- Email: [email protected]
Dermatology education in geriatric fellowship programs: a nationwide survey of program directors
Journal Pre-proof Dermatology education in geriatric fellowship programs: a nationwide survey of program directors Connie S. Zhong, MSc, Connie R. Shi, MD, Vinod E. Nambudiri, MD, MBA PII:
S0190-9622(19)32683-0
DOI:
https://doi.org/10.1016/j.jaad.2019.08.075
Reference:
YMJD 13799
To appear in:
Journal of the American Academy of Dermatology
Received Date: 21 July 2019 Revised Date:
25 August 2019
Accepted Date: 28 August 2019
Please cite this article as: Zhong CS, Shi CR, Nambudiri VE, Dermatology education in geriatric fellowship programs: a nationwide survey of program directors, Journal of the American Academy of Dermatology (2019), doi: https://doi.org/10.1016/j.jaad.2019.08.075. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2019 Published by Elsevier on behalf of the American Academy of Dermatology, Inc.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35
Title: Dermatology education in geriatric fellowship programs: a nationwide survey of program directors Running title: Dermatology education in geriatric fellowship programs Authors: Connie S. Zhong, MSc, 1,2 Connie R. Shi, MD, 1,2 Vinod E. Nambudiri, MD, MBA 1,2 1 2
Harvard Medical School Department of Dermatology, Brigham and Women’s Hospital, Boston, MA
Corresponding author:
Vinod Nambudiri, MD MBA Brigham and Women’s Hospital Department of Dermatology 221 Longwood Avenue, Boston, MA 02115 [email protected]
Keywords: medical education, dermatology, geriatrics, fellowship, subspecialty education coordinator Word Count: 500 Tables: 2 Number of references: 5 Funding sources: None Institutional Review Board Approval: Exempt by Partners Healthcare Institutional Review Board. Protocol No. 2019P000525. Conflicts of Interest: None
36
The growing elderly population has led to calls for more effective healthcare for aging
37
adults. There is a critical role for dermatology within geriatrics and geriatrics training programs
38
to manage common skin diseases in older people,1 prevent drug-related iatrogenic
39
complications,2 and detect cutaneous signs of elder abuse.3 A previous study explored geriatrics
40
education in dermatology programs, finding gaps in holistic treatment, including communication,
41
ethical issues, and safe prescribing.4 However, little is known about formal dermatology
42
curricula and education in geriatrics fellowship programs. Building upon a prior study that
43
examined dermatology education in internal medicine residency programs,5 we aimed to
44
characterize and identify gaps in dermatology education in geriatric fellowship programs.
45
Between May and June 2019, program directors of all 154 ACGME-accredited geriatrics
46
fellowship programs were invited to complete study surveys using the REDCap software
47
platform. Descriptive statistics and multiple logistic regression models were performed in SPSS
48
version 24 (IBM Corp).
49
Fifty-five (35.7%) out of the 154 programs responded to the survey. All fellowships were
50
one year in length, and responding programs were representative of the national distribution
51
(Table 1). Twenty-two (40%) geriatrics programs did not offer dermatology clinical experience,
52
and only 3 (5.5%) programs had an identified dermatology subspecialty coordinator (i.e. a
53
physician guiding the curriculum). Five (9.1%) programs had mandatory dermatology clinic
54
rotations, and three (5.5%) had longitudinal dermatology experiences throughout the year. Most
55
clinical experiences (70.9%) comprised fewer than 5 half-day clinic sessions over the course of
56
fellowship. The most common dermatology learning experiences offered were formal
57
dermatology didactic lectures and board review, with few educational experiences in procedural
58
skills or inpatient dermatology (Table 1).
59
Sixty percent (33/55) of responding programs were at institutions with a dermatology
60
residency program. The presence of a dermatology residency program was associated with
61
higher odds of having greater than 5 half-day dermatology clinic sessions for geriatrics fellows
62
(odds ratio = 4.12, 95% CI 1.01-16.76) (Table 2). The presence of a dermatology residency
63
program was also associated with a non-significant increase in odds of having outpatient clinical
64
experiences and dermatology faculty discussants at teaching conferences (Table 2). Multivariate
65
logistic regression revealed no statistically significant associations between fellowship program
66
demographics (e.g. geographic region, setting, hospital type, and number of fellows per year) and
67
presence of dermatology clinical experience.
68
This study provides insight into dermatology education in geriatrics fellowship programs,
69
highlighting gaps in dermatology education and offering opportunity to strengthen dermatology
70
exposure for geriatrics trainees. Almost half of responding programs did not offer dermatology
71
experiences in their fellowship programs, and of those that did, only 14% (5/35) had mandatory
72
clinical experiences. While the presence of a dermatology residency was associated with longer
73
dermatology clinical experiences, geriatrics programs do not need to have an associated
74
dermatology program or subspecialty coordinator to implement dermatology clinical experiences.
75
Our survey’s somewhat low response rate may have led to bias, though respondents reflected a
76
national distribution. Dermatologists should consider increasing their involvement in
77
dermatology education in geriatrics training to augment effective care for skin disease in the
78
growing elderly population.
79
80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98
References
1.
2. 3.
4.
5.
Linos E, Chren M-M, Covinsky K. Geriatric Dermatology—A Framework for Caring for Older Patients With Skin Disease. JAMA Dermatology. 2018;154(7):757. doi:10.1001/jamadermatol.2018.0286 Endo JO, Wong JW, Norman RA, Chang ALS. Geriatric dermatology. J Am Acad Dermatol. 2013;68(4):521.e1-521.e10. doi:10.1016/j.jaad.2012.10.063 Chang ALS, Wong JW, Endo JO, Norman RA. Geriatric dermatology: Part II. Risk factors and cutaneous signs of elder mistreatment for the dermatologist. J Am Acad Dermatol. 2013;68(4):533.e1-533.e10. doi:10.1016/j.jaad.2013.01.001 Endo J, Awe A, Reddy ST, Hirshfield LE, Kamin C, Lineberry M. Geriatrics Curriculum Needs Assessment for Dermatology Residency Programs. J Grad Med Educ. 2018;10(6):657-664. doi:10.4300/JGME-D-18-00183.1 Shi CR, Katz JT, Vleugels RA, Nambudiri VE. Dermatology education in internal medicine residency programs: A nationwide survey of program directors. J Am Acad Dermatol. May 2018. doi:10.1016/j.jaad.2017.07.062
99 100 101 102 103 104 105 106
Tables Table 1: Demographic characteristics and dermatology educational opportunities offered by surveyed geriatric fellowship programs; N = 55 Table 2: Odds of geriatric fellowship programs offering dermatology education experiences based on the presence of a dermatology residency program.
107 108 109
Table 1: Demographic characteristics and dermatology educational opportunities offered by surveyed geriatric fellowship programs; N = 55 Program characteristics Census region Northeast South Midwest West Setting Urban Suburban Rural Hospital type University-based academic medical center Community hospital VA hospital Number of fellows per PGY year 1 2 3 4 5 6 or more Dermatology subspecialty education coordinator Yes Subspecialty education coordinator is a dermatologist No Dermatology clinical experience Mandatory clinic rotation that all fellows must complete Optional clinic rotation Other experience No How clinical experience is offered Longitudinally throughout the year Discrete block Not applicable/not offered Length of dermatology clinical experience Fewer than 5 half-day clinic sessions Between 5-10 half-day clinic sessions Between 11-20 half-day clinic sessions Greater than 20 half-day clinic sessions
N (%)
National Data*
14 (25.5) 19 (34.5) 13 (23.6) 9 (16.4)
31.2% 31.8% 22.1% 14.9%
37 (67.3) 13 (23.6) 5 (9.1) 35 (63.6) 18 (32.7) 2 (3.6) 10 (18.2) 21 (38.2) 10 (18.2) 6 (10.9) 4 (7.3) 4 (7.3) 3 (5.5) 3 (100) 52 (94.5) 5 (9.1) 20 (36.4) 10 (18.2) 22 (40.0) 3 (5.5) 25 (45.5) 27 (49.1) 39 (70.9) 9 (16.4) 6 (10.9) 1 (1.8)
110 111 112 113 114
Dermatology learning experiences offered Formal dermatology didactic lectures 25 (45.5) Dermatology procedural skills workshops 2 (3.6) Board Review 23 (41.8) Outpatient dermatology clinic 19 (34.5) Inpatient dermatology consultation services 1 (1.8) Dermatology faculty discussants at clinical teaching conferences 7 (12.7) Other 10 (18.2) Site of dermatology residency Yes 33 (60) No 22 (40) *From programs represented in FREIDA, the American Medical Association Residency & Fellowship Database
115 116 117
Table 2: Odds of geriatric fellowship programs offering dermatology educational experiences based on the presence of a dermatology residency program, *p < 0.05 Presence of dermatology residency program Yes Yes Yes Yes Yes Yes Yes Yes Yes
118 119 120 121
Dermatology education experience Odds Ratio
95% Confidence Interval
Presence of dermatology clinical experience More than 5 half-day dermatology clinic sessions Presence of a dermatology subspecialty education coordinator Formal dermatology didactic lectures Dermatology procedural skills workshops Board Review Experiences in outpatient dermatology clinic Experiences in inpatient dermatology consultation services Dermatology faculty discussants at clinical teaching conferences
1.07
0.36- 3.20
4.12
1.01-16.76*
1.10
0.99-1.23
1.36
0.46- 4.04
1.36
0.46-4.04
0.78 2.51
0.26-2.32 0.75-8.43
0.96
0.87-1.05
1.79
0.31-10.15
S0190-9622(19)32683-0
DOI:
https://doi.org/10.1016/j.jaad.2019.08.075
Reference:
YMJD 13799
To appear in:
Journal of the American Academy of Dermatology
Received Date: 21 July 2019 Revised Date:
25 August 2019
Accepted Date: 28 August 2019
Please cite this article as: Zhong CS, Shi CR, Nambudiri VE, Dermatology education in geriatric fellowship programs: a nationwide survey of program directors, Journal of the American Academy of Dermatology (2019), doi: https://doi.org/10.1016/j.jaad.2019.08.075. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2019 Published by Elsevier on behalf of the American Academy of Dermatology, Inc.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35
Title: Dermatology education in geriatric fellowship programs: a nationwide survey of program directors Running title: Dermatology education in geriatric fellowship programs Authors: Connie S. Zhong, MSc, 1,2 Connie R. Shi, MD, 1,2 Vinod E. Nambudiri, MD, MBA 1,2 1 2
Harvard Medical School Department of Dermatology, Brigham and Women’s Hospital, Boston, MA
Corresponding author:
Vinod Nambudiri, MD MBA Brigham and Women’s Hospital Department of Dermatology 221 Longwood Avenue, Boston, MA 02115 [email protected]
Keywords: medical education, dermatology, geriatrics, fellowship, subspecialty education coordinator Word Count: 500 Tables: 2 Number of references: 5 Funding sources: None Institutional Review Board Approval: Exempt by Partners Healthcare Institutional Review Board. Protocol No. 2019P000525. Conflicts of Interest: None
36
The growing elderly population has led to calls for more effective healthcare for aging
37
adults. There is a critical role for dermatology within geriatrics and geriatrics training programs
38
to manage common skin diseases in older people,1 prevent drug-related iatrogenic
39
complications,2 and detect cutaneous signs of elder abuse.3 A previous study explored geriatrics
40
education in dermatology programs, finding gaps in holistic treatment, including communication,
41
ethical issues, and safe prescribing.4 However, little is known about formal dermatology
42
curricula and education in geriatrics fellowship programs. Building upon a prior study that
43
examined dermatology education in internal medicine residency programs,5 we aimed to
44
characterize and identify gaps in dermatology education in geriatric fellowship programs.
45
Between May and June 2019, program directors of all 154 ACGME-accredited geriatrics
46
fellowship programs were invited to complete study surveys using the REDCap software
47
platform. Descriptive statistics and multiple logistic regression models were performed in SPSS
48
version 24 (IBM Corp).
49
Fifty-five (35.7%) out of the 154 programs responded to the survey. All fellowships were
50
one year in length, and responding programs were representative of the national distribution
51
(Table 1). Twenty-two (40%) geriatrics programs did not offer dermatology clinical experience,
52
and only 3 (5.5%) programs had an identified dermatology subspecialty coordinator (i.e. a
53
physician guiding the curriculum). Five (9.1%) programs had mandatory dermatology clinic
54
rotations, and three (5.5%) had longitudinal dermatology experiences throughout the year. Most
55
clinical experiences (70.9%) comprised fewer than 5 half-day clinic sessions over the course of
56
fellowship. The most common dermatology learning experiences offered were formal
57
dermatology didactic lectures and board review, with few educational experiences in procedural
58
skills or inpatient dermatology (Table 1).
59
Sixty percent (33/55) of responding programs were at institutions with a dermatology
60
residency program. The presence of a dermatology residency program was associated with
61
higher odds of having greater than 5 half-day dermatology clinic sessions for geriatrics fellows
62
(odds ratio = 4.12, 95% CI 1.01-16.76) (Table 2). The presence of a dermatology residency
63
program was also associated with a non-significant increase in odds of having outpatient clinical
64
experiences and dermatology faculty discussants at teaching conferences (Table 2). Multivariate
65
logistic regression revealed no statistically significant associations between fellowship program
66
demographics (e.g. geographic region, setting, hospital type, and number of fellows per year) and
67
presence of dermatology clinical experience.
68
This study provides insight into dermatology education in geriatrics fellowship programs,
69
highlighting gaps in dermatology education and offering opportunity to strengthen dermatology
70
exposure for geriatrics trainees. Almost half of responding programs did not offer dermatology
71
experiences in their fellowship programs, and of those that did, only 14% (5/35) had mandatory
72
clinical experiences. While the presence of a dermatology residency was associated with longer
73
dermatology clinical experiences, geriatrics programs do not need to have an associated
74
dermatology program or subspecialty coordinator to implement dermatology clinical experiences.
75
Our survey’s somewhat low response rate may have led to bias, though respondents reflected a
76
national distribution. Dermatologists should consider increasing their involvement in
77
dermatology education in geriatrics training to augment effective care for skin disease in the
78
growing elderly population.
79
80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98
References
1.
2. 3.
4.
5.
Linos E, Chren M-M, Covinsky K. Geriatric Dermatology—A Framework for Caring for Older Patients With Skin Disease. JAMA Dermatology. 2018;154(7):757. doi:10.1001/jamadermatol.2018.0286 Endo JO, Wong JW, Norman RA, Chang ALS. Geriatric dermatology. J Am Acad Dermatol. 2013;68(4):521.e1-521.e10. doi:10.1016/j.jaad.2012.10.063 Chang ALS, Wong JW, Endo JO, Norman RA. Geriatric dermatology: Part II. Risk factors and cutaneous signs of elder mistreatment for the dermatologist. J Am Acad Dermatol. 2013;68(4):533.e1-533.e10. doi:10.1016/j.jaad.2013.01.001 Endo J, Awe A, Reddy ST, Hirshfield LE, Kamin C, Lineberry M. Geriatrics Curriculum Needs Assessment for Dermatology Residency Programs. J Grad Med Educ. 2018;10(6):657-664. doi:10.4300/JGME-D-18-00183.1 Shi CR, Katz JT, Vleugels RA, Nambudiri VE. Dermatology education in internal medicine residency programs: A nationwide survey of program directors. J Am Acad Dermatol. May 2018. doi:10.1016/j.jaad.2017.07.062
99 100 101 102 103 104 105 106
Tables Table 1: Demographic characteristics and dermatology educational opportunities offered by surveyed geriatric fellowship programs; N = 55 Table 2: Odds of geriatric fellowship programs offering dermatology education experiences based on the presence of a dermatology residency program.
107 108 109
Table 1: Demographic characteristics and dermatology educational opportunities offered by surveyed geriatric fellowship programs; N = 55 Program characteristics Census region Northeast South Midwest West Setting Urban Suburban Rural Hospital type University-based academic medical center Community hospital VA hospital Number of fellows per PGY year 1 2 3 4 5 6 or more Dermatology subspecialty education coordinator Yes Subspecialty education coordinator is a dermatologist No Dermatology clinical experience Mandatory clinic rotation that all fellows must complete Optional clinic rotation Other experience No How clinical experience is offered Longitudinally throughout the year Discrete block Not applicable/not offered Length of dermatology clinical experience Fewer than 5 half-day clinic sessions Between 5-10 half-day clinic sessions Between 11-20 half-day clinic sessions Greater than 20 half-day clinic sessions
N (%)
National Data*
14 (25.5) 19 (34.5) 13 (23.6) 9 (16.4)
31.2% 31.8% 22.1% 14.9%
37 (67.3) 13 (23.6) 5 (9.1) 35 (63.6) 18 (32.7) 2 (3.6) 10 (18.2) 21 (38.2) 10 (18.2) 6 (10.9) 4 (7.3) 4 (7.3) 3 (5.5) 3 (100) 52 (94.5) 5 (9.1) 20 (36.4) 10 (18.2) 22 (40.0) 3 (5.5) 25 (45.5) 27 (49.1) 39 (70.9) 9 (16.4) 6 (10.9) 1 (1.8)
110 111 112 113 114
Dermatology learning experiences offered Formal dermatology didactic lectures 25 (45.5) Dermatology procedural skills workshops 2 (3.6) Board Review 23 (41.8) Outpatient dermatology clinic 19 (34.5) Inpatient dermatology consultation services 1 (1.8) Dermatology faculty discussants at clinical teaching conferences 7 (12.7) Other 10 (18.2) Site of dermatology residency Yes 33 (60) No 22 (40) *From programs represented in FREIDA, the American Medical Association Residency & Fellowship Database
115 116 117
Table 2: Odds of geriatric fellowship programs offering dermatology educational experiences based on the presence of a dermatology residency program, *p < 0.05 Presence of dermatology residency program Yes Yes Yes Yes Yes Yes Yes Yes Yes
118 119 120 121
Dermatology education experience Odds Ratio
95% Confidence Interval
Presence of dermatology clinical experience More than 5 half-day dermatology clinic sessions Presence of a dermatology subspecialty education coordinator Formal dermatology didactic lectures Dermatology procedural skills workshops Board Review Experiences in outpatient dermatology clinic Experiences in inpatient dermatology consultation services Dermatology faculty discussants at clinical teaching conferences
1.07
0.36- 3.20
4.12
1.01-16.76*
1.10
0.99-1.23
1.36
0.46- 4.04
1.36
0.46-4.04
0.78 2.51
0.26-2.32 0.75-8.43
0.96
0.87-1.05
1.79
0.31-10.15