Dermatologic Skills Research Articles

Music literacy training in dermatology: A mixed methods cohort study of postgraduate education

AbstractBackgroundWe have previously pioneered arts‐based training to enhance clinical skills in senior and resident dermatologists. However, the utility of music to support the development of dermatological skills such as listening, observation, description and communication is unexplored.ObjectivesWe hypothesised that music literacy training (MLT) would enhance the clinical dermatology skills of newly qualified doctors and could be effectively delivered in a single‐session virtual format.MethodsOur training comprised a 2.5‐h course held in October 2021 on the virtual meeting platform Zoom. The course was led by a music educator and included sessions which placed particular emphasis on listening to music, discriminating auditory cues to interpret imagery and meaning, and describe this to others. Participants explored concepts such as pitch, melody, pace, rhythm, dynamics and timbre by working collaboratively, independently and in small break‐out groups. All participants documented their learning journey through pre‐ and post‐course reflective essays and the training was evaluated by a pre‐ and post‐course dermatology clinical assessment.ResultsMusic served as a catalyst for reflection and discussion, supporting significant improvement key clinical skills such as listening, clinical observation and description in newly qualified doctors. Participants reported increased confidence communicating with others and found the course structure enjoyable and fun.ConclusionsCombined qualitative and quantitative evidence highlights the benefit of MLT in developing key clinical skills in newly qualified doctors which is effective when delivered in a single‐session, virtual format.

Perceptual learning in dermatology-A Finnish cohort study of undergraduate medical students.

Implicit visual skills play an important role in the recognition of skin-related conditions. We aimed to evaluate effectiveness and practicability of digital perceptual learning modules (PLMs) during undergraduate teaching of dermatology. The study consisted of four subsequent dermatology courses including 105 medical students. PLMs designed for an online setting were carried out before, during and at course ends, as well as 6-12 months after the courses (N = 33). We investigated four important outcome measures regarding perceptual learning: diagnostic accuracy (%-percentage of correct responses), decision duration (response time), recognized features (decision basis) and student-perceived confidence. Diagnostic accuracy (p < 0.001, effect size = 0.82), fluency (p < 0.001, = 0.23) and confidence (p < 0.001, = 0.74) increased significantly with successive PLMs during courses. Students classified more visual features and based the diagnosis more on primary lesion. Accuracy increased in all tasks during the courses and reached over 90% in diagnoses of the first to third task difficulty quartile. In the most difficult quartile accuracy reached to 60%. In the follow-up, students' performance remained at high level. Analysis of diagnostic errors showed that there were specific conditions which were systematically confused with each other. Digital PLMs improved high rates of diagnostic accuracy, fluency and student-perceived confidence in recognition of skin-related conditions. There was a long-term consistency in high performance suggesting effective learning retention. In the digital setting, PLMs were practicable and easily integrated into traditional teachings. We believe that there is extensive potential for a wider use of perceptual learning to improve nonanalytical visual skills in dermatology and medical education in general.

Needs and Gaps in Resident Trainee Education, Clinical Patient Care, and Clinical Research in Cosmetic Dermatology: Position Statement of the Association of Academic Cosmetic Dermatology.

Cosmetic dermatology is a key subspecialty of academic dermatology. As such, academic centers are expected to demonstrate excellence in the teaching of cosmetic dermatology skills to trainees, the clinical delivery of cosmetic dermatology services to patients, and the performance of clinical research that advances knowledge and uncovers new therapies in cosmetic dermatology. The Association of Academic Cosmetic Dermatology (AACD), a newly formed medical professional society, includes as its principal aims the support of all of these areas. AACD is comprised of group of board-certified dermatologists who teach cosmetic and laser dermatology at US dermatology residency programs. An expert panel constituted by the AACD recently convened a workshop to review gaps pertaining to academic cosmetic dermatology. This panel considered needs and potential corrective initiatives in three domains: resident education, patient experience, and clinical research. The work of the panel was used to develop a roadmap, which was adopted by consensus, and which will serve to guide the AACD moving forward.

Are Dermatology Electives Meeting The Learning Objectives of Rotators?

Introduction: Learners rely on dermatology electives to supplement their education. Our goal is to determine whether electives adequately address the rotators’ learning objectives. Methods: A survey was distributed to medical students and residents on a dermatology elective to assess their specific learning objectives and rotation satisfaction. Results: The survey had a 50% response rate (n=36). 74.2% of survey respondents were medical students (n=23) and 25.8% were residents (n=8). 57.1% of all rotators were interested improving their morphology/description of skin lesions (n=20). Residents were most interested in exposure to basic dermatological procedures (50%, n=4) whereas medical students were most interested in morphology/ descriptions of skin lesions (81.8%, n=18). Medical students with an interest in dermatology expressed a greater interest in career exploration (n=8) compared to medical student not interested in dermatology (n=4). Discussion: Most rotators wanted to gain basic exposure to dermatology, however training level and interest played a role in determining the most important learning objective. Residents displayed a greater interested in procedural training while medical students wanted to gain more exposure to basic dermatology skills. Conclusion: Customizing the dermatology elective to the trainee will allow the greater engagement during the rotation rather than a ‘one size fits all’ elective.

33514 Learning practical dermatology skills through animated vignettes: An effective medical school educational intervention to support the dissemination of national guidelines

Background: Choosing Wisely is a global initiative to improve outcomes in patient care by reducing unnecessary tests and treatments. The Canadian Dermatology Association developed five recommendations for Choosing Wisely Canada (CWC) to guide diagnosis and management of common dermatology conditions. Traditional models of dermatology education (i.e., didactic teaching, clinical rotations) are increasingly being complemented by novel educational tools, such as problem-based learning. We assessed the impact and reception of animated case-based videos of CWC recommendations for a medical student audience.

VISUAL ANALOGIES IN DERMATOLOGY: IMPACT ON THE DIAGNOSTIC ACUMEN OF UNDERGRADUATE MEDICAL STUDENTS

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Visual analogies are much used in medical education; however, their effect on the development of clinical reasoning has yet to be investigated. In fields such as dermatology in which reasoning is predominantly based on the recognition of visual patterns, analogies may be even more useful. &lt;strong&gt;Objectives: &lt;/strong&gt;To investigate the effects of the use of visual analogies on the accuracy of undergraduate medical students in diagnosing skin disorders. &lt;strong&gt;Methods: &lt;/strong&gt;Sixty-four fourth-year medical students were divided into two groups to train in diagnosing skin diseases, either using visual analogies (study group) or from descriptions of elementary lesions (control group). The accuracy of the groups in diagnosing skin disorders was evaluated at 30 and 90 days after training, with their ability to create analogies also being tested at the 90-day evaluation. &lt;strong&gt;Results: &lt;/strong&gt;Diagnostic accuracy improved in both groups when the students’ performance before training was compared with their accuracy 30 days later (study group: 7.24±1.71 versus 8.76±1.83 respectively, p&amp;lt;0.001; control group: 7.42±2.02 versus 8.27±1.42, respectively, p&amp;lt;0.001). Results were similar 90 days after training. There was no statistically significant difference in diagnostic accuracy between the groups at 30 or 90 days following training (p=0.378). The study group performed better than the control group at making analogies (p&amp;lt;0.001), but there was no statistically significant correlation between diagnostic accuracy and the ability to make analogies (r- -9,15; p=0.437). &lt;strong&gt;Conclusion: &lt;/strong&gt;Diagnostic accuracy improved similarly in both groups. Other formats of visual analogies should be evaluated to clarify their role in developing diagnostic skills in dermatology.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;p&gt;&lt;strong&gt; Article visualizations:&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;img src="/-counters-/edu_01/0947/a.php" alt="Hit counter" /&gt;&lt;/p&gt;

Volunteer Opportunities Within Dermatology: More than Skin Deep.

As acceptance to dermatology residency has become increasingly competitive, rates of volunteerism among applicants seems to be decreasing as other facets of the application gain in importance. However, the unmet demand for dermatologic care in our communities suggests that there is a need for residents and practicing dermatologists to find ways to give back in their communities. This article offers an introduction to several worthwhile means to spend time volunteering dermatologic skills and expertise.

Medical Spanish Musculoskeletal and Dermatologic Educational Module.

IntroductionWhile many medical schools provide opportunities in medical Spanish for medical students, schools often struggle with identifying a structured curriculum. The purpose of this module was to provide a flexible, organ system-based approach to teaching and learning musculoskeletal and dermatologic Spanish terminology, patient-centered communication skills, and sociocultural health contexts.MethodsAn 8-hour educational module for medical students was created to teach musculoskeletal and dermatologic medical communication skills in Spanish within the Hispanic/Latinx cultural context. Participants included 47 fourth-year medical students at an urban medical school with a starting minimum Spanish proficiency at the intermediate level. Faculty provided individualized feedback on speaking, listening, and writing performance of medical Spanish skills, and learners completed a written pre- and postassessment testing skills pertaining to communication domains of vocabulary, grammar, and comprehension as well as self-reported confidence levels.ResultsStudents demonstrated improvement in vocabulary, grammar, comprehension, and self-confidence of musculoskeletal and dermatologic medical Spanish topics. While students with overall lower starting proficiency levels (intermediate) scored lower on the premodule assessment compared to higher proficiency students (advanced/native), the postmodule assessment did not show significant differences in skills performance among these groups.DiscussionAn intermediate Spanish level prerequisite for this musculoskeletal and dermatologic module can result in skills improvement for all learners despite starting proficiency variability. Future study should evaluate learner clinical performance and integration of this module into other educational settings such as graduate medical education (e.g., orthopedic, rehabilitation, and dermatology residency programs) and other health professions (e.g., physical therapy and nursing).

Educational video improves dermatology residents' understanding of Mohs micrographic surgery: A survey-based matched cohort study

To the Editor: Dermatology resident experience with Mohs micrographic surgery is highly variable,1Lee E.H. Nehal K.S. Dusza S.W. Hale E.K. Levine V.J. Procedural dermatology training during dermatology residency: a survey of third-year dermatology residents.J Am Acad Dermatol. 2011; 64: 475-483Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar,2Reichel 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 (37) Google Scholar and it has been reported that surgical training is often underemphasized in the course of dermatology training compared with other proceduralists.3Alam M. Dermatologic surgery training during residency: room for improvement.Dermatol Surg. 2001; 27: 508-509PubMed Google Scholar In surgery, especially dermatologic surgery, there is a need to quickly and intuitively transmit complex information to a wide physician audience, and various creative methods have been attempted, including YouTube4Koya K.D. Bhatia K.R. Hsu J.T. Bhatia A.C. YouTube and the expanding role of videos in dermatologic surgery education.Semin Cutan Med Surg. 2012; 31: 163-167Crossref PubMed Scopus (27) Google Scholar and metaphor.5Lee E. Wolverton J.E. SomaniAK A simple, effective analogy to elucidate the Mohs micrographic surgery procedure – the peanut butter cup.JAMA Dermatol. 2017; 153: 743-744Crossref PubMed Scopus (6) Google Scholar We created a mixed live-action and animated video demonstrating an introduction to Mohs micrographic surgery in an effort to improve residents' basic understanding of how, why, and when Mohs micrographic surgery is performed, with additional information on special considerations for Mohs micrographic surgery performed on unique anatomic locations. Although it was never intended to replace any part of a formal Mohs micrographic surgery fellowship, we hoped that residents' confidence with the basic concepts of Mohs micrographic surgery would improve with this approachable educational method. In this survey-based, matched-cohort study, 83 dermatology resident physicians were recruited by contacting Accreditation Council for Graduate Medical Education program coordinators and requesting dispersal within their programs through the Association of Professors of Dermatology LISTSERV (L-Soft International, Bethesda, MD). The residents were asked to complete a preliminary survey to self-rate their comfort level of Mohs micrographic surgery. The survey consisted of 5 basic Mohs competencies, and participants were asked to rate their comfort with each competency as 1 (low) through 5 (high). They were then asked to view 2 short, educational video modules on Mohs micrographic surgery. The first video demonstrates the excision of a sample and its histologic preparation—and how uniquely in Mohs micrographic surgery this allows for evaluation of complete margins with accurate reference to surrounding surface anatomy. The second video demonstrates special anatomic considerations for excising and preparing samples taken from the eyelids, lips, and nails. After viewing the 2 modules, residents reanswered the same survey questions (Fig 1). The combination of premodule and postmodule answers were presented in a cross-tabulation table for each of the 5 questions. Values above the descending diagonal represented higher responses on the postsurvey, and values below this diagonal indicated higher responses on the presurvey. Owing to non-normal distributions for the survey questions, a nonparametric Wilcoxon signed rank test was used to compare the paired responses. This analysis was performed using SAS 9.4 software (SAS Institute Inc, Cary, NC), and a P value of <.05 was considered statistically significant. Our results demonstrated that the video modules significantly improved residents' self-rated comfort in all survey questions (P < .05) (Fig 2). After viewing the video modules, residents assessed themselves as more comfortable with how the layer is taken by the surgeon, how the layer is inked by the surgeon, how the tissue is positioned on the slide, how 100% of the margin is cleared by the surgeon, and unique issues for specific anatomic locations. With wide variation in Mohs micrographic surgery experience among dermatology residents, an approachable medium for resident exposure to Mohs micrographic surgery is needed, and a module conveying 3-dimensional content may fill that need. Our Mohs micrographic surgery video modules improved residents' self-rated confidence with the basics of Mohs micrographic surgery.

A self-assessment study of procedural skills of doctors in peri-urban district hospitals of Gauteng, South Africa.

BackgroundSeveral studies have been carried out on procedural skills of doctors in district hospitals in rural South Africa. However, there is insufficient information about skills of doctors in peri-urban district hospitals. This paper attempts to supplement this vital information.AimThe aim of the study was to determine self-reported levels of competence in procedural skills of doctors in peri-urban district hospitals and to assess factors influencing this.SettingThe study was undertaken in three district hospitals in two health districts of Gauteng Province.MethodsA cross-sectional descriptive study using a self-administered questionnaire was undertaken in three district hospitals in two health districts of Gauteng Province. The questionnaire assessed procedural skills based on district health service delivery requirements for doctors in district hospitals using a modified skill set developed for family medicine training in South Africa.ResultsThere was a wide range of self-reported competence and experience among doctors for various skill sets. Doctors were generally more competent for procedures in general surgery, medicine, orthopaedics, obstetrics and gynaecology and paediatrics than anaesthesia, ear, nose and throat and ophthalmology. There were statistically significant associations between age and overall anaesthetic competence (p = 0.03); gender and overall competence in surgery (p = 0.03), orthopaedics (p = 0.02) and urology (p = 0.005); years of experience and overall competence in dermatology skills; current hospital and overall competence in anaesthesia (p = 0.01), obstetrics and gynaecology (p = 0.015) and dermatology skills (p = 0.01).ConclusionThis was one of the first studies to look at self-reported procedural competence of doctors in a peri-urban setting in South Africa. The results highlight the need for regular skills audits, standardised training and updating of skills of doctors in district hospitals.

Long-Range Diagnosis of and Support for Skin Conditions in Field Settings.

Skin diseases are a significant cause of morbidity and mortality worldwide; however, access to dermatology services are critically limited, particularly in low- to middle-income countries (LMIC), where there is an overall shortage of physicians. Implementation of long-range technological support tools has been growing in an effort to provide quality dermatology care to even the most remote settings globally. eHealth strategies can provide realistic healthcare solutions if implemented in a feasible and sensitive way, customizing tools to address the unique needs and resource limitations of the local setting. This article summarizes the various types of telemedicine and mobile health (mHealth) tools and their practical applications and benefits for patient care. The challenges and barriers of teledermatology are discussed, as well as steps to consider when implementing a new teledermatology initiative. eHealth arguably offers one of the most flexible and realistic tools for providing critically needed access to dermatology skills in underserved LMICs.

Infectious Dermatoses are Common in Primary Health Care Setting in Côte d’Ivoire

Background: Infectious dermatoses are common in many countries in Africa. These skin conditions mostly caused by bacterial, fungal, viral, and parasitic agents are frequent in primary health care setting. These are favored by poverty that deprives individual of the freedom to satisfy basic needs and rights: this includes freedom to enjoy clean water or sanitary facilities, and good accommodations or remedies for illnesses. Objective: This study was conducted to show the frequency of infectious dermatoses in a primary health center in Côte d’Ivoire. Methods: It was retrospective and descriptive study conducted in the community health care center in Yopougon Attié from 2006 to 2010. Results: About 3.392 patients out of 22.609 (15% of cases) were admitted for dermatoses during a period of 5 years. Only 203 patients got accurate diagnosis for dermatoses. Sixty three patients were males (32.7%) and 135 were females (67.5%). The sex ratio was 2.08 in favor to females. Patients’ age ranged from 6 months to 59 years with average age of 27 years ±2.2. Patients from age group between 15 and 29 years were the most concerned (46.4%), followed by the age group under 14 years (25.8%). Illiterate or primary and secondary education patients (79.9%) were mostly observed. Adverse socio-cultural practices were performed in 56.7% of cases. We observed infectious dermatoses in 92.12% of cases (194/203) infections due to bacterial agents were most observed in 42.6% of cases, followed by viral agents in 31.95% of cases. We found HIV positive patients in 5.7% of cases. Conclusion: Infectious dermatoses are common in primary health care setting in Côte d-Ivoire and can be treated by any physician. But, a dermatological training is needed to improve primary health care practitioners’ dermatological skills for clear diagnosis and appropriate treatment in order to reduce their incidence and prescription costs.

A needs assessment of dermatology skills in medical students at the University of Toronto

A needs assessment of dermatology skills in medical students at the University of Toronto

Objective Structured Clinical Examination as an Assessment Tool for Clinical Skills in Dermatology

BackgroundObjective Structured Clinical Evaluation (OSCE) is an excellent method to evaluate student's abilities, but there are no previous reports implementing it in dermatology. ObjectivesTo determine the feasibility of implementation of a dermatology OSCE in the medical school. MethodsFive stations with standardized patients and image-based assessment were designed. A specific checklist was elaborated in each station with different items which evaluated one competency and were classified into five groups (medical history, physical examination, technical skills, case management and prevention). ResultsA total of 28 students were tested. Twenty-five of them (83.3%) passed the exam globally. Concerning each group of items tested: medical interrogation had a mean score of 71.0; physical examination had a mean score of 63.0; management had a mean score of 58.0; and prevention had a mean score of 58.0 points. The highest results were obtained in interpersonal skills items with 91.8 points. LimitationsTesting a small sample of voluntary students may hinder generalization of our study. ConclusionsOSCE is an useful tool for assessing clinical skills in dermatology and it is possible to carry it out. Our experience enhances that medical school curriculum needs to establish OSCE as an assessment tool in dermatology.

Assessment of cognitive skills in dermatology during internship

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Skin problems constitute a significant percentage of all medical problems, despite which training in recognition and treatment of dermatological disorders during the MBBS course remains abysmal. The situation is compounded due to non-inclusion of dermatology in the final examinations, which results in students having little motivation to learn about this important subject. This study was designed to test whether the present internship training offered in dermatology succeeds in imparting cognitive skills related to common skin problems.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was done by means of a pre- and post-test administered before and after their posting. A set of 20 questions were administered to all interns on the first day of their postings as a pre-test and the post-test was given on the last day, after completion of their two week posting.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The results of this preliminary study suggest that there is considerable improvement after their training. The paired t test, the t value was found to be -16.13 with a p value of &lt;strong&gt;&amp;lt;&lt;/strong&gt;0.001, which was statistically significant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; It is possible that use of a pre- and post-test focuses their attention on common entities and thus could be used to improve cognitive skills. To the best of our knowledge a similar study has not been reported from the Indian subcontinent. &lt;/p&gt;

Objective Structured Clinical Examination as an Assessment Tool for Clinical Skills in Dermatology

BackgroundObjective Structured Clinical Evaluation (OSCE) is an excellent method to evaluate student's abilities, but there are no previous reports implementing it in dermatology. ObjectivesTo determine the feasibility of implementation of a dermatology OSCE in the medical school. MethodsFive stations with standardized patients and image-based assessment were designed. A specific checklist was elaborated in each station with different items which evaluated one competency and were classified into five groups (medical history, physical examination, technical skills, case management and prevention). ResultsA total of 28 students were tested. Twenty-five of them (83.3%) passed the exam globally. Concerning each group of items tested: medical interrogation had a mean score of 71.0; physical examination had a mean score of 63.0; management had a mean score of 58.0; and prevention had a mean score of 58.0 points. The highest results were obtained in interpersonal skills items with 91.8 points. LimitationsTesting a small sample of voluntary students may hinder generalization of our study. ConclusionsOSCE is an useful tool for assessing clinical skills in dermatology and it is possible to carry it out. Our experience enhances that medical school curriculum needs to establish OSCE as an assessment tool in dermatology.

Infectious dermatoses in a primary health care center in Côte d’Ivoire. Case of community health care center in yopougon Attié

Background: Infectious dermatoses are common in many countries in Africa. These skin conditions mostly caused by bacterial, fungal, viral, and parasitic agents are frequent in primary health care setting. These are favored by poverty that deprives individual of the freedom to satisfy basic needs and rights: this includes freedom to enjoy clean water or sanitary facilities, and good accommodations or remedies for illnesses. Objective: This study was conducted to show the frequency of infectious dermatoses in a primary health center in Cote d'Ivoire. Methods: It was retrospective and descriptive study conducted in the community health care center in Yopougon Attie from 2006 to 2010. Results: About 3.392 patients out of 22.609 (15% of cases) were admitted for dermatoses during a period of 5 years. Only 203 patients got accurate diagnosis for dermatoses. Sixty three patients were males (32.7%) and 135 were females (67.5%). The sex ratio was 2.08 in favor to females. Patients' age ranged from 6 months to 59 years with average age of 27 years ±2.2. Patients from age group between 15 and 29 years were the most concerned (46.4%), followed by the age group under 14 years (25.8%). Illiterate or primary and secondary education patients (79.9%) were mostly observed. Adverse socio-cultural practices were performed in 56.7% of cases. We observed infectious dermatoses in 92.12% of cases (194/203) infections due to bacterial agents were most observed in 42.6% of cases, followed by viral agents in 31.95% of cases. We found HIV positive patients in 5.7% of cases. Conclusion: Infectious dermatoses are common in primary health care setting in Cote d'Ivoire and can be treated by any physician. But, a dermatological training is needed to improve primary health care practitioners' dermatological skills for clear diagnosis and appropriate treatment in order to reduce their incidence and prescription costs.

•Health Seeking Behaviour of Patients with Skin Disorders in Kano, Nigeria

Background: To determine and compare the health seeking behavior for common skin disorders of an urban and rural community of Kano, Nigeria Material and Methods: A multistage random sampling was used to select two Local Government Areas (an urban and a rural), each comprising three wards. Structured interviews were conducted to elicit information on the health-seeking behaviour of household members. Results: Total 164 respondents (82 respondents each from rural and urban areas) were used for the study. The age range was 16 - 82 years, the mean age for both groups was 38.9 years +12.9. There are statistically significant more urban respondents with educational attainment above primary school compared to rural respondents. The predominant job in the rural area is farming. The following diseases are more important to the rural populace: vitiligo, pyoderma and scabies; while tinea capitis, scabies and acne vulgaris are more important to urban dwellers. Conclusion: The bulk of skin cases in both rural and urban settings are seen by traditional healers, medicine vendors or \auxiliary health workers have knowledge gaps in dermatology skills. Most of these skin diseases are preventable, curable and controllable problems. The capacity of nondermatologist workers should be improved to recognize common skin diseases. Furthermore referral system should be established such that difficult cases can be referred to dermatologist.

Implementation of an education and skills programme in a teledermatology project for rural veterans

In July 2009 we implemented a store-and-forward teledermatology project to provide dermatology care to veterans living in underserved rural areas of the Pacific Northwest region of the US. We also developed an educational programme for rural primary care providers and imaging technicians. Participants were tested and their competencies were assessed at baseline and during a two-year project. Participation in a comprehensive education programme improved the knowledge of dermatology diagnosis and treatment care plans. All of the providers were performing dermatology procedures (e.g. biopsies, excisions, cauteries) after two years and more patients were being seen at their rural clinics than when the teledermatology project began (85% vs 39%). After two years, 71% of the providers and 56% of the imaging technicians had completed surgical training sessions and all passed their competency assessments. The educational component of the teledermatology project created teams of primary care health-care providers and imaging technicians with improved dermatology educational levels and new dermatology skills.

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.