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

Use of real-time graphics in health education: A systematic review

Introduction: Using real-time graphics in health education is particularly relevant in technical skill development and knowledge acquisition in surgery, emergency medicine, and nursing. Objective: To systematize the literature on using real-time graphics in health education. Methods: A systematic review was conducted in the databases: PubMed, Scopus, Embase, Web of Science, Cochrane Library, CINAHL, and ERIC. Results: The impact of real-time graphics use, including virtual reality (VR), in health education was examined, covering disciplines such as medicine, nursing, and other related professions. The findings of the selected studies for this review and existing literature suggest that implementing real-time graphics technologies in health education can significantly improve learning and the acquisition of clinical skills compared to traditional approaches. Conclusions: Virtual reality was found to be particularly effective in training technical skills and surgical procedures and improving the quality of teaching in various disciplines. These findings support experiential learning theory and the idea that repeated practice and immediate feedback in a safe and controlled environment are essential for skill acquisition.

Changes in United States Residency Program Online Presence Following COVID-19

PHENOMENON

The 2020-2021 residency application cycle was subject to major alterations following the COVID-19 global pandemic. This study determined the online presence of US-based residency training programs during this time period.

APPROACH

An official list of accredited US residency programs for 24 medical specialties was obtained through the Electronic Residency Application Service Programs' online presence and was evaluated for website ownership in addition to Twitter, Instagram, and Facebook account ownership. Date of social media account foundation and virtual opportunities offered were recorded. Doximity Residency Navigator for 2020-2021 was used to determine program rank, and programs were stratified by location using Association of American Medical Colleges regions. Program rank and geographic location were used to determine potential trends in online presence. This study was performed during the residency application cycle from September 2, 2020, to November 29, 2020, during which applications were submitted and the interview cycle began.

FINDINGS

Fifty-seven percent of the 4,562 programs had a presence on social media. One-third of all accounts were created after March 1, 2020, and most (58%) were residency program-associated. A total of 1,315 programs offered virtual open houses through Twitter (829), Instagram (792), and Facebook (295). First-quartile programs had significantly more social media accounts per program on average (1.8) than those in subsequent quartiles, and Western region programs had significantly more accounts per program on average (1.3) than the Central (1.0), Northeastern (1.0), and Southern (1.1) regions.

INSIGHTS

US residency programs created social media accounts and online opportunities for applicants following March 1, 2020. Online interactions may serve as substitutes at a time when in-person interaction is not possible. Future studies may examine the influence and impact of virtual interactions.Supplemental data for this article is available online at https://doi.org/10.1080/10401334.2022.2047050.

Beyond Skin Deep: case-based online modules to teach multidisciplinary care in dermatology among clerkship students

BACKGROUND

Canadian medical schools offer limited clinical dermatology training. In addition, there is a lack of educational resources that are designed specifically for clerkship students that focus on the multidisciplinary nature of dermatology.

OBJECTIVES

After developing case-based educational resources to address the lack of clinical exposure and learning of multidisciplinary care in dermatology, this study aimed to evaluate the educational intervention and gather feedback for future module development.

METHODS

Ten online interactive dermatology case-based modules involving 14 other disciplines were created. Medical students (n = 89) from two Canadian schools were surveyed regarding perceptions of the existing dermatology curriculum. Among 89 students, 46 voluntarily completed the modules, and a survey (a five-point Likert scale ratings) including narrative feedback was provided to determine an improvement in dermatology knowledge and understanding of multidisciplinary care.

RESULTS

Among 89 surveyed students, only 17.1% agreed that their pre-clerkship dermatology education was sufficient and 10.2% felt comfortable managing patients with skin conditions in a clinical setting. Among 46 students, 95.7% of students agreed that the modules fit their learning style (4.17 ± 0.73 on Likert scale) with positive narrative feedback. 91.3% agreed or strongly agreed that the modules enhanced their dermatology knowledge (4.26 ± 0.61). 79.6% of students agreed that the modules helped with understanding the multidisciplinary nature of dermatological cases (3.98 ± 0.81). Student comfort to manage skin conditions increased 7.7 times from 10.2% to 78.3% post-module.

CONCLUSIONS

Clerkship students had limited knowledge of dermatologic conditions; the case-based modules were able to successfully address these deficits and assist students in understanding the multidisciplinary nature of dermatology.

Health sciences students' and instructors' perceptions of the emergency switch to virtual internship amid the COVID-19 pandemic: A case from Qatar

In efforts to contain the COVID-19 pandemic, health colleges at Qatar University shifted their clinical training to virtual internships (VI) and project-based learning (PBL). The shift was new to students and faculty alike, and a major change that posed many challenges. This study aimed to explore the experience of changing to VIs during the pandemic from both the clinical instructors' and health sciences students' perspectives. A qualitative study was conducted based on the framework of readiness to change. It involved focus group discussions with students from the departments of Public Health and Human Nutrition and in-depth interviews with clinical instructors using appropriate online platforms. A total of 4 focus groups with 20 students and 4 interviews with instructors were conducted. Transcripts were analyzed following the inductive-deductive approach. The major themes that emerged from the analysis described students' and clinical instructors' perceptions of the necessity and efficiency of the switch to VI; the design of the VI and the extent of the clinical/field experience and skills that it offered; confidence in the ability to succeed in this type of internship and confidence about reaching expected goals; academic and moral support from clinical faculty and coordinators and the communication process with faculty and preceptors; and finally, the benefits gained and how employers would view this type of internship. Health sciences students' readiness for VI was generally low. Several student and faculty needs have to be addressed, specifically regarding the design of the program and the level of preceptors' communication with students. The findings would direct health programs, clinical instructors, and preceptors to better understand students' needs and efficiently plan for virtual internships during not only emergencies but also whenever there is a need to deliver online experiential learning courses.

The Use of Teledermatology in Medical Education

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.

Free online dermatology course for medical trainees in Ethiopia: A pilot study

Background

The effectiveness of virtual dermatology curricula in developing countries remains unclear despite an urgent need due to the pandemic and other factors.

Objective

To compare a virtual dermatology curriculum deployed in Gondar, Ethiopia with a traditional in-person course.

Methods

We developed a free, on-line dermatology course. 104 trainees from the University of Gondar, Ethiopia, completed the course. Pre- and post-course surveys measuring self-reported proficiency were administered. End-of-Course surveys were distributed to elicit feedback on the course. Performance on final examinations was compared to a historical control group, which did not participate in the course but received standard in-person training.

Results

Compared to historical controls (n = 236), the pilot cohort (n = 104) averaged over 4 points higher on the final exam (P < .0001). Most participants were satisfied with all aspects of the on-line course and desire at least a component of virtual learning in the future.

Limitations

This pilot study was performed at a single institution, and the participants were not randomized. Further studies in demographically diverse cohorts are needed to validate the results.

Conclusion

This dermatology curriculum is a free, innovative platform that can be adapted for dermatology trainees in resource-limited settings.

Development and Implementation of DIGEST: The Digital Interactive Gastroenterology Education Suite for Trainees

INTRODUCTION

Clinical clerkship curricula should exist to provide rotating learners on subspecialty rotations with consistent exposure to specific topics geared toward the discipline of interest, such as pediatric gastroenterology (GI). We aim to describe our experience developing and implementing DIGEST: the Digital Interactive Gastroenterology Education Suite for Trainees, a novel, online GI curriculum delivered to virtual, rotating learners during the coronavirus (COVID-19) pandemic stay-at-home order.

MATERIALS AND METHODS

A general needs assessment in 2019 identified a lack of standardized educational experience amongst the rotating learners on pediatric GI service. The COVID-19 pandemic compelled us to transition our curriculum from our institution's secure share drive to the GOOGLE classroom. A program evaluation was undertaken and included learner responses to content and confidence questionnaires and a health care professions education (HPE) expert's response to a course quality assessment rubric.

RESULTS

Feasibility-the final DIGEST product was free of charge to create but incurred direct and indirect costs of time and training on behalf of the authors. Acceptance-7 possible learners participated and responded to the questionnaires (100% response rate). Learners reported a superior learning experience and increased confidence with DIGEST. An HPE expert reported that the course design of DIGEST met or exceeded expectations in all categories.

CONCLUSIONS

DIGEST is a novel pediatric GI curriculum for rotating learners that could be rapidly deployed, or adapted, for a wide range of clinical disciplines within the Military Health System.

Vascular Surgery Curriculum for Medical Students: A National Targeted Needs Assessment

BACKGROUND

At present, neither the American College of Surgeons (ACS) nor the Society for Vascular Surgery (SVS) provides curriculum recommendations for medical students rotating on a vascular surgery service. We sent a targeted needs assessment to vascular surgeons across the country in order to investigate the need for a structured curriculum for medical students participating in a vascular surgery rotation during their clinical clerkships.

METHODS

The survey was developed with input from medical students, vascular surgeons, and medical educators. Respondents were identified from the Fellowship and Residency Electronic Interactive Database (FREIDA). The needs assessment was sent to program directors of vascular residencies and fellowships and to other vascular surgery educators. The survey collected data regarding the existing vascular surgery curriculum at the respondent's institution, the need for a standardized curriculum, desired experiences for medical students, and important vascular topics for medical students to cover while on rotation.

RESULTS

Responses were obtained from 50 of the 146 surveyed individuals (response rate = 34.2%). 48 respondents (96%) worked in an academic hospital or academic affiliated hospital. With regard to the existing vascular surgery curriculum, only 28 respondents (61%) indicated that they had a curriculum approved by the surgery clerkship director. 37 respondents (77.1%) said there were at least goals and objectives for students on the vascular surgery service, and 29 respondents (60.4%) indicated that there was dedicated time for didactic sessions. Only 17 respondents (35.4%) indicated students gave a case presentation on the service. 29 respondents (63%) agreed or strongly agreed that there should be a standardized vascular curriculum for medical students. When asked to rank 9 topics from most important to least important for students to learn, respondents ranked peripheral arterial disease, aortic disease, and carotid disease highest. Simulation experience was most frequently indicated as a desired addition to the curriculum, and only 16 respondents (33.3%) reported opportunities for vascular surgery specific simulation experiences.

CONCLUSIONS

This study identified the lack of an existing structured curriculum for medical students, the desire for a standardized curriculum, and key topics and experiences that are felt to be important for students to cover.  With this information in hand, vascular educators have the potential to enhance the learning experience of medical students rotating through the service by developing a standardized curriculum.

Evaluating learning of medical students through recorded lectures in clinical courses

One solution offered by technology is learning through recorded lectures (RLs). The main objective of the study was to evaluate the efficacy of online RLs in learning of clinical courses at a School of Medicine. The study comprised four phases: (i) pre-post uncontrolled study to evaluate knowledge gain with RLs, (ii) non-randomised crossover study to compare learning with RL before or after a face-to-face lecture (FL), (iii) focus groups to evaluate perceptions from students about RLs and, (iv) randomised controlled trial to verify whether the addition of questions every 10 min and a summary webpage to an RL improve knowledge. Results showed that knowledge gain occurred through RLs and was similar to FLs. Additionally, either watching an RL after attending an FL or vice versa showed comparable additional knowledge gain. Furthermore, students were in favour of the use of RLs but not as a replacement of FLs. At last, the insertion of questions and a summary in RLs meant no additional knowledge gain. In conclusion, it is feasible to learn through RLs in clinical courses, but the importance given to FLs suggests adopting blended learning.

Implementation of an E-Learning Academic Elective for Hands-On Basic Surgical Skills to Supplement Medical School Surgical Education

OBJECTIVE

To examine the feasibility and utility of a completely online surgical skills elective for undergraduate medical students.

DESIGN

The fully asynchronous, one-week, online learning elective addressed surgical instrument identification, knot tying, and suturing. Tools for knowledge acquisition and self-practice were outlined and individualized performance feedback on technical skills performance was incorporated from peers and experts through video conference.

SETTING

University of Rochester School of Medicine & Dentistry, Rochester, NY.

PARTICIPANTS

A total of 86 third- and fourth-year medical students enrolled and successfully completed the elective.

RESULTS

At elective completion, nearly all students met their course objectives and significantly increased their confidence in surgical instrument identification, knot tying, and suturing. Objective measures of student knowledge and technical skills acquisition were overwhelmingly positive, and faculty and students were very satisfied with providing and receiving performance feedback. Students reported that expert feedback was more useful than peer feedback, and more students than faculty reported that the online modality was equivalent to an in-person session for performance review.

CONCLUSIONS

This innovative online surgical skills elective improved undergraduate medical student confidence, knowledge, and skillset with surgical instrument identification, knot tying, and suturing while also facilitating effective expert feedback on individual performance.

The sudden transition to synchronized online learning during the COVID-19 pandemic in Saudi Arabia: a qualitative study exploring medical students' perspectives

BACKGROUND

The closure of educational activities in the Kingdom of Saudi Arabia due to the ongoing COVID-19 pandemic resulted in an unplanned shift from traditional learning to a setup that exclusively involves digital teaching and learning. Within this context, the present study aimed to explore undergraduate medical students' perceptions regarding the effectiveness of synchronized online learning at Unaizah College of Medicine and Medical Sciences, Qassim University, Saudi Arabia.

METHODS

A qualitative study was conducted using virtual focus group discussions synchronously with the help of a discussion guide consisting of seven open-ended questions. Overall, 60 medical students were recruited using a maximum variation sampling technique; these students then participated in eight focus group discussions. All interviews were recorded, transcribed verbatim, and analyzed for thematic contents using the standard (Mayring, Kiger. M. E. and Braun.V) content analysis framework.

RESULTS

A thematic content analysis yielded four core themes: (1) educational impact, (2) time management, (3) challenges encountered, and (4) preferences for the future. The online modality was well-received, and all participants agreed that online sessions were time saving and that their performance was improved due to enhanced utility of time; however, they indicated that they encountered some challenges, including methodological, content perception, technical, and behavioral challenges during sessions and online exams. Most of the preclinical students preferred online learning for the upcoming academic years.

CONCLUSION

Synchronized online classes were well-accepted by the medical students. This represents significant and promising potential for the future of medical education. The principles of the online learning model and learning outcomes should be rigorously and regularly evaluated to monitor its effectiveness.

Continuing Dermatology Education for Rural Physician Assistants in Ghana: An Assessment of Needs and Effectiveness

PURPOSE

To assess the effectiveness of lectures for continuing medical education (CME) in dermatology in a global health setting and to determine provider and patient demographics of physician assistants (PAs) practicing in rural Ghana.

METHODS

Physician assistants from Ghana who attended dermatology lectures at the International Seminar for Physician Assistants in 2011 or 2014 were included in this study. Surveys were administered to participants to determine dermatology resource availability, commonly encountered skin diseases, and management practices. Quizzes were administered before and after CME dermatology lectures to assess short-term retention of lecture material.

RESULTS

In all, 353 PAs participated in this study. Physician assistants reported seeing an average of 55 patients per day. The most commonly seen skin diseases were infections, with antifungals and antibiotics being the most commonly prescribed medications. Dermatology-related complaints represented 9.5% of total clinic visits. Among practicing PAs, 23.2% reported having internet access. A total of 332 PAs completed the quizzes, and a statistically significant increase in test scores was noted in postlecture quizzes.

CONCLUSIONS

This study reinforces the importance of dermatology education for PAs practicing in rural areas of Ghana and lends insight to critical topics for dermatology curriculum development. In addition, the increase in test scores after CME sessions suggests that lectures are an effective tool for short-term retention of dermatology-related topics. Our study indicates that as the need for health workers increases globally and a paradigm shift away from the traditional physician model of care occurs, dermatology training of PAs is not only important but also achievable.

Does self-modulated learning vs. algorithm-regulated learning of dermatology morphology affect learning efficiency of medical students?

BACKGROUND

Deliberate practice is an important method of skill acquisition and is under-utilized in dermatology training. We delivered a dermatologic morphology training module with immediate feedback for first year medical students. Our goal was to determine whether there are differences in accuracy and learning efficiency between self- regulated and algorithm-regulated groups.

METHODS

First year medical students at the University of Calgary completed a dermatologic morphology module. We randomly assigned them to either a self-regulated arm (students removed cases from the practice pool at their discretion) or an algorithm-regulated arm (an algorithm determined when a case would be removed). We then administered a pre-survey, pre-test, post-test, and post-survey. Data collected included mean diagnostic accuracy of the practice sessions and tests, and the time spent practicing. The surveys assessed demographic data and student satisfaction.

RESULTS

Students in the algorithm-regulated arm completed more cases than the self-regulated arm (52.9 vs. 29.3, p<0.001) and spent twice as much time completing the module than the self-regulated participants (34.3 vs. 17.0 min., p<0.001). Mean scores were equivalent between the algorithm- and self-regulated groups for the pre-test (63% vs. 66%, n = 54) and post-test (90% vs. 86%, n = 10), respectively. Both arms demonstrated statistically significant improvement in the post-test.

CONCLUSION

Both the self-regulated and algorithm-regulated arms improved at post-test. Students spent significantly less time practicing in the self-directed arm, suggesting it was more efficient.

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/

The status of radiation oncology (RO) teaching to medical students in Europe

•

RO teaching is underrepresented in the curriculum of medical students in Europe.

•

RO is often taught and examined in modular courses.

•

E-learning, computer-based examination and OSCE are used in few institutions.

•

Clerkships and policies to enroll students in RO departments should be improved.

Aim

To provide an overview of Radiation Oncology (RO) teaching to medical students around Europe.

Materials and methods

An electronic survey was sent to European academic teachers of RO. The survey focused on the teaching of RO to medical students throughout their undergraduate education.

Results

A total of 87 academic RO teachers from 29 countries were invited to participate in the electronic survey. Thirty-two surveys were completed by respondents from 19 European countries (response rate: 37%). The median number of hours devoted to RO teaching was 10 h (mean 16 h, range 2–60). The number of hours assigned to RO teaching was equal or inferior compared to medical oncology. In two institutions (6%) RO was delivered as a stand-alone course with an individual knowledge assessment. In 30 institutions (94%), the RO course was taught and/or assessed in a modular curriculum with other disciplines. Radiobiology, breast, lung, gastrointestinal, gynecologic malignancies, RO adverse events and palliative RO were taught in 80% of institutions. Pediatric RO, RO for benign conditions and economic topics were taught in less than 30% of institutions. In most institutions, classical written and oral examinations were used. Computer-based examinations and/or objective structured clinical examinations (OSCE) were seldom used. E-learning methods were available in less than 10% of institutions. A clerkship in RO department was available in 28 out of 32 institutions (87%), less than 5% of medical students were involved in research in RO during their undergraduate education. Strategies to encourage medical students to consider RO as a future career were offered in 53% of institutions.

Conclusions

RO teaching to medical students was not uniform in Europe. RO teaching during undergraduate education in Europe was undervalued, and its knowledge and learning tools could be broadened and updated in the core curricula of medical students

Impact of standardized templates and skin cancer learning modules for teledermatology consultations

BACKGROUND

Little research has been done in teledermatology to examine the effects of standardized templates and subject-specific learning modules.

METHODS

We performed a prospective study examining the effects of standardized templates and standardized cutaneous oncology learning modules on teledermatology referrals at Mayo Clinic. This data was then compared to previous teledermatology referrals before standardized templates were adopted.

RESULTS

A total of 42 teledermatology consultations were performed during the 4-month study period. The use of standardized templates resulted in an absolute reduction in face-to-face referrals. Teledermatology consultation increased the absolute diagnostic and management concordance by 26.2% (P = 0.02) and 33.3% (P < 0.01), respectively, and decreased the absolute diagnostic and management discordance by 19.1% (P = 0.03) and 31.0% (P < 0.01), respectively. The largest knowledge gaps were identified in cutaneous oncology. Educational intervention improved theoretical referral rates and confidence in diagnosis and management overall.

CONCLUSION

The implementation of standardized intake templates reduces the rate of face-to-face referrals. Teledermatology improves primary care-based dermatological care and reduces theoretical referral rates.

Substitution of low-risk skin cancer hospital care towards primary care: A qualitative study on views of general practitioners and dermatologists

BACKGROUND

Rising healthcare expenditures places the potential for substitution of hospital care towards primary care high on the political agenda. As low-risk basal cell carcinoma (BCC) care is one of the potential targets for substitution of hospital care towards primary care the objective of this study is to gain insight in the views of healthcare professionals regarding substitution of skin cancer care, and to identify perceived barriers and potential strategies to facilitate substitution.

METHODS

A qualitative study was conducted consisting of 40 interviews with dermatologists and GPs and three focus groups with 18 selected GPs with noted willingness regarding substitution of skin cancer care. The interviews and focus groups focused on general views, perceived barriers and potential strategies to facilitate substitution of skin cancer care, using predefined topic lists. All sessions were audio-taped, transcribed verbatim and analyzed using the program AtlasTi.

RESULTS

GPs were generally positive regarding substitution of skin care whereas dermatologists expressed more concerns. Lack of trust in GPs to adequately perform skin cancer care and a preference of patients for dermatologists are reported as barriers by dermatologists. The main barriers reported by GPs were a lack of confidence in own skills to perform skin cancer care, a lack of trust from both patients and dermatologists and limited time and financial compensation. Facilitating strategies suggested by both groups mainly focused on improving GPs' education and improving the collaboration between primary and secondary care. GPs additionally suggested efforts from dermatologists to increase their own and patients' trust in GPs, and time and financial compensation. The selected group of GPs suggested practical solutions to facilitate substitution focusing on changes in organizational structure including horizontal referring, outreach models and practice size reduction.

CONCLUSIONS

GPs and, to lesser extent, dermatologists are positive regarding substitution of low-risk BCC care, though report substantial barriers that need to be addressed before substitution can be further implemented. Aside from essential strategies such as improving GPs' skin cancer education and time and financial compensation, rearranging the organizational structure in primary care and between primary and secondary care may facilitate effective and safe substitution of low-risk BCC care.

Objective Evaluation of a Didactic Curriculum for the Radiation Oncology Medical Student Clerkship

PURPOSE

A structured didactic radiation oncology clerkship curriculum for medical students is in use at multiple academic medical centers. Objective evidence supporting this educational approach over the traditional clerkship model is lacking. This study evaluated the curriculum efficacy using an objective knowledge assessment.

METHODS AND MATERIALS

Medical students received the Radiation Oncology Education Collaborative Study Group (ROECSG) curriculum consisting of 3 lectures (Overview of Radiation Oncology, Radiation Biology/Physics, and Practical Aspects of Simulation/Radiation Emergencies) and a radiation oncology treatment-planning workshop. A standardized 20-item multiple choice question (MCQ) knowledge assessment was completed pre- and post-curriculum and approximately 6 months after receiving the curriculum.

RESULTS

One hundred forty-six students at 22 academic medical centers completed the ROECSG curriculum from July to November 2016. One hundred nine students completed pre- and post-clerkship MCQ knowledge assessments (response rate 74.7%). Twenty-four students reported a prior rotation at a ROECSG institution and were excluded from analysis. Mean assessment scores increased from pre- to post-curriculum (63.9% vs 80.2%, P < .01). Mean MCQ knowledge subdomain assessment scores all improved post-curriculum (t test, P values < .01). Post-scores for students rotating de novo at ROECSG institutions (n = 30) were higher compared with pre-scores for students with ≥1 prior rotations at non-ROECSG institutions (n = 55) (77.3% vs 68.8%, P = .01), with an effect size of 0.8. Students who completed rotations at ROECSG institutions continued to demonstrate a trend toward improved performance on the objective knowledge assessment at approximately 6 months after curriculum exposure (70.5% vs 65.6%, P = .11).

CONCLUSIONS

Objective evaluation of a structured didactic curriculum for the radiation oncology clerkship at early and late time points demonstrated significant improvement in radiation oncology knowledge. Students who completed clerkships at ROECSG institutions performed objectively better than students who completed clerkships at non-ROECSG institutions. These results support including a structured didactic curriculum as a standard component of the radiation oncology clerkship.

Online Lectures in Undergraduate Medical Education: Scoping Review

BACKGROUND

The adoption of the flipped classroom in undergraduate medical education calls on students to learn from various self-paced tools-including online lectures-before attending in-class sessions. Hence, the design of online lectures merits special attention, given that applying multimedia design principles has been shown to enhance learning outcomes.

OBJECTIVE

The aim of this study was to understand how online lectures have been integrated into medical school curricula, and whether published literature employs well-accepted principles of multimedia design.

METHODS

This scoping review followed the methodology outlined by Arksey and O'Malley (2005). Databases, including MEDLINE, PsycINFO, Education Source, FRANCIS, ERIC, and ProQuest, were searched to find articles from 2006 to 2016 related to online lecture use in undergraduate medical education.

RESULTS

In total, 45 articles met our inclusion criteria. Online lectures were used in preclinical and clinical years, covering basic sciences, clinical medicine, and clinical skills. The use of multimedia design principles was seldom reported. Almost all studies described high student satisfaction and improvement on knowledge tests following online lecture use.

CONCLUSIONS

Integration of online lectures into undergraduate medical education is well-received by students and appears to improve learning outcomes. Future studies should apply established multimedia design principles to the development of online lectures to maximize their educational potential.

Development and Evaluation of a Web-Based Dermatology Teaching Tool for Preclinical Medical Students

INTRODUCTION

There is growing interest in, and emphasis on, electronic teaching tools in medicine. Despite relevant testing on the United States Medical Licensing Examination (USMLE), American medical schools offer limited training in skin disorders. Teaching visual topics like dermatology in classroom formats is challenging. We hypothesized that an electronic module would enhance students' dermatology competency.

METHODS

A self-directed, case-based module was created. To test its efficacy, 40 medical students were randomized to have module access (interventional group) or none (conventional group). Learning outcomes were compared using a multiple-choice exam, including questions relevant and irrelevant to the module. Outcomes included proportions of correctly answered module questions (module scores) and nonmodule questions (nonmodule scores). Difference scores were calculated: (module score) - (nonmodule score). Positive values indicated that knowledge of module questions surpassed that of nonmodule questions. If there were a training effect, the interventional group's difference score should exceed that of the conventional group.

RESULTS

The interventional group scored significantly higher than did the conventional group on module questions-75% (interquartile range [IQR], 69-88) versus 50% (IQR, 38-63), p < .001-and nonmodule questions-85% (IQR, 69-92) versus 69% (IQR, 54-77), p = .02. The Hodges-Lehman median difference estimate of the training effect was 13.0 (95% confidence interval, 0.5-25.5).

DISCUSSION

This e-module is effective at enhancing students' competency in dermatology while emphasizing detailed pathophysiology that prepares them for USMLE Step 1. A module-based curriculum may enhance learning in supplement to traditional teaching modalities.

Undergraduate Dermatology Education in Canada: A National Survey

Background:

Canadian dermatology curriculum was reviewed in 1983, 1987, 1996, and 2008. All these surveys highlighted the disproportionately low level of dermatology teaching in relation to the significant amount of skin disease seen by physicians. Since the official adoption and dissemination of the Canadian Professors of Dermatology (CPD) core curriculum and competencies, there has been no assessment of how these changes have influenced dermatology curriculum.

Objective:

This survey gathered information on the current status of undergraduate dermatology education across Canadian medical schools.

Methods:

A survey was sent electronically to all undergraduate dermatology directors at each of the 17 Canadian medical schools.

Results:

Between 2008 and 2017, dermatology teaching has increased 25% to 25.6 ± 17.2 hours of teaching. However, 75% of this teaching is delivered in preclinical years. The number of faculty members, both dermatologists and nondermatologists, has also increased. A growing number of schools are now using electronic formats of teaching. Most schools (59%) are covering all the CPD core curriculum topics.

Conclusion:

Dermatology education is demonstrating positive trends with regards to teaching hours and faculty members. Nevertheless, a more even distribution of content so that students have increased clinical exposure should be achieved. Furthermore, an online atlas of resources would be helpful in standardising curriculum.

Educational Impact of a Structured Radiation Oncology Clerkship Curriculum: An Interinstitutional Comparison

PURPOSE

Many medical school clerkships have structured curricula; however, most radiation oncology clerkships do not. The Radiation Oncology Education Collaborative Study Group (ROECSG) implemented a curriculum for fourth-year radiation oncology clerkships at 14 institutions. We hypothesized that students completing clerkships with the curriculum would report greater subjective knowledge and comfort to function as a radiation oncology resident compared with students completing clerkships without the curriculum.

METHODS

The ROECSG curriculum included three 1-hour lectures and a 1-hour hands-on radiation treatment planning workshop. Applicants to a single radiation oncology residency program in the 2014-2015 academic year were sent an anonymous, validated clerkship experience survey. Students indicated if clerkships were completed at a curriculum site. Likert-type data (1 = not at all, 5 = extremely) are reported as median (interquartile range).

RESULTS

Respondents described 276 clerkship experiences, of which 64 (23.2%) were completed at a curriculum site. Students whose first clerkship was at a curriculum site perceived greater postclerkship confidence in knowledge of radiation biology (3 [3-4] versus 2 [2-3], P < .01), treatment setup/positioning (3 [2-3] versus 2 [2-3], P < .05), treatment planning (3 [2-3] versus 2 [2-3], P < .01), and ability to integrate evidence-based medicine into treatment (4 [2-4] versus 3 [2-4], P < .05). Students who completed any clerkship with the curriculum had greater postclerkship confidence to function as a radiation oncology resident (3 [3-4] versus 3 [2-3], P < .05).

CONCLUSIONS

These results support the curriculum's ability to increase student knowledge in radiation oncology, especially in the students' first clerkship. Further, these findings suggest that expanded implementation of such curricula may ensure a rewarding educational experience during radiation oncology clerkships.

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.

Assessment of medical students' proficiency in dermatology: Are medical students adequately prepared to diagnose and treat common dermatologic conditions in the United States?

This study assessed whether a current medical school curriculum is adequately preparing medical students to diagnose and treat common dermatologic conditions. A 15-item anonymous multiple choice quiz covering fifteen diseases was developed to test students' ability to diagnose and treat common dermatologic conditions. The quiz also contained five items that assessed students' confidence in their ability to diagnose common dermatologic conditions, their perception of whether they were receiving adequate training in dermatology, and their preferences for additional training in dermatology. The survey was performed in 2014, and was completed by 85 students (79.4%). Many students (87.6%) felt that they received inadequate training in dermatology during medical school. On average, students scored 46.6% on the 15-item quiz. Proficiency at the medical school where the study was performed is considered an overall score of greater than or equal to 70.0%. Students received an average score of 49.9% on the diagnostic items and an average score of 43.2% on the treatment items. The findings of this study suggest that United States medical schools should consider testing their students and assessing whether they are being adequately trained in dermatology. Then schools can decide if they need to re-evaluate the timing and delivery of their current dermatology curriculum, or whether additional curriculum hours or clinical rotations should be assigned for dermatologic training.

An innovative approach to enhance dermatology competencies for advanced practice nurses: service–learning with a migrant farm worker health clinic

The purpose of this article is to describe a novel service–learning opportunity for graduate nursing students that promotes competency in dermatology. A hybrid service–learning course with online didactic content is described, along with tools for evaluation of dermatology competencies. Student evaluation of the course is discussed, and selected research articles are reviewed. Advanced practice nursing and medical education frequently does not adequately prepare primary care providers to be competent in the assessment and management of dermatologic conditions. Embedding dermatology content in a service–learning program can optimize the provision of care, strengthen competencies in dermatology and inter-professional care, and allow students to gain a deeper understanding of the population with which they work. The innovative service–learning program presented is a model for advanced practice nursing education. Tools for evaluating clinical competency and courses often need validation.