included studies was performed using the Mixed Methods Appraisal Tool. Data were extracted and thematically synthesized to generate descriptive and analytical themes. The confidence of the findings of the included studies was assessed via either GRADE or CERQual. Twenty-three studies were included. Findings showed that community pharmacists lacked knowledge of the uses of topical corticosteroids. The recommendations of other treatments were limited. Pharmacists generally undertook dermatology training after graduation. Analytical themes indicated that the practices of community pharmacists were poor and misled patients. Inappropriate education in initial training was identified as a potential reason for their poor practices. This systematic review reveals a gap between patients' needs in practice and dermatological education provided to community pharmacists. Novel approaches regarding education and training should be explored to improve pharmacists' dermatological knowledge and skills.

DE01 Swabs: a practical way to teach medical students about cutaneous infections

Abstract It is well established that dermatology is poorly understood among medical students and doctors of all grades. The combination of time allocated to teaching of dermatology, as well as the high impact of the hidden curriculum reinforcing dermatology as difficult and mysterious, lends itself to perpetuation of the zeitgeist. Cutaneous infections have a particularly high cognitive load due to their relatively short presentation time and wide varieties of manifestations. Investigation of cutaneous infections is also problematic with incorrect sampling undertaken for different infections. Junior doctors frequently default to black charcoal swabs for all skin infections, often getting feedback as inappropriate investigation after the patient has been discharged or are being read by different doctors altogether due to shift working. For 8 years, we have been running a practical tutorial session on skin infections at Swansea University Medical School. Old venesection prosthetic arms are decorated with simulation bacterial, fungal and viral infections. The bacterial pus is cold custard (or ‘pustard’) on swollen reddened sections. Herpetic vesicles are simulated with bubble wrap injected with Hibiscrub®. Tinea is simulated by dry polyvinyl acetate glue surrounded by red marker. The students have access to black charcoal swabs, red viral swabs, scalpels and fungal scraping cards. They also have dry universal containers and investigation forms. The 10–12 year-2 students are tasked with diagnosing each infective presentation with a short history and medical photography to back up the prosthetic representation. They then have to select the most appropriate investigative method and information to give to the microbiology department. Some students only have access to black charcoal swabs and need to improvise working out how to use the universal containers for their investigations. The knowledge is then shared at the end of the 40-min tutorial. This is conducted a day before the skin infection lecture, to reduce the cognitive load of that lecture. There has been consistently good feedback for this session, which allows students to think in real time about common clinical scenarios, making best use of laboratory services and improvising investigative techniques, where appropriate resources may not be available. The prosthetics have worked well year on year. Many of our first students are now practising doctors locally, and their dermatology knowledge is manifest in referrals. By practising the techniques in simulation, they are comfortable doing so in working life.

Exploring the knowledge, attitude, and practices of over-the-counter medical sellers in Ghana.

Rural areas in sub-Saharan Africa face a high prevalence and morbidity of skin disease while also lacking access to dermatologists. In Ghana, where approximately 25 licensed dermatologists are available for 25 million people, community pharmacies, called over-the-counter medical sellers (OTCMS), were established to respond to accessibility inequities, albeit without equitable training. Our study evaluates the dermatologic knowledge, attitudes, and practices (KAP) of OTCMS in Ghana's Ashanti Region. To assess dermatologic KAP, we created a standardized questionnaire and recorded 13 interviews with OTCMS in seven communities. Interviews were completed with help from Ghanaian translators and transcripts were transcribed verbatim, then analyzed qualitatively to determine common themes for analysis. This analysis identified six major themes: i) prescriber qualifications; ii) diagnostics; iii) therapeutics; iv) economics; v) health systems integration; vi) care-seeking behavior. Analysis of these themes outlined many cultural roles and challenges of OTCMS, including serving as the primary contact for dermatologic conditions in rural communities. While possibly necessary due to the lack of accessible dermatologists, this raises concerns for potential harm in diagnostic error and misuse of therapeutics due to the lack of formal dermatology training. In rural parts of Ghana, the KAP of OTCMS play a pivotal role in assessing and treating skin disease for those who might otherwise lack access to adequate dermatologic management. Furthermore, although our study identifies potential issues related to the roles played by OTCMS, it also suggests strategies to improve the dermatologic health of many Ghanaians by enhancing education and healthcare delivery in rural areas.

Evaluating dermatology education in Australia: Medical students' and junior doctors' perceptions.

Despite a high frequency of dermatological general practice and emergency department presentations, including serious and potentially fatal skin conditions, evidence suggests that undergraduate dermatological education remains sparse. Given this, there exists a need to gauge dermatology-relevant knowledge and skill in our new doctors. An online survey was completed by final-phase medical students and junior doctors from Australian medical schools. The survey appraised self-perceived confidence of dermatology knowledge and skills, in addition to 5 knowledge-based multiple-choice questions. Nine hundred and forty-two eligible responses were completed. Respondents reported low confidence in identifying dermatological conditions in people with skin of colour (μ=1.69), handing over to dermatology colleagues (μ=2.00) and in diagnosing and managing acute/emergency dermatology conditions (μ=1.84). In contrast, participants felt most confident in counselling sun-protective behaviours (μ=3.95) and suturing small wounds (μ=3.43). 76.4% of respondents had not undertaken any dermatology placement, and 70.9% had never been formally assessed in dermatology. Those who received dermatology placement had a significantly higher aggregated self-reported confidence (p < 0.0001) and answered significantly more MCQs correctly (p=0.0419). Those who had been formally assessed had a significantly higher self-reported confidence (p < 0.001) and answered significantly more MCQs correctly (p=0.007). Final-phase medical students and junior doctors exhibit low confidence across many dermatology competencies. Participants believed they need more dermatology education, and seldom feel prepared when exposed to dermatologic pathologies. Introduction of a standardised curriculum, formal assessments and increased clinical exposure are possible solutions.

Beyond Skin Deep: case-based online modules to teach multidisciplinary care in dermatology among clerkship students

BackgroundCanadian medical schools offer limited clinical dermatology training. In addition, there is a lack of educational resources that are designed specifically for clerkship students that focus on the multidisciplinary nature of dermatology.ObjectivesAfter developing case-based educational resources to address the lack of clinical exposure and learning of multidisciplinary care in dermatology, this study aimed to evaluate the educational intervention and gather feedback for future module development.MethodsTen online interactive dermatology case-based modules involving 14 other disciplines were created. Medical students (n = 89) from two Canadian schools were surveyed regarding perceptions of the existing dermatology curriculum. Among 89 students, 46 voluntarily completed the modules, and a survey (a five-point Likert scale ratings) including narrative feedback was provided to determine an improvement in dermatology knowledge and understanding of multidisciplinary care.ResultsAmong 89 surveyed students, only 17.1% agreed that their pre-clerkship dermatology education was sufficient and 10.2% felt comfortable managing patients with skin conditions in a clinical setting. Among 46 students, 95.7% of students agreed that the modules fit their learning style (4.17 ± 0.73 on Likert scale) with positive narrative feedback. 91.3% agreed or strongly agreed that the modules enhanced their dermatology knowledge (4.26 ± 0.61). 79.6% of students agreed that the modules helped with understanding the multidisciplinary nature of dermatological cases (3.98 ± 0.81). Student comfort to manage skin conditions increased 7.7 times from 10.2% to 78.3% post-module.ConclusionsClerkship students had limited knowledge of dermatologic conditions; the case-based modules were able to successfully address these deficits and assist students in understanding the multidisciplinary nature of dermatology.

Eleven years of teledermoscopy in the Netherlands: A retrospective quality and performance analysis of 18,738 consultations

Introduction Teledermoscopy supports and enhances the early detection of skin lesions by general practitioners in primary practice through remote consultation with dermatologists. Teledermoscopy has been a regular health service in Dutch primary care since February 2009. Teledermoscopy quality and performance outcomes on Dutch general practitioner primary care 11 years after its implementation were assessed. Methods Dutch primary care teledermoscopy consultation data was retrospectively analysed on timestamps and responses on non-mandatory evaluation questions posed to the general practitioner and teledermatologist during the teledermoscopy consultation process. Anonymized data (February 2009–February 2020) was extracted from a Dutch teledermoscopy service database. The timestamps and evaluation questions data were subject to the teledermoscopy quality and performance outcomes. A limited cost evaluation was performed. Results A total of 18,738 teledermoscopy consultations were sent by 1341 general practitioners (February 2009–February 2020). For 3908 (31.9%) teledermoscopy consultations, the general practitioner requested second opinion advice which led to 712 (18.2%) extra teledermoscopy referrals of patients who would not have been referred without teledermoscopy, including skin cancer teledermoscopy diagnoses. The general practitioner followed the teledermatologists’ advice on patient referral for 8813 (88.5%) patients, reported 97.3% of the teledermoscopy consultations as helpful and 95.1% as instructive, referred 68.0% less patients with teledermoscopy availability, referred overall 59.4% less patients, and needed 5.4 minutes (median) for sending a teledermoscopy consultation. Teledermatologist's median answer and response time was 2 minutes and 2.4 hours, respectively. The estimated cost reduction was €144.18 ($164.65) (50.2%) per teledermoscopy patient. Discussion Teledermoscopy is a useful service in general practitioner practice for requesting dermatologist advice in primary care settings to support the detection of skin lesion at an early stage and at lower costs. Teledermoscopy could also decrease the burden of secondary dermatology care since general practitioners reported that they did not refer the majority of patients to a dermatologist after the teledermoscopy consultation compared to their initial referral decision. General practitioners reported the teledermoscopy system as helpful and instructive which could contribute to enhancement of their dermatological knowledge.