Defining the dermatological content of the undergraduate medical curriculum: a modified Delphi study

Designing a programme to train social workers on how to promote physical activity for disabled people: A Delphi study in the UK

Recently, social workers have been identified as a key messenger group for promoting physical activity (PA) to disabled people. Also identified is the need to train social workers in PA promotion. In response, the purpose of this article is to inform the design of a training programme prototype aiming to support social workers to become active PA messengers. We conducted a three-round Delphi study to identify the essential contents and teaching methods for the programme, as well as the challenges that may jeopardise its success. Qualified experts on physical activity and health, social work, and/or disability working in the UK were invited to partake in the study. The response rates were 55% (33/60) in the first round, 79% (26/33) in the second and 77% (20/26) in the third rounds. Following the last questionnaire round, the experts reached consensus on 8 contents, 7 teaching methods and 10 challenges to success. The top three most important contents were: benefits of PA (1.05 ± 0.22), what PA means to disabled people (1.15 ± 0.36) and person-centred PA planning (1.35 ± 0.57). The most relevant teaching methods were interactive activities and discussions (1.20 ± 0.51) and case studies (1.25 ± 0.43). Blended learning (1.85 ± 0.57) was preferred to e-learning (2.20 ± 0.60) and face-to-face learning (2.10 ± 0.70). Lack of time (1.30 ± 0.46) and confidence (1.45 ± 0.59) were deemed vital challenges. However, consensus around other potential barriers such as lack of interest and commitment (1.30 ± 0.46), lack of buy in from employers (1.75 ± 0.70) and professional inertia (2.05 ± 0.67) suggest that a major challenge for long-term impact is to convince key people that social work and PA promotion make a good match. The results of this study provide a valuable starting point evidence base for PA curriculum development. Future research will delve into expert opinions using in-depth qualitative interviews. Participatory approaches including knowledge cafés will also be used to add more views of stakeholders with experiential knowledge.

Consensus on the Objectives of an Educational Intervention for Patients with Oropharyngeal Dysphagia and Their Informal Caregivers: A Delphi Study

PURPOSE

In the absence of literature allowing for an evidence-based approach to therapeutic patient education (TPE) in Oropharyngeal Dysphagia (OD), this study aims to reach a consensus of experts on the content of a competency framework of an educational program for OD patients and their informal caregivers (ICGs).

METHODS

We used the Delphi consensus-building method. Four categories of experts were recruited: 12 patients, 17 ICGs, 46 healthcare professionals (HCP) (experienced in OD, not necessarily certified in TPE), and 19 experts in TPE (trained individuals to set up and run TPE programs not necessarily HCPs). The content of the questionnaire of the first round (R) was established according to the result of a scoping review and the opinion of an expert committee. We carried out three rounds. In R1 and R2, we collected the opinions on the relevance (7-point Likert-type scale) and on comprehensiveness (YES/No question and asking participants to propose additional content). Participants were also invited to leave comments on each objective. In R3, we asked the participants to give their opinion about the relevance of the objectives again and asked them to rank the themes from highest to lowest priority.

RESULTS

Objectives were considered relevant for all participants if they reached consensus when the interquartile (IQR) ≤ 1, and if the median indicated agreement (Mdn ≥ 6) (6= appropriate, 7 = totally appropriate). Following three rounds, the final content of the educational program is composed of 23 educational objectives organized in 13 themes with an agreement about relevance amongst all participants (Mdn ≥ 6; IQR ≤ 1). The comprehensiveness criterion received also a consensus (IQR ≤ 1). The participants ranked the theme "normal swallowing vs difficulty swallowing" as the highest priority.

CONCLUSION

This Delphi study resulted in a consensus, on the content of a competency framework of an educational program for OD patients and their ICGs. Further steps are needed to construct learning activities based on these objectives before testing their feasibility and efficacy.

Defining performance levels in undergraduate otolaryngology education

OBJECTIVES

This study seeks the opinions of qualified doctors on what they feel medical students should learn about otolaryngology. It aims to identify both the content deemed relevant and the performance levels for medical students in otolaryngology.

METHODS

A national survey developed from a content analysis of undergraduate otolaryngology curricula from the UK was undertaken, accompanied by a review of the literature and input from an expert group. Data were collected from a wide range of doctors.

RESULTS

Participants felt that graduating students should be able to: recognise, assess and initiate management for common and life-threatening acute conditions; take an appropriate patient history; and perform an appropriate examination for the majority of otolaryngology clinical conditions but manage only a select few.

CONCLUSION

This study reports performance levels for otolaryngology topics at an undergraduate level. Participating doctors felt that a higher level of performance should be expected of students treating life-threatening, acute and common otolaryngology conditions.

The spectrum of skin-related conditions in primary care during 2015-2019-A Finnish nationwide database study

Background

Skin‐related conditions are the frequent cause of doctors’ consultations in primary care.

Methods

Based on nationwide data bank information of the Finnish Institute for Health and Welfare, we analysed the 20 most frequent main diagnoses for each ICD‐10 category of all general practitioners’ visits in the public health care in Finland over the years 2015–2019.

Results

The total amount of doctor’s visits was 19 204 613 of which 1 489 228 consultations (7.80%) had a skin‐related condition as the main diagnosis. The most frequent skin‐related conditions were eczematous eruptions, bacterial skin infections and benign skin neoplasms accounting for 749 351 consultations (50.32%). The spectrum of skin‐related conditions was diverse, with a large quantity of rarer diagnoses. Some diagnoses showed significant proportional changes.

Conclusions

The results demonstrate that a limited amount of conditions comprises most of the skin‐related consultations in primary care in Finland. Undergraduate education in dermatology should concentrate on the most frequent conditions seen by general practitioners, but also address the wide range of skin problems.

Determining electrocardiography training priorities for medical students using a modified Delphi method

BACKGROUND

Although electrocardiography is considered a core learning outcome for medical students, there is currently little curricular guidance for undergraduate ECG training. Owing to the absence of expert consensus on undergraduate ECG teaching, curricular content is subject to individual opinion. The aim of this modified Delphi study was to establish expert consensus amongst content and context experts on an ECG curriculum for medical students.

METHODS

The Delphi technique, an established method of obtaining consensus, was used to develop an undergraduate ECG curriculum. Specialists involved in ECG teaching were invited to complete three rounds of online surveys. An undergraduate ECG curriculum was formulated from the topics of ECG instruction for which consensus (i.e. ≥75% agreement) was achieved.

RESULTS

The panellists (n = 131) had a wide range of expertise (42.8% Internal Medicine, 22.9% Cardiology, 16% Family Medicine, 13.7% Emergency Medicine and 4.6% Health Professions Education). Topics that reached consensus to be included in the undergraduate ECG curriculum were classified under technical aspects of performing ECGs, basic ECG analysis, recognition of the normal ECG and abnormal rhythms and waveforms and using electrocardiography as part of a clinical diagnosis. This study emphasises that ECG teaching should be framed within the clinical context. Course conveners should not overload students with complex and voluminous content, but rather focus on commonly encountered and life-threatening conditions, where accurate diagnosis impacts on patient outcome. A list of 23 "must know" ECG diagnoses is therefore proposed.

CONCLUSION

A multidisciplinary expert panel reached consensus on the ECG training priorities for medical students.

Digital Problem-Based Learning: An Innovative and Efficient Method of Teaching Medicine

BACKGROUND

The breadth of knowledge assimilated by undergraduates is substantial. Time must be utilised to impart knowledge and skills to ensure optimal training. Dermatology comprises a large portion of work in primary care; yet UK undergraduate dermatology training is short. Digital problem-based learning (PBL) is an innovative teaching method incorporating clinical images into intense, interactive teaching sessions.

AIM

To determine the efficacy of digital PBL sessions in teaching UK medical students during their dermatology module.

METHODS

In total, 59 second-year medical students at Norwich Medical School during their dermatology secondary care attachment completed two 2.5-h digital PBL sessions. One session was focused on lesions and the second on inflammatory diseases. During each session, students assessed 60 clinical cases each comprising an image with a brief history. In small groups, students discussed the cases, described the images, and agreed a diagnosis followed by a group discussion with the supervising clinician who provided feedback. Following each session, students completed a feedback questionnaire.

RESULTS

In total, 117 sets of feedback were received; 60% of students considered they learnt a great amount in a short time. The majority of students reported feeling more confident to make a dermatological diagnosis and more motivated in clinics as a result of the digital PBL; 64% of students found digital PBL more useful than real patient clinics. The most frequent negative comment was that 2.5 h was too long to concentrate.

CONCLUSIONS

Digital PBL was a popular, effective, and efficient teaching method. Digital PBL sessions should be introduced alongside clinics and other teaching methods for undergraduates.

Achieving consensus on the undergraduate curriculum of public health nursing in Turkey

OBJECTIVE

The aim of this study was to construct a consensus on the undergraduate learning objectives and topics for public health nursing (PHN) in Turkey.

DESIGN

A three-round e-mail-based Delphi study was conducted between May and July 2015 with a national sample.

SAMPLE

Ninety-one academics from 54 universities were invited as experts to participate by e-mail. Fifty-nine academics from 43 universities participated in the study.

MEASUREMENTS

Data were analyzed by computing the median, quartiles one and three, and the interquartile range for each learning outcome and topic. Consensus was considered as less than the interquartile range of 1.2.

RESULTS

Experts who participated in the study added 70 learning outcomes, eight main topics, and 278 sub-topics during the first round. Round I generated 170 learning outcomes, 28 main topics, and 385 sub-topics. At the end of Round II, consensus was reached on 126 learning outcomes, 22 main topics and 168 sub-topics. At the end of Round III, consensus was achieved for 126 learning outcomes, 22 main topics, and 169 sub-topics.

CONCLUSION

The learning outcomes and topics that were decided upon through a consensus process will contribute to the standardization and development of PHN education.

Core Content for Undergraduate Medical Education in Spain: Recommendations of the Instructors' Group of the Spanish Academy of Dermatology and Venereology (AEDV)

BACKGROUND

Skin problems are among the most frequent reasons for seeking medical attention in primary care. In recent years, as a result of the process of adapting medical curricula to the requirements of the European Higher Education Area, the amount of time students spend learning the concepts of dermatology has been reduced in many universities.

MATERIAL AND METHODS

In order to reach a consensus on core content for undergraduate education in dermatology, we sent a survey to the 57 members of the instructors' group of the Spanish Academy of Dermatology and Venereology (AEDV), asking their opinions on what objectives should be set for a dermatology course in Spain. A total of 131 previously selected objectives were listed. We then applied the Delphi method to achieve consensus on which ones the respondents considered important or very important (score≥4 on a Likert scale).

RESULTS

Nineteen responses (33%) were received. On the second round of the Delphi process, 68 objectives achieved average scores of at least 4. The respondents emphasized that graduates should understand the structure and functions of the skin and know about bacterial, viral, and fungal skin infections, the most common sexually transmitted diseases (STDs), and the 4 main inflammatory dermatoses. Students should also learn about common complaints, such as itching and bald patches; the management of dermatologic emergencies; purpura and erythema nodosum as signs of internal disease; and the prevention of STDs and skin cancer. During clinical clerkships students should acquire the communication skills they will need to interview patients, write up a patient's medical history, and refer the patient to a specialist.

CONCLUSIONS

The AEDV's group of instructors have defined their recommendations on the core content that medical faculties should adopt for the undergraduate subject of dermatology in Spain.

Identification of translational dermatology research priorities in the U.K.: results of an electronic Delphi exercise

BACKGROUND

Translational research is the direct application of basic and applied research to patient care. It is estimated that there are at least 2000 different skin diseases; thus, there are considerable challenges in seeking to undertake research on each of these disorders.

OBJECTIVES

This electronic Delphi (e-Delphi) exercise was conducted in order to generate a list of translational dermatology research questions that are regarded as a priority for further investigations.

METHODS

During the first phase of the e-Delphi exercise, 228 research questions were generated by an expert panel that included clinical academic dermatologists, clinical dermatologists, nonclinical scientists, dermatology trainees and representatives from patient support groups.

RESULTS

Following completion of the second and third phases, 40 questions on inflammatory skin disease, 20 questions on structural skin disorders/genodermatoses, 37 questions on skin cancer and eight miscellaneous questions were designated as priority translational dermatology research questions (PRQs). In addition to PRQs on a variety of disease areas (including multiple PRQs on psoriasis, eczema, squamous cell carcinoma and melanoma), there were a number of cross-cutting themes that identified a need to investigate mechanisms/pathogenesis of disease and the necessity to improve treatments for patients with skin disease.

CONCLUSIONS

It is predicted that this list of PRQs will help to provide a strategic direction for translational dermatology research in the U.K. and that addressing this list of questions will ultimately provide clinical benefit for substantial numbers of patients with skin disorders.

What do they need to know: achieving consensus on paediatric musculoskeletal content for medical students

BACKGROUND

Children present commonly with musculoskeletal (MSK) problems, due to a spectrum of causes including potentially life threatening disease, to doctors in varied health care settings. However, doctors involved in the care of children report a lack of confidence in their paediatric musculoskeletal (pMSK) clinical skills and many have little exposure to pMSK teaching. There is no current guidance on the pMSK clinical skills and knowledge required for medical students. The objective of this study was to achieve consensus amongst experts on the learning outcomes for a pMSK curriculum for medical students.

METHODS

This was a two-phase study. In Phase one, pMSK educational topics and categories were identified from UK medical students and experts (recruited from pMSK medicine, child health, education and primary care) utilising focus groups and interviews. These themes and concepts informed the structure of learning outcomes that were presented to a Delphi panel in Phase two, with the aim of achieving consensus on the final content of the curriculum.

RESULTS

In Phase 1 participants identified pMSK skills, knowledge and attitudes relevant for medical students. This content was translated into learning outcomes. In Phase 2, the proposed outcomes were submitted to scrutiny by a two-iteration Delphi process with experts in the field. The agreed learning outcomes (n = 45) were either generic to child health or specific to pMSK medicine, and related to history taking and examination, knowledge about normal development, key clinical presentation and conditions, approaches to investigation and referral pathways.

DISCUSSION

This study has identified evidence and consensu based content for a pMSK curriculum for medical students, derived from key stakeholders and to be integrated into medical student pMSK teaching.

CONCLUSION

It is envisaged that implementation of this content will equip graduating doctors with relevant and important skills and knowledge to assess children with MSK presentations, and facilitate early diagnosis and referral to specialist care.

Core competencies for emergency medicine clerkships: results of a Canadian consensus initiative

Objectives:

There is no consensus on what constitutes the core competencies for emergency medicine (EM) clerkship rotations in Canada. Existing EM curricula have been developed through informal consensus and often focus on EM content to be known at the end of training rather than what is an appropriate focus for a time-limited rotation in EM. We sought to define the core competencies for EM clerkship in Canada through consensus among an expert panel of Canadian EM educators.

Methods:

We used a modified Delphi method and the CanMEDS 2005 Physician Competency Framework to develop a consensus among expert EM educators from across Canada.

Results:

Thirty experts from nine different medical schools across Canada participated on the panel. The initial list consisted of 152 competencies organized in the seven domains of the CanMEDS 2005 Physician Competency Framework. After the second round of the Delphi process, the list of competencies was reduced to 62 (59% reduction). A complete list of competencies is provided.

Conclusion:

This study established a national consensus defining the core competencies for EM clerkship in Canada.

What Should General Practice Trainees Learn about Atopic Eczema?

Effective atopic eczema (AE) control not only improves quality of life but may also prevent the atopic march. The Royal College of General Practitioners’ (RCGP) curriculum does not currently provide specific learning outcomes on AE management. We aimed to gain consensus on learning outcomes to inform curriculum development. A modified Delphi method was used with questionnaires distributed to gather the views of a range of health care professionals (HCPs) including general practitioners (GPs), dermatologists, dermatology nurses and parents of children with AE attending a dedicated paediatric dermatology clinic. Ninety-one questionnaires were distributed to 61 HCPs and 30 parents; 81 were returned. All agreed that learning should focus on the common clinical features, complications and management of AE and the need to appreciate its psychosocial impact. Areas of divergence included knowledge of alternative therapies. Parents felt GPs should better understand how to identify, manage and refer severe AD and recognized the value of the specialist eczema nurse. Dermatologists and parents highlighted inconsistencies in advice regarding topical steroids. This study identifies important areas for inclusion as learning outcomes on AE management in the RCGP curriculum and highlights the importance of patients and parents as a valuable resource in the development of medical education.

Planning the content of a brief educational course in maxillofacial emergencies for staff in accident and emergency departments: a modified Delphi study

It is well known that staff in accident and emergency (A&E) departments lack the knowledge and confidence needed to deal with maxillofacial emergencies, and that it is related to limited education at undergraduate and postgraduate levels. We therefore aimed to design a syllabus for a short course to educate staff about the most common emergencies. To find out which learning outcomes should be included and to reach a consensus, we did a 3-stage modified Delphi study of the opinions of members of the British Association of Oral and Maxillofacial Surgeons (BAOMS). Of a possible 890 members, 188 responded (21%) in the second round and 105 in the third (12%). Eighteen (37%) of the 49 proposed learning outcomes were rated very important and all of them were retained in the syllabus after the third round. Thirty (61%) items were retained with a consensus of 51% or above in the final round. The Delphi technique is a useful addition to the armamentarium of those involved in education, and has been used effectively in syllabus design. We achieved good consensus on the items to be included and the syllabus will be piloted locally.

A Delphi consensus study to identify current clinically most valuable orthopaedic anatomy components for teaching medical students

BACKGROUND

Over recent years, wide ranging changes have occurred in undergraduate medical curricula with reduction of hours allocated for teaching anatomy. Anatomy forms the foundation of clinical practice. However, the challenge of acquiring sufficient anatomical knowledge in undergraduate medical education for safe and competent clinical practice remains. The purpose of this study is to identify clinically most valuable orthopaedic anatomy components that are relevant to current clinical practice in order to reinforce anatomy teaching.

METHODS

Modified Delphi technique with three rounds involving twenty currently practicing orthopaedic consultants and senior speciality orthopaedic registrars (StR, year six and above) was conducted. Anatomical components applied in corresponding clinical situations were generated from the opinions of this expert panel in the first round and the clinical importance of each of these components were rated with a four point Likert scale in the subsequent two rounds to generate consensus. Percentage agreement was utilised as outcome measure for components rated as considerably/very important with consensus of more than 94%.

RESULTS

Response rates were 90% for the first round and 100% for the next two rounds. After three Delphi rounds, thirty four anatomy components applied in general/ specific clinical conditions and clinical tests were identified as clinically most valuable following iteration.

CONCLUSIONS

The findings of this study provide clinicians opinions regarding the current required essential anatomical knowledge for a graduating medical student to apply during their orthopaedic clinical encounters. The information obtained can be utilised to encourage further development of clinical anatomy curriculum reflecting the evolving nature of health care.

When are circular lesions square? A national clinical education skin lesion audit and study

Background

Skin cancer is the most prevalent cancer by organ type and referral accuracy is vital for diagnosis and management. The British Association of Dermatologists (BAD) and literature highlight the importance of accurate skin lesion examination, diagnosis and educationally-relevant studies.

Methods

We undertook a review of the relevant literature, a national audit of skin lesion description standards and a study of speciality training influences on these descriptions. Questionnaires (n=200), with pictures of a circular and an oval lesion, were distributed to UK dermatology/plastic surgery consultants and speciality trainees (ST), general practitioners (GP), and medical students (MS). The following variables were analysed against a pre-defined 95% inclusion accuracy standard: site, shape, size, skin/colour, and presence of associated scars.

Results

There were 250 lesion descriptions provided by 125 consultants, STs, GPs, and MSs. Inclusion accuracy was greatest for consultants over STs (80% vs. 68%; P<0.001), GPs (57%) and MSs (46%) (P<0.0001), for STs over GPs (P<0.010) and MSs (P<0.0001) and for GPs over MSs (P<0.010), all falling below audit standard. Size description accuracy sub-analysis according to circular/oval dimensions was as follows: consultants (94%), GPs (80%), STs (73%), MSs (37%), with the most common error implying a quadrilateral shape (66%). Addressing BAD guidelines and published requirements for more empirical performance data to improve teaching methods, we performed a national audit and studied skin lesion descriptions. To improve diagnostic and referral accuracy for patients, healthcare professionals must strive towards accuracy (a circle is not a square).

Conclusions

We provide supportive evidence that increased speciality training improves this process and propose that greater focus is placed on such training early on during medical training, and maintained throughout clinical practice.

Online learning in a dermatology clerkship: piloting the new American Academy of Dermatology Medical Student Core Curriculum

BACKGROUND

Multiple studies have shown that both current and future primary care providers have insufficient education and training in dermatology. To address the limitations and wide variability in medical student dermatology instruction, the American Academy of Dermatology (AAD) created a standardized, online curriculum for both dermatology learners and educators.

OBJECTIVE

We sought to determine the impact of the integration of the AAD online curriculum into a 2-week introductory dermatology clerkship for fourth-year medical students.

METHODS

In addition to their clinical duties, we assigned 18 online modules at a rate of 1 to 3 per day. We evaluated knowledge acquisition using a 50-item, multiple-choice pretest and posttest. Postmodule and end-of-course questionnaires contained both closed and open-ended items soliciting students' perceptions about usability and satisfaction.

RESULTS

All 51 participants significantly improved in their dermatology knowledge (P < .001). The majority of students found the modules easy to navigate (95%) and worth their time (93%). All respondents supported the continuation of the modules as part of the dermatology clerkship.

LIMITATIONS

Without a control group who did not experience the online curriculum, we are unable to isolate the specific impact of the online modules on students' learning.

CONCLUSION

This study demonstrates the successful integration of this educational resource into a 2-week, university-based dermatology clerkship. Students' perceptions regarding usability and satisfaction were overwhelmingly positive, suggesting that the online curriculum is highly acceptable to learners. Widespread use of this curriculum may be a significant advancement in standardized dermatology learning for medical students.

Dermatology undergraduate skin cancer training: a disconnect between recommendations, clinical exposure and competence

BACKGROUND

Skin cancers are the most common malignancies in Caucasian populations. Non-specialists are responsible for the initial assessment of skin lesions and are required to act as the gatekeepers to dermatological cancer services in many healthcare systems. The majority of such physicians receive very limited formal undergraduate or postgraduate dermatology training. The British Association of Dermatologists (BAD) has produced guidelines that list the lesions that students should be able to diagnose on graduation and the majority of UK medical schools' operate curricula in keeping with these. There is, however, virtually no evidence as to whether these competencies are being achieved. We set out to determine students' competence at skin lesion diagnosis and to quantify their clinical exposure to examples of such lesions during their dermatology attachment.

METHODS

Three linked studies were undertaken. In the first, students' competence was tested by randomized slideshows of images containing the 16 lesions recommended in the UK guidelines. Students' accuracy was tested at the beginning (Day 1) and end (Day 10) of their clinical placement, with a random sample of students retested 12 months later. Secondly, students' exposure to these lesions was recorded during their attachments. Finally a survey of the additional dermatological resources used by the students was undertaken.

RESULTS

Study 1: Students' diagnostic accuracy increased from 11% on Day 1 to 33% on Day 10 (effect size +2.72). After 12 months half of this effect had disappeared and the students accuracy had dropped to 24%. Study 2: Students' exposure to the recommended lesions was poor with 82% not even witnessing a single example of each of the 3 major skin cancers. Despite these measurements, only a minority of students reported that they were not confident at diagnosing skin tumours. Study 3: The majority of students use additional resources to supplement their learning.

CONCLUSIONS

In the light of what we know about learning in dermatology, our data would suggest, that the current (traditional) undergraduate attachment is inadequate to meet the UK recommendations for graduate competence. As well as critically examining the basis for these recommendations, we need more empirical data on student performance and exposure, in order to improve teaching and learning.

Preparedness of Foundation Year 1 doctors in dermatology

BACKGROUND

UK medical graduates are required to reach standards defined by the General Medical Council (in Tomorrows Doctors) in all specialties, including dermatology.

AIMS

We assessed the self-reported competence of Foundation Year 1 (FY1) doctors in the diagnosis and management of skin disease correlated against their undergraduate dermatology experience.

METHODS

The FY1 doctors attending a teaching programme were surveyed at six hospital sites throughout the North Western Deanery. Questionnaires were completed on self-reported competence in learning outcomes defined by the British Association of Dermatologists (BAD). Information recorded previous undergraduate teaching (duration and delivery), and whether they felt sufficiently prepared to diagnose and manage patients with skin disease in their clinical practice.

RESULTS

Of 174 FY1 doctors, 118 attended the teaching sessions. All of the attendees completed a questionnaire. Trainees who undertook longitudinal placements in dermatology (defined as 10 or more half days of clinical experience) regarded themselves significantly more prepared to practise for their stage of training: 61 per cent compared with 8.9 per cent (χ(2) = 32.8, df = 1, p < 0.05). Furthermore, these trainees rated their abilities in basic history taking, clinical examination, management of dermatological emergencies and diagnosis of skin malignancy as being greater than those who had not experienced longitudinal placements in the specialty.

CONCLUSIONS

Longitudinal placements in dermatology offer undergraduates experience in the diagnosis and management of skin disease that develops confidence for foundation practice.

Determining the content of an educational ENT website using the Delphi technique

The aim of this study was to develop an educational website (www.enttheatre.com) that showed common ENT operations and emergencies, in order to help improve the basic surgical ENT knowledge of medical students and junior doctors. A two-round Delphi survey was conducted to establish the contents of the website. 'Experts' who participated in the Delphi process included otolaryngology consultants and trainees, junior doctors, general practitioners, and medical students. First- and second-round Delphi response rates were 49 per cent (61/125) and 92 per cent (56/61), respectively. Our paper presents a consensus opinion on what basic surgical knowledge a medical student or junior doctor should be familiar with in otolaryngology.

Evaluation of educational methods in dermatology and confidence levels: a national survey of UK medical students

BACKGROUND

The high prevalence of skin conditions makes dermatology education an essential part of the undergraduate medical curriculum. The aim of this study was to assess the impact of different educational methods on confidence levels in dermatology among UK medical students.

METHODS

A survey-based study was carried out to establish: (i) educational experience in dermatology, and (ii) confidence levels in the British Association of Dermatologists core curriculum learning outcomes. Measures of confidence were rated using a five-point Likert scale.

RESULTS

Completed questionnaires were obtained from 449 final-year medical students at 14 medical schools (12.9% of 3485 final-year UK medical students). Students who received teaching from dermatologists (P ≤ 0.01), dermatology specialist nurses (P ≤ 0.001), and expert patients (P ≤ 0.001) reported higher levels of confidence. Learning in clinical settings (P ≤ 0.001) and small-group settings (P ≤ 0.001) was associated with higher confidence levels. Student-selected components in dermatology were associated with higher confidence levels (P ≤ 0.001). Confidence levels were consistently lower in dermatological emergencies compared with chronic conditions, reflecting the lack of clinical exposure. Overall, 64.9% of students were at least adequately confident in assessing, and 52.0% were similarly confident in managing patients with skin conditions.

CONCLUSIONS

The findings of this study show that specialist clinical experiences and small-group learning had the most significant influence on confidence levels in dermatology. Many medical students nearing qualification were less than adequately confident in their abilities to assess and manage skin conditions, suggesting that a greater emphasis on dermatology is required.

Using a Delphi process to establish consensus on emergency medicine clerkship competencies

BACKGROUND

Currently, there is no consensus on the core competencies required for emergency medicine (EM) clerkships in Canada. Existing EM curricula have been developed through informal consensus or local efforts. The Delphi process has been used extensively as a means for establishing consensus.

AIM

The purpose of this project was to define core competencies for EM clerkships in Canada, to validate a Delphi process in the context of national curriculum development, and to demonstrate the adoption of the CanMEDS physician competency paradigm in the undergraduate medical education realm.

METHODS

Using a modified Delphi process, we developed a consensus amongst a panel of expert emergency physicians from across Canada utilizing the CanMEDS 2005 Physician Competency Framework.

RESULTS

Thirty experts from nine different medical schools across Canada participated on the panel. The initial list consisted of 152 competencies organized in the seven domains of the CanMEDS 2005 Physician Competency Framework. After the second round of the Delphi process, the list of competencies was reduced to 62 (59% reduction).

CONCLUSION

This study demonstrated that a modified Delphi process can result in a strong consensus around a realistic number of core competencies for EM clerkships. We propose that such a method could be used by other medical specialties and health professions to develop rotation-specific core competencies.

The development of a national pediatric trauma curriculum

BACKGROUND

Educational programs dedicated to pediatric trauma are either not available or comprehensive. Pediatric trauma is thus managed by a range of specialists with training in a variety of related fields. Post-certification fellowships in pediatric medicine all mandate education in the assessment and management of the injured child. The purpose of this study was to develop a blueprint for a national pediatric trauma training curriculum.

METHODS

A team of four experts developed content for a national pediatric trauma curriculum and disseminated it to 11 pediatric trauma sites across Canada. The objectives contained both knowledge and skill sets related to the management of the pediatric trauma patients. A multi-tiered Delphi process was used to develop the final content.

RESULTS

All the 11 pediatric teaching centers across the country participated. A final list, representing a consensus of views, was developed in 10 domains through the iterative process of the Delphi technique. The domains for the curriculum included introduction to pediatric trauma and epidemiology, initial management, pediatric airway, shock, thoracic injuries, abdominal and pelvic injuries, spinal and neurological injuries, pediatric head injuries, burns and electrical injuries, and orthopedic injuries.

CONCLUSION

The Delphi process is an invaluable tool in developing curricula. The pediatric trauma curriculum can be used in teaching hospitals for house staff education and meeting core competencies. The blueprint can be validated further in the future.

Medical school dermatology curriculum: are we adequately preparing primary care physicians?

BACKGROUND

There is a lack of information regarding the dermatology learning needs of primary care physicians and residents.

OBJECTIVE

To determine dermatologic topics that primary care physicians consider important and to determine primary care residents' ratings of the teaching adequacy of these topics in the undergraduate medical curriculum.

METHODS

Primary care physicians and residents were surveyed regarding the importance and teaching adequacy of 17 dermatologic content areas.

RESULTS

Ninety-two primary care physicians identified 13 dermatologic content areas important for their practices. Two hundred fifty-two primary care residents identified 8 adequately taught topics and 9 inadequately taught topics.

LIMITATIONS

Internal medicine and family medicine physicians and residents from only 10 regions were surveyed.

CONCLUSION

Seventeen content areas can be divided into 3 categories: dermatologic topics that are important and adequately taught, topics that are unimportant, and a group of important, yet inadequately taught content areas. This latter group should be further integrated into dermatology curricula at U.S. medical schools.

Medical Student Core Curriculum in Dermatology Survey

BACKGROUND

Few published articles focus on undergraduate dermatology education.

OBJECTIVE

To quantify the amount and type of dermatology instruction for medical students and to rank specific diseases by the expectations of learners.

METHODS

Electronic surveys were sent via e-mail to 109 dermatology residency programs as well as to 33 medical schools without dermatology programs.

RESULTS

Responses were received from 64% of dermatology residency programs. Half of the responding institutions require 10 or fewer hours of dermatology instruction, and 8% require no dermatology instruction. Seventy-five percent or more of the responding dermatologists expected medical students to learn to diagnose or treat 33 skin diseases after completing a clinical dermatology rotation.

LIMITATIONS

Surveys were sent only to academic institutions.

CONCLUSIONS

Dermatology educators expect medical students to learn to diagnose or treat common skin diseases, but little time is designated for this in most medical schools. The aggregate opinions of dermatology educators may be used to prioritize future curricula.

Audit of dermatological content of U.K. undergraduate curricula

BACKGROUND

Recommendations for the dermatology content (learning outcomes) of the core undergraduate curriculum were sent to all U.K. medical schools in June 2006.

OBJECTIVE

To carry out an audit of the content of the core curriculum in each U.K. medical school against the recommendations for a core undergraduate dermatology curriculum (the criteria) published by the British Association of Dermatologists, to identify areas of good practice and to gather evidence for developing the learning and teaching of dermatology.

METHODS

A questionnaire was circulated to the dermatology teaching leads of all U.K. medical schools (29) and one Irish medical school. Questions which the teaching leads were unable to answer were sent to the relevant deans and responses incorporated into the results. All curricula should include the essential learning outcomes that focus on clinical skills; as this was an audit to benchmark current practice, we did not set standards for the other recommendations for a core curriculum.

RESULTS

Replies were received from teaching leads in 29 of the 30 medical schools and from 16 of the deans. Essential clinical skills such as taking a dermatological history and examining the skin were included in the curricula of most, but not all, medical schools. Areas of good practice include teaching on tumours, acne and psoriasis, but we found some surprising omissions including the diagnosis of meningococcaemia. Our data suggest that some students have little exposure to dermatology, but dermatology teaching takes place in secondary care in all medical schools. Knowledge-based assessments are used by 27 medical schools.

CONCLUSIONS

Curricula should be strengthened so that the recommended learning outcomes feature in the core curricula of all medical schools. Teaching leads in all specialties, including those in the community, should communicate so that learning and teaching are integrated horizontally and vertically. The results should provide a baseline for future audits.