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Advancing the Science and Art of Teaching Dermatology
Abstracts Presented at the Eighth Winter Meeting of the Dermatology Teachers Exchange Group, March 1, 1998, Orlando, Fla
Introduction by Ponciano D. Cruz, Jr, MD
Arch Dermatol. 1998;134:857-860.
INTRODUCTION
Arising from a need for teachers of dermatology who are dug-in-the-trenches to meet and exchange ideas, the Dermatology Teachers Exchange Group (DTEG) was conceived 8 years ago with the purpose of advancing the science and art of teaching and learning dermatology. Formerly known as the Residency Curriculum Exchange Group, the DTEG has expanded its concerns to include not only resident trainees, but also dermatologic practitioners, medical students, and nondermatologic physicians. Its purview encompasses curriculum development, teaching strategies, faculty development, modes of evaluation, and transmission of information.
The DTEG convenes biannually in late winter (February or March), concurrent with the annual meeting of the American Academy of Dermatology, and in the fall (October), concurrent with the meeting of the Association of Professors of Dermatology. At the most recent meeting, which was held March 1, 1998, in Orlando, Fla, 8 abstracts on a variety of teaching concerns were presented.
The DTEG has also conducted several workshops, particularly during the fall meetings. Previous workshops were led by Kelly Skeff, MD, PhD, on the role of feedback in improving teaching skills; Larry Klein, PhD, on how to write test questions for evaluating trainees; and David Irby, PhD, on time efficient and effective strategies in teaching in the ambulatory setting. The next DTEG meeting on October 2, 1998 (concurrent with the Association of Professors of Dermatology meeting), will feature a workshop on evidence-based medicine and outcomes research.
The DTEG is led by a steering committee including Ponciano D. Cruz, Jr, MD, John E. Olerud, MD, Robert T. Brodell, MD, Steven E. Wolverton, MD, William D. James, MD, Mary C. Spellman, MD, Lynne H. Morrison, MD, Janet A. Fairly, MD, Kathi Madison, MD, Jill S. Crollick, MD, and Sabra Sullivan, MD.
Since its inception, the DTEG has been supported by small annual grants from Pharmacia-UpJohn, Kalamazoo, Mich. Recently, additional monies were given by Glaxo Wellcome, Research Triangle Park, NC; Dermik Laboratories, Fort Washington, Pa; Allergan Skin Care, Irvine, Calif; and Janssen Pharmaceutica, Piscataway, NJ. Finally, funds to defray the cost of the annual workshop have been set aside by the Association of Professors of Dermatology.
ABSTRACT 1
TEACHING OF DERMATOLOGY USING THE PROBLEM-BASED LEARNING METHOD AT INDIANA UNIVERSITY MEDICAL CENTER TO UNDERGRADUATE MEDICAL STUDENTS
Samuel Ayaya, MD, Holly Faust, MD, Department of Dermatology, Indiana University Medical Center, Indianapolis
We developed an introductory course in dermatology for medical students in their fifth year of medical education using the problem-based learning method. Our objective was to have these students understand dermatologic terminology, perform a good physical examination of the skin, arrive at a diagnosis, and manage common skin problems appropriately. To integrate basic sciences into the clinical sciences, the 15-step problem-based learning method process was adopted. A tutorial problem booklet and tutor guide were developed. Other methods of teaching included overview lectures, audiovisual aids, histological slides, microbiologic slides, and laboratory practicals. Faculty included other specialists who are involved in teaching. We assessed the students using viva voce. The results were that the 2 classes achieved the stated objectives. The first group of physicians graduated in 1997 and are practicing. It was concluded that the program was achieving its aim, although it could be better streamlined. Recommendations were to include an oral examination video, increase time spent in the clinic by the students, and increase the number of Kodachrome cases available to the students. The students will be assessed using Kodachrome cases.
ABSTRACT 2
MNEMONICS IN DERMATOLOGY
Robert T. Brodell, MD, Northeastern Ohio Universities, Warren
In an era of exploding amounts of knowledge in medicine, any effort to promote learning and retention is important. A specific technique, grounded in the basic science of learning, involves the use of memory tricks termed mnemonics. This technique is applicable to learning medical information at all levels and provides a framework for teaching medical students and residents.
The successful use of mnemonics by the student requires study. The basic science of learning has demonstrated that educational material must be practiced over and over in the same manner each time so that the information is retained. The teacher is responsible for ensuring that the mnemonic device chosen is factually correct and clinically applicable. Motivation of the student is a key component of learning that is often overlooked. An example below demonstrates the effectiveness of this technique.
The Causes of Erythema Nodosum
NOdosum: no cause is found in 60% of cases
Drugs including iodides, bromides, and sulfonamides
Oral contraceptives
Sarcoidosis
Ulcerative colitis, Crohn disease, and Behcet syndrome
Microbiology (chronic viral, chronic bacterial, and chronic fungal origins)
ABSTRACT 3
ARE WE TEACHING PHOTOTHERAPY? RESULTS OF AN INFORMAL SURVEY OF PHOTOTHERAPY EDUCATION
Lawrence J. Green, MD, Department of Dermatology, George Washington University School of Medicine, Washington
An informal survey was undertaken to evaluate if phototherapy education in dermatology teaching programs is standardized and preparatory for private practice. In early 1994, the American Academy of Dermatology office mailed surveys addressed to chief residents and chairs of departments in US teaching programs. A total of 66 residents and 48 chairs responded to this 11-question survey. Chief residents were also asked a 12th question regarding comfort level performing phototherapeutic modalities.
Seventy-seven percent of chief residents and chairssay that they have formal core phototherapy lectures at their institutions. Most respondents indicate that these lectures last less than 3 hours. Seventy-seven percent of chairs and 55% of chief residents indicate that they have a hands-on tutorial by faculty on the use of phototherapy equipment. Thirty-four percent of chairs and 48% of chief residents state that they have no phototherapy units on inpatient hospital wards. Five percent of chief residents do not feel comfortable using any phototherapeutic modalities after residency, while 10% and 28% do not feel comfortable using psoralen–UV-A (PUVA) and hand/foot PUVA, respectively.
Some questions engendered from this survey include the following: (1) Should recommendations be made for a more defined, structured core curriculum devoted to the principles and practice of phototherapy? (2) Should such a curriculum mandate a faculty-taught hands-on tutorial? (3) Should training programs be expected to have all graduating residents feel comfortable performing UV-B, PUVA, and hand/foot PUVA?
ABSTRACT 4
DEVELOPING A COMPUTER-BASED DECISION-SUPPORT TOOL TO TRIAGE SKIN CANCER
Toby Maurer, MD, Karen Maffei, MD, Amy Bronstone, MD, Barbara Gerbert, MD, Tim Berger, MD, University of California, San Francisco, and West Portal Software, San Francisco
Managed care organizations require primary care physicians to triage patients for skin cancer, yet many primary care physicians are unable to perform this function proficiently. In a study in which primary care residents were asked to identify cancerous lesions on patients, they successfully did so less than 50% of the time. (B. Gerbert, T. Maurer, T. Berger, et al. Primary care physicians as gatekeepers in managed care: primary care physicians' and dermatologists' skills at secondary prevention of skin cancer. Arch Dermatol. 1996;132:1030-1038). Triaging for skin cancer is a complex and difficult task, requiring primary care physicians to attend to important features of patients' skin lesions and medical history, sort these data, perform probability calculations, and follow complex lines of reasoning. Because computer programs can perform most of these functions faster and more reliably than physicians, such programs may help physicians triage for skin cancer and in turn teach them how to identify cutaneous cancers. The goal of this project is to develop a prototype of a computer-based decision-support tool to improve the accuracy of primary care residents and physicians in triaging lesions suggestive of nonmelanoma skin cancer. During phase 1, we developed a set of algorithms for triaging lesions suggestive of nonmelanoma skin cancer and developed a prototype of a computer-based decision-support tool based on these algorithms. We are now conducting a pilot test of the prototype with a sample of primary care residents and physicians.
ABSTRACT 5
USING VIDEOS IN DERMATOLOGIC EDUCATION
Ginat W. Mirowski, MD, Antoinette F. Hood, MD, Holly B. Faust, MD, Diane Hook, MD, Paul Hagan, MD, Departments of Dermatology, Pathology, and Medical Educational Resources Program, Indiana University School of Medicine, and Department of Oral Surgery Medicine Pathology, Indiana University Dental School, Indianapolis
At our institution we are faced with the unique challenge of teaching introductory dermatology to 280 second-year medical students in 9 geographically dispersed sites and to 100 second-year dental students. Availability of faculty is limited, and time allotted for teaching varies at the different locations. To address these challenges, we developed 4 short videos (time in minutes and seconds in parentheses): I, The Dermatologic Examination (9:16); II, The Oral Examination (7:55); III, Diagnostic Tools and Procedures (11:00); and IV, Dermatologic Terms (11:00). Copies of the videos are made available to each instructor teaching the dermatology section in Introduction to Clinical Medicine. To increase student access, copies are also placed in the various medical and dental libraries and learning centers throughout the state. In the future, the videos also will be placed on our Web site.
We believe that these videos will provide a degree of equivalency of educational information available to the preclinical students and will permit faculty to concentrate both time and resources on other learning issues in dermatology. These videos also will be used as a refresher tool in the senior electives in dermatology, oral medicine, and in teaching primary care physicians who are doing a rotation in dermatology.
ABSTRACT 6
INDIANA UNIVERSITY VIRTUAL DERMATOLOGY: MEDICAL STUDENT EDUCATION AND CONTINUING MEDICAL EDUCATION ON THE WORLD WIDE WEB
Edward C. Nemergut, MD, Antoinette F. Hood, MD, Departments of Dermatology and Pathology, Indiana University School of Medicine, Indianapolis
Since its inception, the World Wide Web (WWW) has provided an excellent method for the electronic exchange of multimedia information. We describe the conception of WWW-based dermatology case studies at the Indiana University (IU) School of Medicine. Each case was constructed using a CGI utility program, Coldfusion, that permits all case information to be stored in a common database. When the user begins to work a specific case on the WWW, the data are then filled into a preprogrammed case-template. This format allows cases to be presented in somewhat greater detail than is currently available on the WWW for dermatology and allows changes in each case to be made more easily. Cases are thus intended to move beyond simply an electronic "What's Your Diagnosis" and more accurately simulate the clinical encounter. Each case works off of a growing database complete with history, physical examination, laboratory tests and costs, cutaneous and histopathologic images, diagnosis, and discussion. The difficulty for cases range from those appropriate for medical students to unusual cases that are appropriate for practicing physicians. Case information and images are constructed from the Department of Dermatology files.
After working through each case and arriving at the correct diagnosis, the user has the opportunity to take an examination reviewing the important aspects of that particular disease or disorder. The user's answers to examination questions are evaluated online and, if performance is satisfactory, the program will generate a form that the user may then fill out and submit to the IU Office of Continuing Medical Education for category 1 credit. The cases are available to anyone with WWW access through the IU Department of Pathology Web server. This program is an interactive teaching experience that provides self-assessment and continuing medical education accreditation if desired. Most importantly, IU Virtual Dermatology provides the opportunity for physicians to learn at their own convenience.
ABSTRACT 7
THE EDUCATOR'S PORTFOLIO: AN ESSENTIAL MEANS FOR DOCUMENTING SCHOLARSHIP
Gregory J. Raugi, MD, University of Washington, Seattle, Veterans Affairs Medical Center, Seattle
Education is a form of scholarship in that it transforms and extends knowledge. The standards applied to other forms of scholarship, namely excellence, peer review, and dissemination, apply equally to education. The problems faced by clinician-teachers center on documentation and validation of that scholarship. The educator's portfolio is a useful tool that can significantly aid clinician-teachers in achieving these objectives. A portfolio is a systematic collection of information over time that gives examples of the person's creative effort, showing growth, change, and adaptation; it shows evidence of self-analysis and reflection and, most importantly, it documents scholarship. The content of an educator's portfolio should document the broad spectrum of the scholarly activities of clinician-teachers. Many schools now use a modified portfolio system in promotion review. However, few institutions encourage portfolio use as a means of faculty development. The model portfolio developed at the Medical College of Wisconsin (D. Simpson, J. Morzinski, A. Beecher, J. Lindemann. Teaching and Learning in Medicine. 1994:203-206.) will be examined with reference to how it is useful for dermatology clinical educators. Some of the problems encountered while building a portfolio will be discussed.
ABSTRACT 8
OVERVIEW OF OUR REVISED CLINICAL ELECTIVE FOR MEDICAL STUDENTS
Mary L. Williams, MD, Toby Maurer, MD, University of California, San Francisco
Dermatology is a popular elective among our third- and fourth-year medical students. Previously we offered a 1-month elective, but because our clinics could not accommodate more than 6 students per group, many were unable to obtain clinical experience in dermatology. To compensate, we had given all students a series (8-12 hours) of clinical lectures during their fourth year, which students and faculty uniformly disliked. Our solution was to offer an intense 2-week clinical elective. Students rotate through the clinics at all 3 of our teaching hospitals and see dermatology patients each morning and afternoon. Their primary teachers in the clinics are the residents (residents evaluate students' performance and students evaluate residents' teaching skills). Wednesday mornings are set aside for the departmental weekly conference and for a teaching conference with the chief resident (slide shows of morphology/terminology and common dermatoses). A faculty member is assigned to instruct each group of students. He or she meets with the students for 4 one-hour sessions. The first session provides an orientation for the students, while the last 3 are devoted to student presentations. Each student gives two 10- to 15-minute presentations of cases they have seen with common disorders, focusing on diagnosis and management. Students are also loaned copies of a dematology book (Lookingbill, Donald.Principles of Dermatology. 2nd ed. Philadelphia, Pa: WB Saunders Co; 1993), which they are required to read and complete an open book multiple-choice test. Faculty preceptors are responsible for providing the final student evaluations. The elective seems to be a success based on nearly full subscription by University of California, San Francisco, students and uniformly positive to enthusiastic comments on student evaluations. Faculty are also pleased with the course because they are not required to prepare lectures and teaching sessions can be scheduled at their convenience. As structured, the course offers all our students the opportunity for hands-on dermatology training, emphasizes active rather than passive learning, and places a minimal burden on our faculty.
AUTHOR INFORMATION
Accepted for publication March 24, 1998.
Reprints: Ponciano D. Cruz, Jr, MD, Department of Dermatology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75235-9069.
From the Department of Dermatology, University of Texas Southwestern Medical Center, Dallas. (Introduction by Dr Cruz.)
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