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Advancing the Science and Art of Teaching Dermatology
Abstracts Presented at the 11th Winter Meeting of the Dermatology Teachers Exchange Group,March 4, 2001, Washington, DC
Introduction by Ponciano D. Cruz, Jr, MD
Arch Dermatol. 2001;137:1085-1088.
INTRODUCTION
The Dermatology Teachers Exchange Group (DTEG) convenes biannually in late winter (February or March), concurrent with the annual meeting of the American Academy of Dermatology, and in the fall, concurrent with the meeting of the Association of Professors of Dermatology. At the most recent meeting, which was held March 4, 2001, in Washington, DC, 10 abstracts were presented on a wide spectrum of topics. These abstracts are presented herein in alphabetical order based on the surname of the first author.
The DTEG is organized by a steering committee led by Ponciano D. Cruz, Jr. Members for this year include Robert T. Brodell, MD; Antoinette F. Hood, MD; John E. Olerud, MD; and Steven E. Wolverton, MD. The next DTEG meeting on September 7, 2001, in Chicago, Ill, will feature a workshop on teaching ethics in dermatology residency programs.
ABSTRACT 1
DERMATOLOGY JOURNAL CLUB MEETINGS: A REVIEW OF THE PARTICIPANTS, STYLE, AND FUNCTION
Bryan E. Anderson, MD, James G. Marks, Jr, MD, Jeffrey J. Miller, MD, Division of Dermatology, Penn State College of Medicine, Hershey, Pa
We examined how journal club is conducted in dermatology residency programs and what role it plays in resident education. Eighty-nine program directors responded to our questionnaire. The frequency and duration of journal club meetings is diversified. Faculty participation at journal club varies from no faculty present to all faculty present. Most programs (47%) conduct journal club weekly for 1 hour. The Archives of Dermatology and the Journal of the American Academy of Dermatology are reviewed by every program. The next 3 most common journals reviewed in journal club are the New England Journal of Medicine, Journal of the American Medical Association, and Pediatric Dermatology. Journal club plays and will continue to play a significant role in dermatology residency education.
ABSTRACT 2
METHODS OF INTERACTIVE TEACHING OF DERMATOLOGIC SURGICAL FLAPS AND ANATOMY
Daniel Berg, MD, Division of Dermatology, University of Washington Medical Center, Seattle
Traditional teaching of human anatomy and flap design relies primarily on bedside interaction and preceptorship. To supplement this approach, we have added interactive tools that allow training in an environment where questions and wrong answers are more easily acceptable than they are within earshot of the patient about to have surgery done with the assistance of a trainee. We have initiated an annual cadaver dissection course for our residents in conjunction with our otolaryngology colleagues. Out of 7 respondents, the overall course evaluation score was 5.8/6.0. In addition, the bedside teaching and our didactic program are supplemented by use of digital images and readily available software that allows the resident to design flaps (by drawing on the images) for a specific patient's defect either just before the surgery or in a teaching session. Details of the course and our digital image interactive sessions will be provided. The audience will learn a simple method to incorporate interactive teaching of anatomy and flap design using digital images.
ABSTRACT 3
AN UPDATE ON TECHNOLOGY USED IN DERMATOLOGY RESIDENCY TRAINING PROGRAMS
Ashish Bhatia, MD, Paul Kostuchenko, MD, Robert Brodell, MD, Bryan Davis, MD, Julia Nunley, MD, Algin Garrett, MD, Paul Mazmanian, MD, Medical College of Virginia, Richmond; Northeastern Ohio Universities College of Medicine, Rootstown; and Case Western Reserve University School of Medicine, Cleveland, Ohio
Every year there are an increasing number of technological innovations designed to enhance the educational experiences of medical students and residents. Some of these technological advances in medical education are also geared toward directly or indirectly improving the quality of patient care. Though the dermatology literature contains very few articles referring to technology in residency training, some dermatology residency training programs are adopting modern technology to improve the educational experience and assist in patient care. Some of the technologies being used across the medical specialties include handheld computers, online and compact disc–based references and tutorials, online resident schedules, digital photography, telemedicine, and various presentation software.
To better understand the technologies being used by residents and program directors in the training of dermatology residents, we have designed a short survey instrument to be sent to the dermatology residency training programs in the United States. The results of this survey will be presented at the 2001 Dermatology Teachers Exchange Group Meeting in Washington, DC, and will also be made available at http://www.derm.md.
In addition, we have reviewed the educational literature and the medical literature to explore the currently reported uses, advantages, and disadvantages of various technological tools used in resident education and patient care. This information will also be presented.
ABSTRACT 4
THE INTEGRATED BASIC AND CLINICAL SCIENCE CONFERENCE SERIES AT SOUTHWESTERN: A 15-YEAR RETROSPECTIVE
Ponciano D. Cruz, Jr, MD, Department of Dermatology, University of Texas Southwestern Medical Center, Dallas
Fifteen years ago, we reported (J Am Acad Dermatol. 1987;16:413) a need for a nationally structured educational curriculum in dermatology residency programs as elicited from a survey of chief residents. We described the establishment of the Integrated Basic and Clinical Science Conference Series that addressed such need. Five years later, having received the American Academy of Dermatology Award for Excellence in Education, we published (J Am Acad Dermatol. 1993;29:761) our progress with the Conference Series and its evolution into a venue that combined critical reviews of textbook chapters and periodicals with feedback assessment of trainees. The conference includes 90-minutes weekly sessions, with each session indexed to clustered topics that cover virtually all of medical dermatology (separate the conference series cover procedural dermatology and dermatopathology). The format fuses self-study (material is expected to have been read prior to the conference) with didactic teaching and visual displays (by resident moderators), and with group discussion. Weekly (6-point) quizzes at the beginning of the conference and biannual assessments (including 100 written items, 50 Kodachrome slides [Eastman Kodak Company, Rochester, NY] and 25 microscopic slides) allow residents to calibrate their cognitive strengths and weaknesses for specific topics and for global dermatology. Content material has been codified electronically and is thereby easy to access and to modify. Weekly assessments with preferred responses are available on the Southwestern Medical Center Web site at http://www.utsouthwestern.edu. Most recently, moderators have been persuaded to include the most important abstracts from relevant publications and to classify them based on type of evidence. Today, the conference series remains the cornerstone medium for Southwestern Medical Center residents to acquire and master cognitive knowledge in dermatology. Based on our experience and those of other programs that have adopted the concept into their curricula, it is an effective and most time-efficient mechanism for achieving this goal.
ABSTRACT 5
IS FORMAL RESEARCH TRAINING PRIOR TO DERMATOLOGY RESIDENCY A PREDICTOR OF AN ACADEMIC CAREER?
Ponciano D. Cruz, Jr, MD, Department of Dermatology, University of Texas Southwestern Medical Center, Dallas
Eventual careers are an important factor considered by (some) training programs in evaluating resident applicants, yet a systematic study in dermatology to identify predictors of such outcomes has not been conducted. To begin to address this issue, we posed the question: Is formal research training prior to residency a predictor of an academic career among our graduates? We conducted a retrospective study of our 80 graduates (through the year 2000) by classifying them into 3 categories at the point of entry into residency, namely, those with a research doctorate degree (PhD); those with formal research training but not a PhD degree; and those without formal research training. We also sorted them into 4 career outcomes, namely, academic with laboratory research; academic clinical; academic initially then community practice eventually; and community practice from the start. Finally, we analyzed our data by crossing the 2 sets of categories. Of our total graduates, 70% chose community practice, whereas 30% selected academic careers (of these, 16% were purely clinical, whereas 6% had a laboratory research component; and 8% of those who initially chose academics later moved toward community practice). Furthermore, only 22% of residents without formal research training chose academic careers, whereas 59% of residents with prior formal research training (64% of those with a PhD and 50% of those without a PhD) did so. Our results (based on the experience of a single training program) suggest that applicants with formal research training prior to residency are more likely (than those without such training) to pursue academic careers. Expansion of this study to include data from other programs may lead to more definitive conclusions.
ABSTRACT 6
MEDICAL STUDENT ATTITUDES TOWARD DIFFERENT PRECEPTING STYLES
Jeffrey J. Miller, MD, Division of Dermatology, Penn State College of Medicine, Hershey, Pa
This study examined medical student attitudes toward 2 different precepting styles: (1) precepting the history and physical examination outside the patient room and (2) precepting the history outside the patient room and then the physical examination inside the room.
Study participants included third- and fourth-year medical students on a 1-month dermatology rotation. Faculty alternated precepting style each month. At rotation end, medical students completed a survey about preference of precepting styles using a 5-point scale (1, dislike; 5 like).
During a 10-month period, 19 medical students completed the study. The average score for precepting outside and inside the patient room was 3.8 and 3.5, respectively. Major advantages for presenting outside the patient room were increased comfort and independent thinking. Major advantages for presenting inside the patient room were "seeing and describing" and immediate feedback. Results of a morphology examination on a limited number of students revealed no difference in student performance with regard to precepting styles.
In conclusion, medical students benefit from precepting inside and outside the patient room. Precepting is an art with multiple teaching and learning opportunities.
ABSTRACT 7
CREATING A NOVEL, SYSTEMATIC WAY TO TEACH DERMATOPATHOLOGY VIA A WEB-BASED COMPUTER PLATFORM
Girish Munavalli, MD, Alvin Solomon, MD, Calvin McCall, MD, Department of Dermatology, Emory University School of Medicine, Atlanta, Ga
Dermatopathology remains one of the most interesting, yet challenging disciplines for dermatology residents to master. Success depends on repetitive evaluation of microscopic specimens. Unfortunately, this requires constant access to a conventional microscope and teaching slides. To facilitate review of microscopic specimens by the residents in our program, we developed a Web-based, interactive method for viewing digitally photographed slides. This interactive process is superior to most digital microscopy image collections because it allows the user to use his or her judgment in selecting and viewing salient histological features at different magnifications, rather than simply viewing images in a serial fashion. In this manner, the user gets the feel of virtually manipulating the microscopic field, as one would when using a conventional microscope.
Slides were selected based on their technical quality and teaching value. Care was taken to include common entities. Each slide was digitally photographed at standard magnifications. The resulting images were digitally enhanced and compressed. Using advanced software scripting techniques, a locally accessible internet "Web page" is generated, which shows a low-power image of the slide. The user can decide which portion of the microscopic field to magnify for further evaluation in an attempt to identify the disease. Additionally, prompts are available to remind the user of key histological features.
In an ongoing process, we have archived 6070 diseases in this manner for review by the residents at Emory University, Atlanta, Ga. We are encouraged by the positive comments concerning their educational value. We believe that this interactive computer-based format will serve as an important adjunct to standard microscopy textbooks and organized conferences in teaching residents dermatopathology.
ABSTRACT 8
TEACHING PHYSICIAN-PATIENT COMMUNICATION: A COURSE FOR RESIDENTS IN DERMATOLOGY
Neil S. Prose, MD, Department of Medicine (Dermatology), Duke University Medical Center, Durham, NC
Effective techniques for physician-patient communication are the subject of numerous articles and textbooks, and the primary focus of a number of national organizations (Bayer Institute for Health Care Communication Inc, West Haven, Conn, and American Academy on Physician and Patient, McLean, Va). These specific interviewing skills allow the patient to express his or her major health concerns, and enable the physician to convey empathy. Dermatologists are often called on to deal with difficult interpersonal situations, but have no formal training in communication skills.
In response to this need, we developed a series of communications workshops for our 9 dermatology residents. These 3-hour workshops each focused on a specific topic (eg, how to deliver bad news, how to work with angry patients, how to give feedback to learners). At the beginning of each workshop, the participants were asked to write a brief narrative about a relevant personal experience. These narratives were read aloud and discussed. After a brief didactic session on communications techniques, the residents participated in role playing related to some of the experiences they had described in their narrative. Each role playing session was followed by discussion and feedback.
The success of the workshops was evaluated through written feedback from each of the participants. Overall, residents felt that they had learned new communication skills and that the sessions were helpful. This experience may provide a model for other dermatology programs to teach physician-patient communication.
ABSTRACT 9
FOUR-YEAR DERMATOLOGY SCHOLARS PROGRAM AT THE UNIVERSITY OF WISCONSIN
George Reizner, MD, Gary S. Wood, MD, Division of Dermatology, University of Wisconsin, Madison
Alteration of the rules governing payment of resident salaries by the federal government has resulted in a marked decline in the number of dermatology residents with postgraduate training in other areas. This has resulted in the certification of dermatology trainees with a less diversified base of knowledge. We are concerned that it also may promote the expectation that the path between internship and clinical practice should be as short as possible, and it may reduce preparation for academic medicine and public service. In an attempt to address these concerns, we have instituted a 4-year dermatology residency program. In addition to the clinical training required in the typical 3-year program, the University of Wisconsin program will include the opportunity for in-depth study in a field chosen by the resident under the guidance of a faculty mentor. The nature of this supplemental experience will be tailored to each trainee. It might include laboratory, clinical, epidemiological, or outcomes research; pursuit of an advanced degree; completion of a fellowship in health care policy; or other options. Throughout the 4-year period, trainees will have writing requirements ranging from case reports to larger manuscripts related to their in-depth study. They will also be encouraged to network with established experts in their field of concentration. The overall goals are to produce dermatologists who will take a scholarly approach to the practice of medicine in either the academic or private setting, provide our specialty with special expertise and novel perspectives from other fields, and be active leaders and educators.
ABSTRACT 10
PROBLEM-BASED LEARNING AS AN EFFECTIVE TOOL IN DERMATOLOGY RESIDENCY TRAINING
Erik Stratman, MD, Jon Dyer, MD, Divisions of Dermatology, University of Wisconsin, Madison, and University of Missouri, Columbia
Dermatology residency training is an excellent setting for problem-based learning. This type of case-based curriculum encourages critical thinking, problem solving, and self-directed education. It also fosters communication skills important in the practice of medicine. We have created such a curriculum for interactive small groups comprising not only the dermatology residents but also medical students and residents from other specialties. The case is distributed 1 page at a time to the participants, with 1 person selected to read the case aloud. Cases begin with a history followed by the physical examination findings, where Kodachrome slides of pertinent skin findings are shown. The case proceeds until a series of questions is encountered. Questions arising throughout each case are tiered in difficulty level for the various participants and often reflect the practical decision-making processes encountered in dermatology. These questions are discussed among the group, often with the senior residents acting as moderators. Differential diagnoses, procedural techniques, diagnostics, therapeutic options, adverse effects, and expectations are among the topics of these questions. The case does not proceed until all in the group are satisfied with the thoroughness of discussion. The group follows the case to its conclusion, and each case ends with a list of tiered objectives that cover basic science, epidemiology, pathophysiology, clinical features, histopathology, and therapeutic methods. Objectives are divided among the group and discussed after there has been time for evidence-based preparation. With this style of teaming, the pressures of faculty didactics are decreased as residents take an assertive role in their evidence-based education. In addition, basic dermatology knowledge is fostered in nondermatology residents and medical students. Finally, practical dermatological problem-solving skills are cultivated as are communication skills among colleagues, thus leading to better dermatologists. We present this learning style as an easily integrated, effective adjunct to dermatology residency training.
AUTHOR INFORMATION
Accepted for publication on April 11, 2001.
Corresponding author: Ponciano D. Cruz, Jr, MD, Department of Dermatology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 (e-mail: ponciano.cruz{at}utsouthwestern.edu).
From the Department of Dermatology, University of Texas Southwestern Medical Center, Dallas.
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