Fast‐tracking teledermatology into dermatology trainee timetables, an overdue necessity in the COVID era and beyond

Abstract

Teledermatology has been defined as using technology‐enabled healthcare delivery models to provide dermatology patient care, from a distance 1,2 . The increasing use of teledermatology has primarily been driven by a significant rise in demand on dermatology departments and a shortage of consultant dermatologists in the United Kingdom 3 . The British Association of Dermatologists supports the use of teledermatology as a means of improving access to dermatology professionals 4 . Currently, teledermatology in the NHS plays a particularly important role in triaging referrals on the skin cancer 2‐week‐wait (2ww) pathway, given the necessity for rapid lesion assessment, the ever‐increasing volume of 2ww referrals received by dermatology departments, and the significant proportion of benign lesions referred that do not require a face‐to‐face consultation. Skin cancer 2ww referrals to our centre have sharply increased by 44.1% over the last two years, and in the 12 months preceding the UK COVID‐19 lockdown (March 2019 to February 2020) represented 41.8% of all referrals to the dermatology department. Teledermatology for 2ww referrals was implemented at our centre in 2019 to manage this demand.

The Use of Teledermatology in Medical Education

“…Teledermatology platforms for trainee education should ideally be built upon or based in a pre-existing teledermatology system, not only to provide trainees a system based around patient care as opposed to a simulation or trainee-based system, but also as the infrastructure and security measures are already in place. Hussain et al proposed a system for Storeand-Forward platforms where trainees would see their own reduced teledermatology list in parallel with the consultant, followed by a review of all trainee cases at the end of each session [15]. This proposal mirrors training techniques used by other highly visual specialties such as radiology and provides an effective opportunity for trainees to apply their knowledge with a high level of independence yet still receive detailed feedback.…”

“…This proposal mirrors training techniques used by other highly visual specialties such as radiology and provides an effective opportunity for trainees to apply their knowledge with a high level of independence yet still receive detailed feedback. For live or real-time consultation models, previously described systems where trainees interview patients in-person, potentially taking photos or videos of the presenting complaint, and communicate to off-site consulting physicians provide trainees the opportunity to refine their presentations and narrow their focus on the most pertinent information [15].…”

A paradigm shift in trainee confidence in teledermatology and virtual working during the COVID‐19 pandemic: results of a follow‐up UK‐wide survey

“…Going forward, as training needs must reflect the reality of everyday clinical practice, we highlight the importance of including formal teledermatology teaching in trainee timetables 3 . This could take the form of consultant‐guided teledermatology triage sessions for primary care referrals, in which trainees are directly supervised to do the reporting.…”

Intradisciplinary team meeting for teledermatology: an aid to improving clinician confidence

“…3 The increasingly important role of teledermatology is reflected by its appearance in the new UK trainee curriculum for the first time from August 2021. 4 As well as trainees, consultants unused to virtual work will also need support in developing teledermatology skills. We describe the implementation of a weekly teledermatology intradisciplinary team (IDT) meeting for skin cancer cases at our centre, and present an evaluation of the meeting's impact both on clinician confidence in teledermatology and on patient outcomes.…”

“…Unsurprisingly, owing to the relative novelty of this technique, low levels of confidence in teledermatology have been identified both among trainees 2 and also consultants 3 . The increasingly important role of teledermatology is reflected by its appearance in the new UK trainee curriculum for the first time from August 2021 4 . As well as trainees, consultants unused to virtual work will also need support in developing teledermatology skills.…”