What are the learning outcomes of a short postgraduate training course in dermatology for primary care doctors?

Assessment of Primary Care Physicians' Expertise of Common Dermatological Conditions in the Jouf Region, Saudi Arabia: A Mixed Methods Study

Primary care physicians (PCPs) are the first line of defense for the management of common dermatological conditions (DCs). This study aimed to assess how dermatological diseases are identified, managed, and referred to in primary healthcare centers (PHCs). This was a mixed methods study comprising a cross-sectional survey and semi-structured interviews recruited through PHCs across the Jouf region of Saudi Arabia. Sixty-one PCPs completed the data, and eight participants were interviewed. A survey based on a sample of 22 photographs of common DCs in the Kingdom was administered to the participants to answer questions about the correct diagnosis, appropriate management, referral strategy, and encounter rate. In our sampled population, the mean overall knowledge level on a scale of 10 was 7.08 (±1.3). Among participants that had good to acceptable scores, 51 (83.6%) were in the overall knowledge parameter, 46 (75.4%) in the diagnosis parameter, and 49 (80.3%) in the management parameter. PCPs with five years or more of experience were found to have significantly higher overall knowledge and management scores. Most of our PCPs demonstrated sufficient knowledge of common DCs and had good to acceptable scores in all parameters. However, educational and regulatory aspects of PCPs' clinical management were identified. Focused training, provision of workshops, and improving medical school curricula regarding common DCs are recommended.

Designing and implementing equity-based pandemic preparedness and response learning modules: lessons from a multi-country short-course

BACKGROUND

The COVID-19 pandemic has had disproportionate impacts across race, social class, and geography. Insufficient attention has been paid to addressing the massive inequities worsened by COVID-19. In July 2020, Partners In Health (PIH) and the University of Global Health Equity (UGHE) delivered a four-module short course, 'An Equity Approach to Pandemic Preparedness and Response: Emerging Insights from COVID-19 Global Response Leaders.'

OBJECTIVE

We describe the design and use of a case-based, short-course education model to transfer knowledge and skills in equity approaches to pandemic preparedness and response.

METHODS

This course used case studies of Massachusetts and Navajo Nation in the US, and Rwanda to highlight examples of equity-centered pandemic response. Course participants completed a post-session assessment survey after each of the four modules. A mixed-method analysis was conducted to elucidate knowledge acquisition on key topics and assess participants' experience and satisfaction with the course.

RESULTS

Forty-four percent of participants identified, 'Immediate need for skills and information to address COVID-19' as their primary reason for attending the course. Participants reported that they are very likely (4.75 out of 5) to use the information, tools, or skills from the course in their work. The average score for content-related questions answered correctly was 82-88% for each session. Participants (~70-90%) said their understanding was Excellent or Very Good for each session. Participants expressed a deepened understanding of the importance of prioritizing vulnerable communities and built global solidarity.

CONCLUSION

The training contributed to a new level of understanding of the social determinants of health and equity issues surrounding pandemic preparedness and response. This course elucidated the intersection of racism and wealth inequality; the role of the social determinants of health in pandemic preparedness and response; and the impacts of neocolonialism on pandemic response in low- and middle-income countries.

Educational Interventions to Support Primary Care Provider Performance of Diagnostic Skin Cancer Examinations: A Systematic Literature Review

To our knowledge, there is no available standardized educational curriculum designed to promote the incorporation of skin cancer examinations and procedures into general practice. To explore the contemporary training landscape, we conducted a systematic review of educational interventions designed to support skin cancer diagnostic examinations by primary care providers (PCPs). Our review uniquely encompasses all PCPs, including practicing physicians, residents, and advanced practice practitioners (APPs). The objective of this study is to review and synthesize worldwide data on educational interventions addressing PCP performance of skin cancer diagnostic examinations. A systematic review was performed in MEDLINE, Cochrane, EMBASE, and Scopus for English language articles worldwide published from 2000 onwards. Articles were screened for eligibility, and possibly overlapping datasets were resolved. Data extracted included curriculum content, delivery format, and educational outcomes. This review followed the PRISMA guidelines. A total of 63 studies were selected for data inclusion with one addressing training for resident physicians, 4 for APPs, and the remainder for practicing physicians. Educational interventions included in this review reflect the pre-SARS-CoV-2 pandemic educational environment: half provided live/synchronous instruction of about 5-h duration on average, and a quarter featured interactive components. Less than a quarter of interventions included practice change as a specific reported outcome. Without sustainable practice change, the anticipated long-term benefits of early cancer detection in patients remain limited. Previous and existing educational interventions designed to support skin cancer detection by PCPs demonstrate heterogeneous curriculum content, delivery methods, and educational outcomes. An ideal intervention would teach consensus-derived clinical competencies, provide meaningful learner feedback, and measure outcomes, such as knowledge/competency, confidence/attitudes, and practice change, using validated instruments.

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.

Insight into the management of actinic keratosis: a qualitative interview study among general practitioners and dermatologists

BACKGROUND

The increasing incidence of actinic keratosis (AK) is causing a large burden on healthcare systems. The current management of patients with AK seems to vary within and between primary and secondary care; however, an in-depth understanding of healthcare providers' management of AK is currently lacking.

OBJECTIVES

To gain insight into the management of AK by exploring the underlying motives of current practices among general practitioners (GPs) and dermatologists in the Netherlands.

METHODS

A qualitative study was conducted consisting of semistructured individual interviews with 22 GPs and 18 dermatologists focusing on the underlying motives regarding AK management. A predefined topic list was used. All interviews were audiotaped, transcribed verbatim and inductively analysed by two researchers drawing on elements of grounded theory.

RESULTS

GPs reported conducting limited proactive clinical assessments of cutaneous photodamage due to a perceived lack of value, varying in their method of diagnosing AK. They mainly applied cryotherapy or referred to secondary care due to lack of experience, varying in their applications and providing mostly patient-driven follow-up care. They also reported a great need for guidelines due to a lack of knowledge of AK management. Dermatologists indicated pursuing proactive clinical assessments of cutaneous photodamage and the goal of providing guideline-driven AK care. However, patient preferences still largely influence both treatment choices and follow-up regimens. Furthermore, dermatologists reported the need to improve AK and skin cancer management in primary care.

CONCLUSIONS

For AK care to become more standardized and uniform in Dutch primary care, the implementation of guidelines and (continuing) education are needed to address the commonly reported barriers of lack of value, experience and knowledge among GPs. For efficient use of care among dermatologists, shared decision-making tools along with adequate (framing of) patient information may be useful.

The impact of confidence on clinical dental practice

INTRODUCTION

Increasing confidence through learning has the potential to change General Dental Practitioners' (GDPs) perceptions of clinical practice. By examining how changes in confidence influence the clinical practice of two cohorts of GDPs, during and following an extended period of postgraduate training, we show the importance of confidence to GDPs and that a lack of confidence is a primary reason why GDPs attend postgraduate training courses.

METHODS

A mixed-method approach was adopted for this study. Quantitative data were collected via a series of linked questionnaires; qualitative data were collected using focus group discussions, interviews and contemporaneous field notes. Analysis was undertaken using SPSS software and a phenomenological approach, respectively.

FINDINGS

Participants indicated an increase in confidence in their ability to undertake dental procedures, which led to an increase in confidence in communication skills, and their ability to undertake complex restorative procedures. This led to greater treatment acceptance by patients resulting in better "job satisfaction."

DISCUSSION

A sense of confidence is central to personal development and ongoing study, leading to first, an improved capability to perform tasks (competence); second, confidence is a product of the relationship and trust of those people associated with the individual/professional and third, the correct level of challenge is important to confidence.

CONCLUSIONS

The issue of confidence has not been looked at in postgraduate dentistry, but it is well recognised in medical education fields.

Healthcare utilization and management of actinic keratosis in primary and secondary care: a complementary database analysis

Background

The high prevalence of actinic keratosis (AK) requires the optimal use of healthcare resources.

Objectives

To gain insight in to the healthcare utilization of people with AK in a population‐based cohort, and the management of AK in a primary and secondary care setting.

Methods

A retrospective cohort study using three complementary data sources was conducted to describe the use of care, diagnosis, treatment and follow‐up of patients with AK in the Netherlands. Data sources consisted of a population‐based cohort study (Rotterdam Study), routine general practitioner (GP) records (Integrated Primary Care Information) and nationwide claims data (DRG Information System).

Results

In the population‐based cohort (Rotterdam Study), 69% (918 of 1322) of participants diagnosed with AK during a skin‐screening visit had no previous AK‐related visit in their GP record. This proportion was 50% for participants with extensive AK (i.e. ≥ 10 AKs; n = 270). Cryotherapy was the most used AK treatment by both GPs (78%) and dermatologists (41–56%). Topical agents were the second most used treatment by dermatologists (13–21%) but were rarely applied in primary care (2%). During the first AK‐related GP visit, 31% (171 of 554) were referred to a dermatologist, and the likelihood of being referred was comparable between low‐ and high‐risk patients, which is inconsistent with the Dutch general practitioner guidelines for ‘suspicious skin lesions’ from 2017. Annually, 40 000 new claims representing 13% of all dermatology claims were labelled as cutaneous premalignancy. Extensive follow‐up rates (56%) in secondary care were registered, while only 18% received a claim for a subsequent cutaneous malignancy in 5 years.

Conclusions

AK management seems to diverge from guidelines in both primary and secondary care. Underutilization of field treatments, inappropriate treatments and high referral rates without proper risk stratification in primary care, combined with extensive follow‐up in secondary care result in the inefficient use of healthcare resources and overburdening in secondary care. Efforts directed to better risk differentiation and guideline adherence may prove useful in increasing the efficiency in AK management.

What's already known about this topic?

The prevalence of actinic keratosis (AK) is high and, in particular, multiple AKs are a strong skin cancer predictor.

The high prevalence of AK requires optimal use of healthcare resources.

Nevertheless, (population based) AK healthcare utilization and management data are very rare.

What does this study add?

Although AK‐related care already consumes substantial resources, about 70% of the AK population has never received care.

Primary care AK management demonstrated underutilization of topical therapies and high referral rates without proper risk stratification, while in secondary care the extensive follow‐up schedules were applied.

This inefficient use of healthcare resources highlights the need for better harmonization and risk stratification to increase the efficiency of AK care.

Linked Comment: https://doi.org/10.1111/bjd.17862.

https://doi.org/10.1111/bjd.18269 available online

https://www.bjdonline.com/article/

Topical corticosteroids knowledge, attitudes, and practices of primary care physicians

OBJECTIVES

To assess knowledge, attitudes, and practices of primary care physicians (PCPs) toward topical corticosteroids (TCs). Methods: A cross-sectional, 53-item questionnaire based study on TCs was conducted among PCPs in Riyadh, Kingdom of Saudi Arabia between January and March 2015. A maximum score of 30 was calculated for the knowledge portion. Results: Out of 420 PCPs, 336 responded (80%). Most participants (89.6%) reported prescribing TCs. The mean knowledge score was 17.14 (SD=5.48). Only 39% PCPs correctly identified that there are 7 or 4 TCs potency groups (2 different classification systems). The MBBS/MD and diploma-certified physicians scored lower than board-qualified PCPs (p less than 0.05). Family medicine physicians scored higher than general practitioners (GPs) (p less than 0.05). Hospital-based PCPs scored better than private practice PCPs (p less than 0.05). Moreover, those who felt somewhat comfortable (32.5%) in treating dermatology patients were more knowledgeable (p less than 0.05). Lastly, 76.5% of physicians were interested in attending courses on dermatologic therapies.  Conclusion: Knowledge of TCs among PCPs was inadequate. Targeted educational interventions delivered by dermatologists are recommended.

Prevalence of dermatoses in dermatologic evaluation requests from patients admitted to a tertiary hospital for 10 years

Skin diseases are common in hospitalized patients. However, there is a lack of data concerning their frequency. The objective of this study is to evaluate the prevalence of dermatological diagnoses in hospitalized patients after consultation requested by nondermatologist physicians to the Department of Dermatology, Hospital de Clinicas de Porto Alegre period of 10 years. A total of 5685 patients were evaluated, representing an average of 48.2 patients per month. The five most frequent groups were infectious dermatoses(33.25%), eczematous dermatoses (11.49%), drug reactions (11.43%), vascular dermatoses (6.81%) and group of pruritus, prurigo nodularis and urticaria (hives) (4.71%).

Implementing a new teaching and learning strategy for CVAD care

BACKGROUND

Central venous access devices (CVADs) are now a fundamental part of contemporary healthcare. Despite having many advantages, there are also complications associated with them. Evidence suggests that educating and training health professionals who maintain CVADs is essential for preventing such complications, however, the most effective approach for this training has not been evaluated.

AIM

The aim of this study was to determine whether the introduction of an innovative educational intervention within a higher education institution (HEI) improved the confidence and knowledge of registered nurses dealing with CVADs.

METHODS

A survey design consisting of a self-completion questionnaire and open-ended questions was used.

RESULTS

This study demonstrated that nurses felt more confident following participation in the training. In addition, nurses discussed the advantages of training outside of the clinical setting as it provided them with a safe place to practise and gave them time to learn without interruption. The findings from this study suggest that the HEIs can provide an effective and safe environment for registered nurses to build confidence and knowledge in CVAD management.

Dermatological conditions presenting at the Emergency Department in Siena University Hospital from 2006 to 2011

BACKGROUND

Published studies on emergency dermatology consultations are few because there are few dermatology emergency units in the world. No study has yet described the Italian situation.

OBJECTIVES

To quantify and characterize patients evaluated in our dermatology emergency unit from 2006 to 2011.

METHODS

We studied personal details, diagnosis, annual trend of cases, emergency level and hospitalization of dermatology cases over the 6-year period.

RESULTS

A total of 12,226 patients were evaluated. The most numerous diagnostic group was infections (27.1%), followed by non-specific and descriptive diagnosis (22.5%), skin conditions caused by mechanical or physical agents (13.1%), eczematous diseases (10.5%), insect bites (9.5%) and urticaria/angio-oedema (8.8%). The most common indications for admission to hospital were skin conditions caused by mechanical or physical agents (33.3%), infections (27.5%), drug eruption (15.9%) and autoimmune or inflammatory disorders (7.4%). Emergency dermatology cases followed a variable annual trend, with more consultations in the summer months.

CONCLUSION

This is the first long-term retrospective analysis of a large series of dermatology emergency patients. It provides useful quantitative and qualitative information on cases for physicians and the national health system for the purposes of improving patient care and cost-effectiveness.

Improvement in self-reported confidence in nurses' professional skills in the emergency department

Background

The aim of this study was to assess nurses’ self-reported confidence in their professional skills before and after an extensive Emergency Department (ED) reform in Kanta-Häme Central Hospital.

Methods

Emergency nurses participated in transitional training commencing two years before the establishment of the new organization in 2007. Training was followed by weekly practical educational sessions in the new ED. During this process nurses improved their transition skills, defined house rules for the new clinic and improved their knowledge of new technology and instruments. The main processes involving critically ill ED patients were described and modelled with an electronic flow chart software.

During the transitional training nurses compiled lists of practical skills and measures needed in the ED. These were updated after feedback from physicians in primary and secondary care and head physicians in Kanta-Häme Central Hospital. The final 189-item list comprised 15 different categories, each containing from 4 to 35 items. Based on the work described above, a questionnaire was developed to reflect ED nurses’ skills in clinical measures but also to estimate the need for professional education and practical training. Nurses working in the ED were asked to fill the questionnaire in January 2007 (response rate 97%) and in January 2011 (response rate 98%).

Results

Nurses’ self-reported confidence in their professional skills improved significally in eight classes out of fifteen. These classes were cannulations, urinary catheterizations, patient monitoring, cardiac patients, equipment, triage and nurse practising, psychiatric patients as well as infection risk. Best results were noted in urinary catheterizations, patient monitoring and infection risk. When studying the group of nurses participating in both surveys in 2007 and 2011, improvements were observed in all fifteen categories. All but two of these changes were significant (p<0.05).

Conclusions

During an extensive reform of emergency services, we noted a significant improvement in the professional skills of nurses. This improvement was especially consistent among nurses working in the ED during the whole transition process. Nurses’ education and training program in the ED may be successfully put into practice when based on co-operation between nurses and physicians dedicated to emergency services.