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Patel H, Revankar R, Valliani A, Revankar N, Yerigeri S, Kaskas N, Stoff B. Teledermatology in medical student, postgraduate trainee, and global dermatology education: A systematic review. JAAD Int 2023; 11:106-111. [PMID: 36941913 PMCID: PMC10018315 DOI: 10.1016/j.jdin.2023.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2023] [Indexed: 02/22/2023] Open
Abstract
Background In the aftermath of the COVID-19 pandemic, medical students and residents in the U.S. and globally have gained more exposure to teledermatology, both for the purposes of clinical practice and education. Objective We conducted a systematic review to assess outcomes from teledermatology interventions for dermatology trainees in the U.S. and globally in accordance with Preferred Reporting Items for Systematic Reviews (PRISMA). Methods We searched MEDLINE, EMBASE, Web of Science, and Cochrane CENTRAL for articles written in English and published database inception to November 20, 2022. Results In total, 15 studies met the inclusion criteria. Outcomes reported ranged broadly from resident-provider concordance rates, diagnostic accuracy in comparison to control groups, number of patients seen, and self-reported satisfaction and improvement. Generally, studies indicated high satisfaction rates and improvement in educational outcomes among medical students, residents, and other trainees in the global health setting. Limitations Because of the heterogeneity of study design and outcomes reported, meta-analysis could not be performed. Conclusion Teledermatology can be successfully deployed for clinical care and education domestically and in the global health setting.
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Affiliation(s)
- Heli Patel
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia
| | | | - Aly Valliani
- The Icahn School of Medicine at Mount Sinai, New York
| | - Nikita Revankar
- East Carolina University Brody School of Medicine, Greenville, North Carolina
| | | | - Nadine Kaskas
- The Icahn School of Medicine at Mount Sinai, New York
| | - Benjamin Stoff
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
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Sud E, Anjankar A. Applications of Telemedicine in Dermatology. Cureus 2022; 14:e27740. [PMID: 36106261 PMCID: PMC9445412 DOI: 10.7759/cureus.27740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/07/2022] [Indexed: 11/30/2022] Open
Abstract
Telemedicine is a technological tool that enhances well-being all around the globe. Practicing medicine or performing a clinical examination from a distance was a mere thought until this decade's pandemic hit the world. Telemedicine is practicing medicine sitting on one side of a globe and diagnosing and treating a different individual from the opposite part of the world. There is a long way to go for medical practitioners to execute an entire clinical examination analogous to an accurate clinical examination. Telemedicine is a supplement to a patient's total care, not a replacement for in-person doctor visits. Family doctors can easily access specialists using telemedicine, which enables them to monitor their patients closely. Numerous telemedicine systems, including store and forward, real-time and remote, or self-monitoring, are used worldwide for education, healthcare delivery and control, sickness screening, and disaster management. Even if telemedicine cannot solve every issue, it can significantly lessen the strain on the healthcare system. Nevertheless, investigations performed via telemedicine have started incorporating various medical instruments called telemedicine peripherals, including electronic stethoscopes, teleophthalmoscopes, and video-otoscopes. The prevailing disease around the globe of coronavirus has remarkably debilitated the medical infrastructure in providing diagnosis, treatment, monitoring, and follow-ups. As a result, there is a significant change in the way of practicing medicine and managing patients. Telemedicine provides timely patient care and reduces the risk of exposure to various communicable diseases offered to medical practitioners. The development of imaging technologies has significantly impacted dermatology, a specialty that relies on visual signals. Reviewing dermatology's existing situation and potential digital future, in brief, is the goal of this study. This study provides brief information on telemedicine, its application and scope in dermatology, and how it can alter the healthcare system.
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Mocharnuk J, Lockard T, Georgesen C, English JC. Inpatient Teledermatology: a Review. CURRENT DERMATOLOGY REPORTS 2022; 11:52-59. [PMID: 35402084 PMCID: PMC8976271 DOI: 10.1007/s13671-022-00360-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 11/22/2022]
Abstract
Purpose of Review Inpatient teledermatology is a rapidly growing field with significant potential to add value and streamline patient care. This review summarizes the current literature on inpatient teledermatology, primarily focusing on its diagnostic and clinical management utility as compared to live dermatologic evaluation. Recent Findings The COVID-19 pandemic has accelerated the adoption of inpatient teledermatology, which has been shown to be comparable to live hospitalist evaluation for triage, diagnosis, and management of hospitalized patients for a wide variety of conditions. Despite its comparative cost-effectiveness and recent changes in reimbursement practices, inpatient teledermatology still lacks sufficient reimbursement incentive for widespread implementation. Summary Inpatient teledermatology is an effective, efficient, accurate, and cost-effective means of managing the hospital burden of skin disease, especially in areas where access to dermatologic care is limited. It is essential that dermatologists and referring providers comprehend the use and potential pitfalls of inpatient teledermatology to effectively incorporate it into hospital practice.
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Lam M, Doiron PR. The Use of Teledermatology in Medical Education. MEDICAL SCIENCE EDUCATOR 2022; 32:243-246. [PMID: 34815891 PMCID: PMC8601370 DOI: 10.1007/s40670-021-01465-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/04/2021] [Indexed: 06/13/2023]
Abstract
Certain aspects of medical education have transitioned to virtual platforms since the start of the COVID-19 pandemic. This commentary explores advantages and barriers to teledermatology in medical education, which has the potential to reach an extensive pool of learners and preceptors but may be limited by logistical and security considerations of a virtual platform. Dermatology in particular lends itself to an online platform as a highly visual specialty, although clinical exam would be highly dependent on quality of images captured. With teledermatology, learners can begin developing an approach to delivering care remotely, and becoming accustomed to virtual platforms.
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Affiliation(s)
- Megan Lam
- Michael G. DeGroote School of Medicine, Faculty of Medicine, McMaster University, 1280 Main St. West, Hamilton, ON L8S 4L8 Canada
| | - Philip R. Doiron
- Division of Dermatology, Women’s College Hospital, Toronto, ON Canada
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Iqbal EJ, Sutton T, Akther MS, Samhan A, MacDonald S, Coleman JR, Turner PL, Nikolian VC. Current Surgical Trainee Perceptions and Experiences in Telehealth. Telemed J E Health 2021; 28:789-797. [PMID: 34637650 DOI: 10.1089/tmj.2021.0237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Broad expansion of telehealth technologies has been implemented during the coronavirus disease 2019 (COVID-19) pandemic to allow for physical distancing and limitation of viral transmission within health care facilities. Although telehealth has been studied for its impact on patients, payors, and practitioners, its educational impact is largely unstudied. To better understand the trainee experience and perception of telehealth during the COVID-19 pandemic, we conducted a survey of the membership of the American College of Surgeons Resident and Associate Society (RAS). Methods: An anonymous survey was sent to members of RAS. Descriptive analysis was used to report experiences and perceptions. Chi-square analysis was used to compare cohorts with and without exposure to telehealth. Results: Of the 465 RAS respondents, 292 (62.8%) reported knowledge of telehealth technologies at their institutions. The majority of these respondents experienced a decrease in in-person clinic volume (94.4%) and an associated increase in virtual clinic volume (95.7%) related to the COVID-19 pandemic. Trainee integration into telehealth workflows increased drastically from prepandemic levels (11% vs. 54.5%, p < 0.001). Likelihood of trainee exposure to telehealth was associated with university-based training programs or larger program size. Trainees demonstrated a desire for more integration and development of curricula. Conclusions: These data serve as the first description of surgical trainee experience with, and opinion of, telehealth. Trainees recognize the importance of their integration and training in telehealth. These results should be used to guide the development of workflows and curricula that integrate trainees into telemedicine clinics.
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Affiliation(s)
- Emaad J Iqbal
- Department of Surgery, Columbia University, New York City, New York, USA
| | - Thomas Sutton
- Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Mudassir S Akther
- Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Ashraf Samhan
- Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Stephanie MacDonald
- Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Julia R Coleman
- Department of Surgery, University of Colorado, Denver, Colorado, USA
| | - Patricia L Turner
- American College of Surgeons, Chicago, Illinois, USA.,Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Vahagn C Nikolian
- Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA
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Shah YS, Fliotsos MJ, Alaqeel A, Boland MV, Zafar S, Srikumaran D, Woreta FA. Use of Teleophthalmology for Evaluation of Ophthalmic Emergencies by Ophthalmology Residents in the Emergency Department. Telemed J E Health 2021; 28:858-864. [PMID: 34619063 DOI: 10.1089/tmj.2021.0334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Utilizing telemedicine is one approach to reduce the ever-increasing burden of patients on emergency departments (EDs) and consulting physicians. Utilization of telemedicine services in the ED may also benefit resident education. Materials and Methods: Ten first-year ophthalmology residents were trained to use a Topcon 3D Optical Coherence Tomography (OCT)-1 Maestro to capture OCT images and fundus photos in patients presenting to the ED with urgent ophthalmic concerns. Findings were communicated to the supervising ophthalmologist. Retrospective chart review was conducted to obtain patient characteristics and final ophthalmologist diagnosis. Residents rated ease of use, technical reliability, and educational value through a survey. Results: From December 1, 2019, to December 1, 2020, the device was used in 109 patient encounters, capturing 887 images (average 8.1 images per encounter). Patients on whom the device was used were on average 48.5 years old (±17.2, range 17-90) and 59.6% were female. The imaging device was utilized most commonly for evaluating papilledema (n = 21, 18.6%), new-onset visual acuity/visual field defects (n = 12, 10.6%), retinal detachment/tear (n = 8, 7.1%), and ophthalmic trauma workup (n = 8, 7.1%). Eight residents completed the survey and most (n = 7) agreed or strongly agreed that the device helped them diagnose patients more accurately. Technical issues such as machine malfunction, image artifacts, and problems syncing with the electronic health record and computer were noted by survey respondents. Conclusions: The most common use of teleophthalmology in the ED setting was evaluation of papilledema; the majority of residents perceived an educational benefit from this tool. Efforts should be made to address the technical challenges to increase the utility of this device.
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Affiliation(s)
- Yesha S Shah
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael J Fliotsos
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Abdulaziz Alaqeel
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael V Boland
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Sidra Zafar
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Divya Srikumaran
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Fasika A Woreta
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Teledermatology Addressing Disparities in Health Care Access: a Review. CURRENT DERMATOLOGY REPORTS 2021; 10:40-47. [PMID: 33747638 PMCID: PMC7953516 DOI: 10.1007/s13671-021-00329-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2021] [Indexed: 11/09/2022]
Abstract
Purpose of Review Dermatologists have been at the forefront of researching telemedicine to expand access to care. The current COVID-19 pandemic has prompted even greater expansion and implementation of teledermatology. This review discusses the research examining the potential impact of teledermatology addressing disparities in care. Recent Findings Teledermatology appears to increase access to dermatology given expanded means to deliver care. Specifically, recent studies have found increased access among Medicaid-insured, resource-poor urban and rural, and elderly populations. Teledermatology implementation also facilitates education among providers at different levels of training. Still, as some patients have inconsistent access to the required technology, increased reliance on telemedicine may also potentially increase disparities for some populations. Summary Teledermatology may serve to reduce disparities in health care access in many underserved and marginalized communities. Future research should continue to study implementation, especially given the expansion during the COVID-19 pandemic. Ultimately, teledermatology may play an important role in ensuring equitable care access for all.
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Stovel RG, Gabarin N, Cavalcanti RB, Abrams H. Curricular needs for training telemedicine physicians: A scoping review. MEDICAL TEACHER 2020; 42:1234-1242. [PMID: 32757675 DOI: 10.1080/0142159x.2020.1799959] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
PURPOSE The use of telemedicine, a part of 'Virtual Care', is rapidly entering mainstream clinical practice. The ideal curriculum for educating physicians to practice in this emerging field has not been established. We examined the literature to evaluate published curricula for quality and comprehensiveness through the lens of Competency-Based Medical Education (CBME). METHODS We performed a scoping review using CanMEDS as a framework. Peer-reviewed articles describing telemedicine training curricula were identified. Trainee population, curricular points, stage of implementation, evaluation depth, country, and citations (a marker of quality) were examined. RESULTS Forty-three curricula from 11 countries were identified, addressing all training levels and covering multiple specialties. Instructional methods included lectures (60.5%), hands-on experiences (76%), directed reading (24%), online modules (21%), reflection (13%), simulation (34%), and group discussions (16%). Hands-on curricula covered all CanMEDS roles more often. Twenty-nine of the implemented curricula were evaluated; 83% were rated positively. CONCLUSIONS Our scoping review helps inform more comprehensive and efficacious curricula for teaching telemedicine. We suggest centering curricula on a competency-based, outcomes-oriented framework such as CanMEDS with multiple teaching modalities complementing hands-on experiences. This will facilitate rigorous telemedicine training to deliver on the promise of high-quality patient care.
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Affiliation(s)
- Rebecca G Stovel
- Department of Medicine, University of Toronto, Toronto, Canada
- HoPingKong Centre for Excellence in Education and Practice (CEEP), Toronto, Canada
- Department of Medicine, Women's College Hospital, Toronto, Canada
| | - Nadia Gabarin
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Rodrigo B Cavalcanti
- Department of Medicine, University of Toronto, Toronto, Canada
- HoPingKong Centre for Excellence in Education and Practice (CEEP), Toronto, Canada
- Department of Medicine, University Health Network, Toronto, Canada
| | - Howard Abrams
- Department of Medicine, University of Toronto, Toronto, Canada
- Department of Medicine, University Health Network, Toronto, Canada
- OpenLab, University Health Network, Toronto, Canada
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10
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Pasquali P, Sonthalia S, Moreno-Ramirez D, Sharma P, Agrawal M, Gupta S, Kumar D, Arora D. Teledermatology and its Current Perspective. Indian Dermatol Online J 2020; 11:12-20. [PMID: 32055502 PMCID: PMC7001387 DOI: 10.4103/idoj.idoj_241_19] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Teledermatology is one of the most important and commonly employed subsets of telemedicine, a special alternative to face-to-face (FTF) doctor--patient consultation that refers to the use of electronic telecommunication tools to facilitate the provision of healthcare between the "seeker" and "provider." It is used for consultation, education, second opinion, and monitoring medical conditions. This article will review basic concepts, the integration of noninvasive imaging technique images, artificial intelligence, and the current ethical and legal issues.
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Affiliation(s)
- Paola Pasquali
- Dermatology Department, Pius Hospital de Valls, Tarragona, Spain
| | | | | | - Pooram Sharma
- Skin Institute and School of Dermatology, New Delhi, India
| | - Mahima Agrawal
- Department of Dermatology and STD, LHMC & Associated Hospitals, New Delhi, India
| | - Somesh Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Dinesh Kumar
- Dr. Dinesh´s Skin and Hair Clinic, Chennai, Tamil Nadu, India
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11
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Lee KJ, Finnane A, Soyer HP. Recent trends in teledermatology and teledermoscopy. Dermatol Pract Concept 2018; 8:214-223. [PMID: 30116667 PMCID: PMC6092076 DOI: 10.5826/dpc.0803a13] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/21/2018] [Indexed: 11/28/2022] Open
Abstract
Teledermatology is a useful alternative where specialized dermatological assistance is not available and has been used successfully to support health professionals in a wide range of settings worldwide, in either an asynchronous store-and-forward format or a real-time video conferencing format. Teledermoscopy, which includes dermoscopic images in the teleconsultation, is another addition that improves remote assessments of pigmented lesions. A more recent variant is mobile teledermoscopy, which uses a smartphone to deliver the same type of service. Teledermoscopy’s greatest strength may be as a triage and monitoring tool, as it can reduce the number of unnecessary referrals, wait times, and the cost of providing and receiving dermatological care. While face-to-face (FTF) care remains the gold standard for diagnosis, drawbacks of not using FTF care as the primary method can be mitigated if teleconsultants are willing to refer to FTF care whenever there is uncertainty. Teledermatology has generally been well accepted by patients and practitioners alike. Barriers to the large-scale use of teledermatology remain. Assigning medicolegal responsibility and instituting a reimbursement system are critical to promoting widespread use by medical professionals, while privacy and security features and a mechanism to link teleconsultations to patients’ existing health records are essential to maximize patient benefit. Direct-to-consumer services also need attention from regulators to ensure that consumers can enjoy the benefits of telemedicine without the dangers of unregulated or untested platforms.
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Affiliation(s)
- Katie J Lee
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia
| | - Anna Finnane
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia.,The University of Queensland, School of Public Health, Herston, Australia
| | - H Peter Soyer
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia.,Department of Dermatology, Princess Alexandra Hospital, Brisbane, Australia
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Combination of Melolabial Interpolation Flap and Nasal Sidewall and Cheek Advancement Flaps Allows for Repair of Complex Compound Defects. Dermatol Surg 2018; 44:785-795. [PMID: 29360657 DOI: 10.1097/dss.0000000000001471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The paramedian forehead flap (PMFF) is the repair of choice for large nasal defects involving multiple cosmetic subunits. However, the PMFF may not be optimal for all patients. The combination of a melolabial interpolation flap (MLIF) and a nasal sidewall flap may serve as an alternative. OBJECTIVE To present the surgical technique and aesthetic outcomes of the alternative reconstruction for surgical defects of the lower nose. MATERIALS AND METHODS Fourteen patients with multisubunit nasal Mohs defects reconstructed alternatively were identified from 2 academic centers in this retrospective case series. Illustrations and photographs were used to demonstrate surgical technique and outcomes. Final aesthetic results were analyzed using the Patient and Observer Scar Assessment Scale. RESULTS The physician observer rated the scar outcome a mean score of 10.9 ± 3.3. Patients rated their results as a mean of 9.1 ± 4.7. The mean "Patient" Overall Opinion score was 2.3 ± 2.6 and the mean "Observer" Overall Opinion score was 1.9 ± 0.9. No patients reported problems with nasal airflow or obstruction, and cosmetic complications such as pincushioning or alar buckling were not observed. CONCLUSION The combined MLIF and nasal sidewall flap is an alternative repair for complex distal nasal defects.
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Yeung H, Sargen MR, Luk KM, Berry EG, Gurnee EA, Heuring E, McMichael J, Chen SC, Stoff BK. Teledermatology and teledermatopathology as educational tools for international dermatology: a virtual grand rounds pilot curriculum. Int J Dermatol 2018; 57:1358-1362. [PMID: 29693243 DOI: 10.1111/ijd.14014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 03/10/2018] [Accepted: 04/02/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Teledermatology may improve dermatologic care access in underserved areas and expand the clinical experience of dermatologists-in-training. The potential for teledermatology to supplement global health curricula in dermatology residency education has not been explored. METHODS An international virtual grand rounds (VGR) curriculum was created based on teledermatology cases from Kabul, Afghanistan. The learning objectives included understanding the diagnosis and management of skin diseases in unfamiliar resource-limited settings and highlighting socioeconomic, cross-cultural, and ethical issues. A 17-item, Likert scale questionnaire was used to assess the effectiveness of the curriculum, including specific Accreditation Council for Graduate Medical Education (ACGME) competencies, as well as interest in global health and teledermatology. RESULTS The survey was completed by 85 of 118 VGR attendees (72% response rate). Most respondents considered the curriculum valuable to their education (mean 4.5 on a 5-point Likert scale; standard deviation, 0.5), learned more about diagnosis and treatment of skin diseases in international settings (4.5; 0.6) and in the US (4.1; 0.8), and learned more about socioeconomic, cultural, and ethical issues in skin health (4.6; 0.5). The majority also reported being more interested in global dermatology (4.1; 0.8) and would recommend VGR to a colleague (4.5; 0.6). CONCLUSION This pilot curriculum provided an innovative platform to enhance undergraduate and graduate medical education in international dermatology. International teledermatology education may be used to address multiple ACGME core competencies and increase resident awareness of sociocultural determinants of skin health.
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Affiliation(s)
- Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael R Sargen
- Departments of Dermatology and Pathology, Stanford University, Stanford, CA, USA
| | - Kevin M Luk
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Elizabeth G Berry
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Emily A Gurnee
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Erin Heuring
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Josette McMichael
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Suephy C Chen
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA.,Division of Dermatology, Atlanta Veterans Affairs Medical Center, Decatur, GA, USA
| | - Benjamin K Stoff
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA.,Division of Dermatology, Atlanta Veterans Affairs Medical Center, Decatur, GA, USA.,Emory Center for Ethics, Emory University, Atlanta, GA, USA
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Carter ZA, Goldman S, Anderson K, Li X, Hynan LS, Chong BF, Dominguez AR. Creation of an Internal Teledermatology Store-and-Forward System in an Existing Electronic Health Record: A Pilot Study in a Safety-Net Public Health and Hospital System. JAMA Dermatol 2017; 153:644-650. [PMID: 28423156 DOI: 10.1001/jamadermatol.2017.0204] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance External store-and-forward (SAF) teledermatology systems operate separately from the primary health record and have many limitations, including care fragmentation, inadequate communication among clinicians, and privacy and security concerns, among others. Development of internal SAF workflows within existing electronic health records (EHRs) should be the standard for large health care organizations for delivering high-quality dermatologic care, improving access, and capturing other telemedicine benchmark data. Epic EHR software (Epic Systems Corporation) is currently one of the most widely used EHR system in the United States, and development of a successful SAF workflow within it is needed. Objectives To develop an SAF teledermatology workflow within the Epic system, the existing EHR system of Parkland Health and Hospital System (Dallas, Texas), assess its effectiveness in improving access to care, and validate its reliability; and to evaluate the system's ability to capture meaningful outcomes. Design, Setting, and Participants Electronic consults were independently evaluated by 2 board-certified dermatologists, who provided diagnoses and treatment plans to primary care physicians (PCPs). Results were compared with in-person referrals from May to December 2013 from the same clinic (a community outpatient clinic in a safety-net public hospital system). Patients were those 18 years or older with dermatologic complaints who would have otherwise been referred to dermatology clinic. Main Outcomes and Measures Median time to evaluation; percentage of patients evaluated by a dermatologist through either teledermatology or in-person compared with the previous year. Results Seventy-nine teledermatology consults were placed by 6 PCPs from an outpatient clinic between May and December 2014; 57 (74%) were female and their mean (SD) age was 47.0 (12.4) years. Teledermatology reduced median time to evaluation from 70.0 days (interquartile range [IQR], 33.25-83.0 days) to 0.5 days (IQR, 0.172-0.94 days) and median time to treatment from 73.5 to 3.0 days compared with in-person dermatology visits. Overall, a greater percentage of patients (120 of 144 [83.3%]) were evaluated by a dermatologist through either teledermatology or in-person during the 2014 study period compared with the previous year (111 of 173 [64.2%]). Primary care physicians followed management recommendations 93% of the time. Conclusions and Relevance Epic-based SAF teledermatology can improve access to dermatologic care in a public safety-net hospital setting. We hope that the system will serve as a model for other health care organizations wanting to create SAF teledermatology workflows within the Epic EHR system.
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Affiliation(s)
| | - Shauna Goldman
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas
| | - Kristen Anderson
- Division of Information Technology, Parkland Health and Hospital Systems, Dallas, Texas
| | - Xiaxiao Li
- University of Texas Southwestern Medical School, Dallas
| | - Linda S Hynan
- Department of Clinical Science, Psychiatry, University of Texas Southwestern Medical Center, Dallas
| | - Benjamin F Chong
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas3Division of Information Technology, Parkland Health and Hospital Systems, Dallas, Texas
| | - Arturo R Dominguez
- Division of Information Technology, Parkland Health and Hospital Systems, Dallas, Texas5Departments of Dermatology and Internal Medicine, University of Texas Southwestern Medical Center, Dallas
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Lee IA. Invited Commentary on Teledermatology Education: the Evidence, the Tools, and the Potential ECHO. CURRENT DERMATOLOGY REPORTS 2016. [DOI: 10.1007/s13671-016-0161-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Okita AL, Molina Tinoco LJ, Patatas OHG, Guerreiro A, Criado PR, Gabbi TVB, Ferreira PS, Neto CF. Use of Smartphones in Telemedicine: Comparative Study Between Standard and Teledermatological Evaluation of High-Complex Care Hospital Inpatients. Telemed J E Health 2016; 22:755-60. [DOI: 10.1089/tmj.2015.0086] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Aline Lissa Okita
- Department of Dermatology, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil
| | | | | | | | - Paulo Ricardo Criado
- Department of Dermatology, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil
| | | | - Paula Silva Ferreira
- Department of Dermatology, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil
| | - Cyro Festa Neto
- Department of Dermatology, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil
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17
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Patel J, Parr K, Buehler-Bota T, Hood AF. Integrating Outpatient Teledermatology Education Into the Dermatology Resident Curriculum. J Grad Med Educ 2016; 8:468-9. [PMID: 27413472 PMCID: PMC4936887 DOI: 10.4300/jgme-d-15-00792.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jigar Patel
- Medical Student, Department of Dermatology, Eastern Virginia Medical School, Medical Student, Dermatology Section, Hampton Veterans Affairs Medical Center
| | - Karina Parr
- Assistant Professor, Department of Dermatology, Eastern Virginia Medical School, Chief, Dermatology Section, Hampton Veterans Affairs Medical Center
| | - Tara Buehler-Bota
- Resident, Department of Dermatology, Eastern Virginia Medical School, Resident, Dermatology Section, Hampton Veterans Affairs Medical Center
| | - Antoinette F Hood
- Professor, Department of Dermatology, Eastern Virginia Medical School, Professor, Dermatology Section, Hampton Veterans Affairs Medical Center
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