Integrating Outpatient Teledermatology Education Into the Dermatology Resident Curriculum

Abstract

T elemedicine has the potential to transform how we deliver tomorrow's health care, and residents must learn how to practice on this platform. There is a shortage of dermatologists in the United States, particularly in rural areas, where 1 in 8 primary care visits is related to skin disease.1 Some of the benefits of teledermatology (TD) are the potential to increase access, reduce wait times, and provide costeffective care. In the outpatient setting, literature has consistently demonstrated a comparable accuracy of TD to in-person visits. Studies also suggest appropriate utilization of TD as an educational tool. 2,3 We affirm this impression and advocate a standardized curriculum to enable dermatology residents to become adept at practicing TD. The TD program at Hampton Veterans Affairs Medical Center (VAMC) was implemented in 2012 using store-and-forward technology. From July 2013 to August 2015, a total of 2106 TD consults were reviewed from 3 rural outposts. In the program, a third-year resident reviews the history/images sent from the primary care physician and develops a diagnosis/ management strategy. The case is then presented to a faculty member who determines the final impression and plan. Using TD technology, our residents have evaluated a range of disorders from benign/malignant neoplasms to inflammatory diseases, such as atopic dermatitis and psoriasis. Prior to reading consults, all third-year residents and supervising attending physicians must undergo the national VAMC TD training modules, including TeleReader and VistA Imaging Display training. Each third-year resident spends 4 months on the TD rotation, averaging about 80 cases per month.Using TD, a recent study found a concordance rate of 53% and 65% for diagnosis and management plans between resident and attending dermatologists, respectively.2 This suggests that there are opportunities for educating residents, both on diagnoses and on treatment. Another TD program at the Denver VAMC evaluated its role in resident and medical student education. Both groups agreed that TD was an important educational tool, particularly in areas of practice-based learning and medical knowledge. 3Teledermatology represents a unique tool to assess resident performance in accordance with the Accreditation Council for Graduate Medical Education competencies outlined in the Dermatology Milestone Project. With limited data as well as a lack of tactile and dermatoscopic examination, residents learn to triage lesions that require reassurance, topical/systemic treatments, or in-person visit for examination or biopsy. With TD, attending physicians can better assess a trainee's knowledge, ability to adapt to various health care delivery systems, communication skills, and care coordination. Residents also learn about resources available at different sites and receive training on working effectively within an interprofessional team, as some cases require follow-up communication with consulting physicians.With telemedicine continuing to play an emerging role, training programs...

Access to Dermatological Care with an Innovative Online Model for Psoriasis Management: Results from a Randomized Controlled Trial

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Impact of COVID-19 pandemic on dermatology practice in India

“…[ 20 21 ] Various centers have already added these modes of learning as residents are evaluated using this tool. [ 22 23 ] It also connects dermatologists from very different ethnicities and cultures to exchange knowledge with each other. [ 24 ] In India, while virtual teaching was not much practiced till now, this pandemic has opened doors to various webinars and virtual rounds.…”

Teledermatology and teledermatopathology as educational tools for international dermatology: a virtual grand rounds pilot curriculum

“…Several dermatology residency curricula have already integrated teledermatology to improve residents' diagnostic acumen of skin diseases through cased‐based practice and supervision from trained dermatologists. Integration of this technology into dermatology resident curricula may also fulfill certain competencies, such as medical knowledge and practice‐based learning, in the Dermatology Milestone Project by the Accreditation Council for Graduate Medical Education (ACGME) …”

“…Integration of this technology into dermatology resident curricula may also fulfill certain competencies, such as medical knowledge and practice-based learning, in the Dermatology Milestone Project by the Accreditation Council for Graduate Medical Education (ACGME). [6][7][8] International Journal of Dermatology 2018, 57, 1358-1362 ª 2018 The International Society of Dermatology While the capacity of teledermatology to improve skin healthcare and general aspects of education has been studied, it remains unclear whether it may be used to improve global health education for dermatologists and dermatology trainees.…”