Dermatology Residency Training Research Articles

Top DEI Topics to Incorporate Into Dermatology Residency Training: An Electronic Delphi Consensus Study.

Current dermatology residency education may be deficient in curricular topics and training related to diversity, equity, and inclusion (DEI). Integrating more DEI topics within residency curricula may improve clinical care delivered to diverse populations and improve cultural humility among trainees. The objective of this electronic Delphi (e-Delphi) study was to reach a consensus on the most important DEI topics for inclusion in dermatology residency program curricula nationwide. Sixty-one DEI-related topics were proposed by an expert panel consisting of dermatologists from the Association of Professors of Dermatology DEI subcommittee and the American Academy of Dermatology Diversity Task Force. Two rounds of anonymous electronic surveys based on a 5-point Likert scale were administered using a modified e-Delphi design. Voluntary participants including residents and academic dermatologists were self-selected after an email was sent to the Association of Professors of Dermatology listserve.

Family planning influences and perceptions among dermatology residents from ACGME-accredited training programs: a survey-based study.

As an increasing number of women pursue careers in dermatology, the structure and culture of training must reflect the evolving needs of dermatology residents. To examine perceived barriers to and perceptions of family planning amongst dermatology residents capable of becoming pregnant, evidence-based principles were employed to develop a 40-question survey for dermatology residents in ACGME-accredited training programs. A pilot study was conducted with the Harvard Combined Dermatology Residency Training Program residents before full-scale national electronic survey distribution from April to June 2023. Information was collected regarding factors influencing attitudes towards becoming pregnant during residency, as well as information regarding residency program family leave, fertility preservation, and lactation policies. Ultimately, 95 dermatology residents capable of becoming pregnant completed the survey. The majority (77.9%) of respondents reported intentionally delaying having children because of their careers, and 73.7% believed there is a negative stigma attached to being pregnant or having children during dermatology residency. Of respondents who had not yet attempted to become pregnant, 75.3% were concerned about the possibility of future infertility. Of the 60% of respondents considering fertility preservation options, 84.6% noted concerns about these procedures being cost-prohibitive on a resident salary. Only 2% of respondents reported that cryopreservation was fully covered through their residency benefits, while 20% reported partial coverage. Reported program parental leave policies varied considerably with 54.9%, 25.4%, 1.4%, and 18.3% of residents reporting 4-6 weeks, 7-8 weeks, 9-10 weeks, and 11 + weeks of available leave, respectively. Notably, 53.5% of respondents reported that vacation or sick days must be used for parental leave. Respondents reported lactation policies and on-site childcare at 49.5% and 8.4% of residency programs, respectively. The trends noted in the survey responses signal concerning aspects of family planning and fertility for dermatology residents capable of becoming pregnant. Residency family planning policies, benefits, and resources should evolve and homogenize across programs to fully support trainees.

Dermatology residents' perspectives on virtual dermatopathology education.

Dermatopathology education accounts for 30% of U.S. dermatology residency training. The COVID-19 pandemic expedited the implementation of virtual dermatopathology in place of traditional microscopy for resident education. This study examined U.S. dermatology residents' perceptions of virtual dermatopathology, as research in this area is lacking. An anonymous, confidential, institutional review board-approved survey was electronically distributed to U.S. dermatology residents consisting of 16 questions comparing attitudes towards virtual and traditional dermatopathology education. Responses were n = 59. Statistical analysis was performed using SAS software. Participants believe virtual imaging is superior to conventional microscopy in schedule flexibility (96.6% vs. 1.7%, p < 0.0001), lecture convenience (94.8% vs. 0.0%, p < 0.0001), personal review (96.6% vs. 0.0%, p < 0.0001), cost-effectiveness (64.4% vs. 6.8%, p < 0.0001), and board exam preparation (52.5% vs. 16.9%, p = 0.0005). Conventional microscopy was favored for image quality (50.8% vs. 25.4%, p = 0.0127) and overall utility (50.8% vs. 27.1%, p = 0.0195). Our study supports virtual dermatopathology utilization as a valuable tool in dermatology residency training. Also it is shown that conventional microscopy training continues to play a key role. Further studies should examine whether, if ever, virtual dermatopathology could gradually replace conventional microscopy with the advent of newer and more powerful digital and scanning technology.

Sensitive Skin: A Survey of Dermatology Resident Physicians' Perspectives and Educational Exposures.

Sensitive skin (SS) is a common patient complaint presenting to the dermatology office, but there exists a lack of consensus on defining criteria and evidence-based management approaches. Furthermore, incorporation of SS training into the dermatology residency curriculum is unknown, and therefore the authors herein sought to determine dermatology resident physicians' exposure to education about SS, perspectives on SS, and management approaches.&nbsp;Ninety-nine percent of residents believe that SS should be included in some capacity in their dermatology residency training. However, less than half of responding residents received education specifically about SS during their training and less than one-fourth of residents reported feeling very knowledgeable about SS diagnosis, clinical evaluation, or management. Residents who had received specific education about SS were significantly more likely to self-describe as "very knowledgeable" about all queried topics. Residents reported challenges with all aspects of SS patient care, and cited heterogenous approaches to SS patients. These data highlight a gap in residency education, as indicated by limited consensus over diagnostic and management approaches to SS.J Drugs Dermatol. 2024;23(2):85-89. &nbsp; doi:10.36849/JDD.7830.

Pediatric Dermatology in Canada: A Broad Review of Population Needs, Workforce and Training With Proposed Solutions.

The need for pediatric dermatology services is increasing across Canada. In parallel, the complexity of treatment with novel targeted therapeutics has increased. Currently, there is no accredited and limited non-accredited fellowship training access to pediatric dermatology in Canada. Understanding the current state of pediatric dermatology training in Canada will provide insight into opportunities for strategic improvement. A survey was distributed to 44 pediatric dermatology providers. In addition, a review of the burden of pediatric skin disease and education/training in Canada was performed. Thirty-four specialists responded to the survey (77% response rate). One third of current pediatric dermatology providers are over 50 years old and half of these (15%) plan to retire within the next 5 years. Half of respondents were dermatologists, 35% were pediatricians, and 11% were double boarded. Almost all respondents practiced in an academic setting (94%). Most had further fellowship training in pediatric dermatology (82.4%) but only 57% achieved this training in Canada, due to lack of accredited or non-accredited funded fellowship positions. There is a high and growing need for pediatric dermatology specialty care in a diverse range of settings. The current provider population and training programs are insufficient to meet current and future demands. We highlighted solutions to close this gap between supply and demand including increased double board certification in Pediatrics and Dermatology, a protected pediatric stream within existing Dermatology residency training programs and accredited fellowships in Pediatric Dermatology for both dermatologists and pediatricians.

Dermatologic care of the lesbian, gay, bisexual and transgender community of India.

Background In the Indian subcontinent, the lesbian, gay, bisexual, transgender, and queer community, commonly referred to as the third gender or transgender, is expected to exceed one million by 2030. Data on dermatologic conditions of the transgender population is deficient. Aims This study aimed to identify the common dermatological concerns and dermatologic procedures of the lesbian, gay, bisexual, transgender, and queer community of India. Methods This cross-sectional survey analysed the transgender participants of a non-institutionalised population in India via health camps that included 51 adult participants who self-identified as trans men and trans women. Results This study included 51 participants aged 20-49 years, of which the majority (94%) were trans women. The common dermatological problems were terminal hairs over the face, beard distribution, androgenetic alopecia, scars of gender-affirming surgeries, facial melanosis with topical steroid damaged skin and the need for facial feminisation procedures among trans women, while trans men had testosterone-related acne, androgenetic alopecia. Overall, 40.6% of participants reported dissatisfaction with one or more of their body parts. Laser hair removal was the most common gender-affirming dermatologic procedure. Conclusion This study provides an essential overview of the common dermatological conditions and procedures in the Indian lesbian, gay, bisexual, transgender, and queer community. Lesbian, gay, bisexual, transgender, and queer persons have insufficient access to dermatological services due to inadequate exposure and fear of discrimination. Even though transgender patients also present with similar dermatologic conditions as the general population, they have distinct cosmetic and treatment concerns during the period of transition owing to hormone-related or surgery-related changes. Addressing these challenges through enhancing dermatology residency training programs should be the focus of tomorrow. Limitations Considering convenience sampling and representative bias, further studies need to be conducted involving multiple study locations and larger sample sizes.

Interviewing Dermatology Applicants in a Virtual Setting: A Perspective after 2020-2021 Match

Abstract&#x0D; Introduction &#x0D; The COVID-19 pandemic greatly affected the 2020-2021 residency application cycle. In 2020, residency programs across the country, including dermatology residency training programs, created social media accounts and implemented virtual open houses. It is unclear whether these methods effectively evaluated and recruited applicants. We aimed to assess the impact of visiting rotations, pre-interview events, and virtual interviews through the lens of dermatology program directors and medical students who matched into dermatology in 2021. &#x0D; Methods&#x0D; A survey consisting of multiple-choice and open-ended questions was distributed to all 138 dermatology residency program directors in the United States on May 4, 2021, by email.&#x0D; Results &#x0D; With a program director (PD) response rate of approximately 13%, the data obtained from the survey is limited. However, 68% of PDs were in agreeance that the absence of a student’s away rotation would limit their ability to gauge an applicant. Further, the most offered virtual pre-interview event was a Q&amp;A session with residents. However, virtual open houses were the most highly rated virtual pre-interview event (average effectiveness score 6.8 out of 10).&#x0D; Conclusion&#x0D; Residency programs and applicants adapted to the virtual application cycle through enhanced virtual interaction, and these opportunities appeared to impact the application cycle in nuanced ways. While this study was limited by a low response rate, it may provide a framework for the continued use of virtual opportunities in the wake of a global pandemic.

Perceptions of Community Service in Dermatology Residency Training Programs: A Survey-Based Study of Program Directors, Residents, and Recent Dermatology Residency Graduates.

Integrating community service (CS) into the dermatology residency program curriculum creates a rewarding training environment that promotes an interest in health disparities, increases skin health equity, and augments the cultural sensitivity of its trainees. To better understand the importance of CS activities in dermatology residency programs, program directors, residents, and recent dermatology residency graduates were surveyed about their perceptions and participation in CS-defined as participation in activities to increase dermatologic access, education, and resources in under-served communities.

The Resident Physician Shortage Reduction Act: An opportunity to address the rural dermatology workforce deficit

Access to dermatological care is especially challenging in rural America, with a greater density of dermatologists concentrated in urban areas.1 One strategy for expanding the dermatology workforce is increasing the number of dermatology residency training positions, including in rural settings.2 In the Consolidated Appropriations Act (CAA) of 2021, the Congress allocated Medicare funding for 1000 residency positions over 5 years, effectively ending the 25-year federal funding drought for graduate medical education.

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.

The Student Dermatology Clinic for the Underserved: A Service-Learning Model to Promote Skin Health Equity

People who are uninsured and live in underserved communities face several barriers to accessing dermatologic care, including financial, geographic, and racial barriers, resulting in detrimental effects on health outcomes and quality of life. We (1) describe and evaluate an innovative, student-faculty run dermatology free clinic that serves people in marginalized populations and (2) present action steps to strategically develop community partnerships and integrate a service-learning program into a dermatology residency training program for medical students and residents. The Student Dermatology Clinic for the Underserved (SDU) is a quarterly, student-faculty run free clinic at a community health center in Pittsburgh that serves the marginalized populations within our community. Interprofessional teams of medical students and dermatology residents evaluate patients, devise patient care plans with the dermatology attending physician, and coordinate follow-up care. In a survey of residents who voluntarily participated in SDU, 88% (n=8) report that their involvement increased their awareness of health disparities and social factors impacting dermatologic care and encouraged them to be more involved in community service throughout their career. The SDU clinic is an instrumental resource in our community that allows for patient-centered, longitudinal care, while reducing barriers to access for patients in underserved communities. In this service-learning model for dermatology residency training programs, we not only address the dermatologic needs of marginalized populations, but we also create a rewarding training environment for medical students and residents that facilitates vertical learning and interprofessional collaboration, fosters an interest in health disparities, increases skin health equity, and cultivates cultural sensitivity.

Publication Trends and Their Relationship With Academic Success Among Dermatology Residents: Cross-sectional Analysis.

Involvement in scholarly activities is considered to be one of the foundational pillars of medical education. This study aims to investigate publication rates before, during, and after residency to determine whether research productivity throughout medical training correlates with future academic success and research involvement. We successfully identified a list of 296 graduates from 25 US dermatology residency programs from the years 2013-2015. The publication history for each graduate was compiled using Scopus, PubMed, and Google Scholar. The Pearson correlation test and linear regression were used to assess the relationship between research productivity and continued academic success after residency graduation. Before residency, graduates published a mean of 1.9 (SD 3.5) total publications and a mean of 0.88 (SD 1.5) first-author publications. During residency, graduates published a mean of 2.7 (SD 3.6) total publications and a mean of 1.39 (SD 2.0) first-author publications. Graduates who pursued a fellowship had more total publications (t294=-4.0; P<.001), more first-author publications (t294=-3.9; P<.001), and a higher h-index (t294=-3.8; P=.002). Graduates who chose to pursue careers in academic medicine had more mean total publications (t294=-7.5; P<.001), more first-author publications (t294=-5.9; P<.001), and a higher mean h-index (t294=-6.9; P<.001). Graduates with one or more first-author publications before residency were 1.3 times more likely to pursue a career in academic medicine (adjusted odds ratio 1.3, 95% CI 1.1-1.5). Graduates who pursued a fellowship were also 1.9 times more likely to pursue a career in academic medicine (adjusted odds ratio 1.9, 95% CI 1.2-3.2). Our results suggest that research productivity before and during residency training are potential markers for continued academic success and research involvement after completing dermatology residency training.

A cross-sectional analysis of Medicaid acceptance among US dermatology residency training programs

To the Editor: As few as 15.5% of nonacademic adult medical dermatology practices accept patients covered by Medicaid, the primary insurer for low-income and disabled Americans.1 However, Medicaid acceptance among academic dermatology training sites is unknown. To assess trainee exposure to this patient population, we cross-sectionally investigated Medicaid acceptance rates across dermatology training sites.

Teledermatology Utilization and Integration in Residency Training Over the COVID-19 Pandemic.

BackgroundDuring the 2019 Coronavirus (COVID-19) pandemic, the Division of Dermatology, University of Ottawa, adapted pre-existing local healthcare infrastructures to provide increased provider-to-provider teledermatology services as well as integrated teledermatology into the dermatology residency training program.Objectives(1) To assess the differences in utilization of provider-to-provider teledermatology services before and during the COVID-19 pandemic; and (2) to assess dermatology resident and faculty experiences with the integration of teledermatology into dermatology residency training at the University of Ottawa.MethodsWe conducted a cross-sectional analysis comparing provider-to-provider teledermatology consults submitted to dermatologists from April 2019 to October 2019 pre-pandemic with the same period during the pandemic in 2020. Two different questionnaires were also disseminated to the dermatology residents and faculty at our institution inquiring about their perspectives on teledermatology, education, and practice.ResultsThe number of dermatologists completing consults, the number of providers submitting a case to Dermatology, and the number of consults initiated all increased during the pandemic period. Ninety-one percent of residents agreed that eConsults and teledermatology enhanced their residency education, enabled continuation of training during the pandemic, and that eConsult-based training should be incorporated into the curriculum. Ninety-six percent of staff incorporated a virtual dermatology practice model, and one-third used teledermatology with residents during the pandemic. Most staff felt there was value in providing virtual visits in some capacity during the pandemic.ConclusionsOur study confirms that the use of teledermatology services continues to increase accessibility during the pandemic. Teledermatology enhances the education and training of residents and will be incorporated into dermatology residency programs.

27675 Acceptance of patients insured by Medicaid at American dermatology residency training sites

Background: Medicaid is the second-largest funder of American graduate medical education (GME). Federal guidelines do not require Medicaid-recipient GME programs to accept Medicaid-insured patients at all training sites, and rates of Medicaid acceptance among dermatology residency programs are unknown. To determine whether Medicaid acceptance by dermatologists is influenced by limited exposure to Medicaid-insured patients during training, we investigated Medicaid acceptance across American dermatology residency outpatient training sites.

28470 Dermatology residents’ perspectives on the role of community service and service-learning in dermatology residency training programs: A nationwide survey

Introduction: Marginalized populations face several barriers to accessing equitable dermatologic care. Dermatology residency programs that integrate service for the underserved into their program goals are three times more successful in graduating residents who practice in underserved communities.

28644 Inpatient training modules increase dermatology resident confidence for hospital consults

Inpatient dermatology consults are an integral aspect of dermatology resident training. These cases allow for managing acute and life-threatening dermatologic disorders, exploring complex medical dermatology in an acute care setting, and working in interdisciplinary teams to promote patient care. Residents often feel unprepared to care for such complicated patients due to lack of specific training for the inpatient setting. We outline one program’s approach to logging inpatient cases and the creation of training modules given to PGY-2 residents prior to seeing inpatient dermatology consults.

25461 The Student Dermatology Clinic for the Underserved: A service-learning model for dermatology residency training programs

Introduction: Patients who are uninsured and underserved face barriers to accessing dermatologic care, including longer wait times and higher rejection rates. The Student Dermatology Clinic for the Underserved (SDU) is a quarterly, student-faculty run free clinic at a community health center in Pittsburgh that serves the marginalized populations within our community. Interprofessional teams of medical students and dermatology residents evaluate patients, devise patient care plans with the dermatology attending physician, and coordinate follow-up care.

Mobile App Usage Among Dermatology Residents in America.

Mobile applications (apps) have been a growing part of medicine for the last decade. Our cross-sectional online survey studied the role of apps in dermatology resident training. The demographic results and response rate suggest that our study sample is representative of the target population of dermatology residents in America. Our survey highlights the increasing role of apps in dermatology resident training, differences in priorities among different years of residency, and differences in information utilization between sexes. This knowledge should help guide standardization, quality assurance, and formal integration of medical mobile apps into traditional dermatology teaching.

Business Education in Dermatology Residency: A Survey of Program Directors.

With the rising cost of health care in the United States and an increasingly competitive market, dermatology residents would benefit from business training. We constructed an 8-part questionnaire for dermatology program directors (PDs) to determine the current perceptions of and resources available for business education. Of the 139 surveys distributed, 35 were completed (25.2%). Approximately one half of the respondents said their programs offered business training, primarily through seminars or lectures. Most PDs felt business education during residency was important and that programs should implement more training. The most important topics identified for inclusion in a business curriculum were economics or finance, management, and health care policy or government. Our survey identified a gap between the perceived importance and current supply of business education during dermatology residency training. Future efforts should aim to develop a standardized, dermatology-specific curriculum that is readily available to all programs and residents.