Diagnosis of Skin Lesions by Trainee Surgeons: Experience Improves Accuracy

Abstract

Ann RC oll Surg Engl 2009; 91:4 94-499 494The UK Government's restructuring of specialist training,outlinedinModernising Medical Careers (MMC), 1 will have asignificanti mpact on surgical training in all surgical specialties including plastic surgery.Frequent evaluationofboth the surgical and diagnostic skills of traineesw ill be needed to determine the impact of shortened specialisttraining.Skin lesions make up alarge part of the plastic surgeon's out-patient workload and one of the effectso ft he Government's'two-week rule' and guidelines for referral of suspected skin cancers has been an increase in total referral ratios from primary to secondary care. 2The rise in the number of suspect lesions being referred represents as ignificant service requirement and one that will result in junior registrars seeing an increasing number of skin lesions. Whilst several studies have compared the clinical accuracy of consultants and specialist registrars, [3][4][5] few have addressed the learning curve of individual trainees with regard to clinical diagnosis.There is little evidence to reflect how quickly (or even if) trainees' clinical diagnostic skills improve with time, given regular exposure to skin pathology.T he clinically obvious melanoma or basal cell carcinoma can be recognised from the textbook; however,an umber of skin lesions (both benign and malignant) do not always fit textbook descriptions. The diagnosis of these lesions and decisions regarding appropriate management can be difficult for the trainee and comes with experience.In this study,weassessed the diagnostic accuracy of junior surgical trainees attending ar apid-access pigmented lesion clinic. Accurate clinical diagnosis depends on the reliable recognition of signs and symptoms. This expertise comes from experience in seeing patients which has been traditionallyg ained over al ong training period. Shortened specialist training (Modernising Medical Careers)h as led to ag reater reliance on structured teaching and skills transfer programmes. The accuracy of clinical diagnosis and the rate at which diagnostic skills improve during training is important for the assessment of trainees, and the delivery of care. PLASTIC SURGERY Ann RC oll Surg Engl

The Reliability of Teledermatology to Triage Inpatient Dermatology Consultations

“…In other areas of dermatology, increased training and experience have been shown to improve diagnostic accuracy. [28][29][30][31] We suspect that with increased familiarity, concordance and reliability will improve similarly when inpatient consultative teledermatology is studied further. It will also be important to examine the impact of increased contact with the primary team, including potential for follow-up.…”

Whatsapp based visual impression versus actual impression in patients of common skin disorders: A cross-sectional comparative study

“…Out of 59 patients of fungal infections, most of them were of Dermatophytoses (51), and few of Onychomycosis (8). Out of 20 patients of bacterial infections, maximum were of folliculitis (13), few of impetigo (4) and carbuncle (3). In viral infections, from 26 patients, most of them were of Herpes zoster (6), Molluscumcontagiosum(6), Viral warts (6), Chicken pox (4) and Herpes labialis (4).…”

“…In other areas of dermatology, increased training and experience have been shown to improve diagnostic accuracy with teledermatology. 1,[10][11][12][13] Thomas J suggested that after initial face-to-face or tele consultation, it becomes very easy for the patient as well as the doctor who can have a followup through tele-consultation, which apart from saving time and travel ensures best outcome of the treatment. 14 Tan E et al also suggested that making diagnoses with images alone is challenging, and additional multimodal communication is likely important.…”

Skin excisions: Not so simple for the regionally based general surgical trainee

“…Registrar inexperience is likely a large component that has attributed to our margin rate. Clinical experience has been shown to be a significant factor influencing diagnostic accuracy for skin lesions in trainee surgeons, 17 and it has been shown that consultants display significantly greater sensitivity and positive predictive value for diagnosing malignant skin lesions 18,19 . A lack of experience can lead to difficulty discerning the border between malignant and normal skin and might also cause concern for poor cosmetic result, difficulty with wound closure or even breaching of the anaesthetic field.…”