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Efficacy of a multimodality curriculum in a pigmented lesion clinic to teach dermatoscopy to dermatology residents
P6504
P6563
Are dermatology residents adequately prepared for the business of medicine? Rajiv I. Nijhawan, MD, St. Luke’s-Roosevelt Hospital Centers and Beth Israel Medical Centers, New York, NY, United States; Kavita Mariwalla, MD, St. Luke’sRoosevelt Hospital Centers and Beth Israel Medical Center, New York, NY, United States; Lauren A. Smith, MD, New York University School of Medicine, New York, NY, United States; Thomas E. Rohrer, MD, SkinCare Physicians, Chestnut Hill, MA, United States New physicians of all specialties spend valuable time at the beginning of their careers learning the basics of practice management. To assess current dermatology residents’ knowledge, education, exposure, and comfort level as it relates to billing and coding, a 16-question survey was administered to all attendees of the Practice Management Symposium for Residents held at the 70th Annual Meeting of the American Academy of Dermatology. The majority of respondents (85/182; 46.7%) reported being only somewhat comfortable with coding for office visits and basic dermatologic procedures. Forty-nine out of 174 (28.2%) respondents reported not having any didactic sessions on how to code for dermatologic visits. Yet, the majority (117/179; 65.4%) reported completing their own billing 75% to 100% of the time. The majority of residents (113/178; 64.5%) reported receiving feedback from their attendings\25% of the time or never. Most residents (174/181; 96.1%) reported that learning billing and coding during residency as being somewhat or extremely important. Our study results suggest that a more standardized curriculum as it relates to the business of medicine is desired by current dermatology residents to guarantee well-prepared graduates as they enter the practice of medicine.
Dermpedia.org: An online project created to advance the field of dermatology by organizing the knowledge and experience acquired by clinicians worldwide Neal Kumar, Tufts University School of Medicine, Boston, MA, United States; Catherine Buzney, Tufts University School of Medicine, Boston, MA, United States Dermpedia.org (Dermpedia) is a web site devoted to collecting and disseminating the ever-expanding knowledge, science, and experience of dermatology across the globe. In creating a wiki-style, interactive, user-driven online community, Dermpedia uses the concept of ‘‘crowd sourcing’’ enabled by modern web technology to leverage mass collaboration. Cases posted online are organized by different criteria such as diagnosis and linked to various collections, research projects, and digital textbooks. Because these cases capture a wide range of clinical scenarios and diagnostic dilemmas, Dermpedia provides a platform for dermatologists, residents, and medical students to share as well as discuss experiences in the field, thus achieving the web site’s education goals. In contrast to printed textbooks which present dated, established knowledge, Dermpedia contains a wiki-style usereditable textbook which enables limitless case examples uploaded by clinicians and a previously unachievable depth of illustration for each disease entity. Furthermore, Dermpedia serves as an online community for clinicians, encouraging these individuals to create their own collections, present information about themselves or their institutions, publish teaching cases, and promote discussion around these examples. Dermpedia’s web technologies also enable users to host grand rounds, courses, seminars, self-assessment modules, and collaborative research projects. Dermpedia’s website technology, built with custom functionality on the Drupal platform, is managed by a medical student with support from an international physician advisory board. Within just 3 years following web site development, membership has rapidly grown to 2500 individuals. Dermpedia membership is free of charge to all users as the website is now entirely funded by revenue from an annual stationary Dermpedia Continuing Medical Education (CME) course. The web site also sees over 13,000 unique visitors each month, with 108,990 unique visitors in 2011. Its content currently includes 1296 cases and 9850 images; the top 5 search keywords of visitors are ‘‘lichen planus,’’ ‘‘granuloma annulare,’’ ‘‘pemphigus vulgaris,’’ ‘‘pityriasis rosea,’’ and ‘‘seborrheic dermatitis.’’ In creating a free, online, sustainable medical society, Dermpedia aims to harness the collective knowledge of clinicians worldwide in efforts to strengthen education and thus optimize patient care within the field of dermatology.
Commercial support: None identified.
Commercial support: None identified.
P6041 Dermatologic needs of an underserved patient population Danielle Tartar, PhD, University of Missouri-Columbia, Columbia, MO, United States; LeAnna Lane, MD, University of Missouri-Columbia, Columbia, MO, United States; Whitney Hovenic, MD, University of Missouri-Columbia, Columbia, MO, United States Background: In 2011, 16.3% of the US population lacked health insurance (US Census Bureau). Free health care clinics frequently are the sole means by which patients can access specialty care such as dermatology. The risk of dermatologic disease in the indigent population is high given greater sun exposure and lower emphasis on preventative care. MedZou Clinic offers free dermatology services to uninsured patients. This monthly clinic is staffed by medical students from the University of Missouri and is overseen by volunteer resident and attending physicians. Services available include diagnosis and management, free or low-cost prescriptions, laboratory testing and minor procedures. Methods: We performed a retrospective chart review of previously seen patients and a prospective study of new and return patient demographics including age, employment status, housing status, educational level achieved, and drug and alcohol use. Our goal was to describe the most common dermatologic conditions for which this population seeks care and to identify demographic factors to better serve patient needs. Results: Average patient age was 38.9 (range, 14-64 years) and 62% were female. Over a third (38.4%) of respondents chose housing status ‘‘homeless’’ versus ‘‘own’’ or ‘‘rent.’’ The most frequent diagnosis made was benign pigmented nevus (16%), second was eczema (13%) followed closely by acne (12%). The most common comorbidities in our patient population were psychiatric, with 23% of our patients having a diagnosed psychiatric condition including depression and bipolar disorder. Discussion: The diagnoses seen in our population were surprisingly similar to those of insured patients seen in dermatology clinics. This was despite the high proportion of homeless patients, who have previously been described to have more acute conditions, such as cutaneous infections. As dermatologists are available only monthly at MedZou clinic, it is likely that acute complaints are managed elsewhere. The most common diagnosis of benign pigmented nevus perhaps indicates that uninsured patients may wait to seek out dermatologic care until they are concerned about cancer such as melanoma. Our data indicate common needs between insured and uninsured patients. However, access to specialty dermatology care for the uninsured is woefully inadequate. There is clearly room for growth in our specialty to reach out to this population. Commercial support: None identified.
APRIL 2013
P6571 Efficacy of a multimodality curriculum in a pigmented lesion clinic to teach dermatoscopy to dermatology residents Amy Cao, The Ottawa Hospital, Ottawa, Canada; Jennifer Beecker, MD, The Ottawa Hospital, Ottawa, Canada Background: Dermatoscopy is a useful tool in assessing worrisome pigmented lesions, and its use has increased rapidly in recent years. It is particularly useful for assessing early melanoma, and determining the need for biopsy. As such, it has become a fundamental skill for dermatologists to acquire. Despite this, many sources note that dermatology residents often lack formal training in dermatoscopy. Objectives: This study aims to evaluate the efficacy of a novel multi-modality pilot learning program in which residents are trained in the use of dermatoscopy and total body imaging as a tool in the diagnosis of melanoma. Methods: A learning program will be designed to include the following components: a short educational computer based module, followed by a few sessions with an expert dermatologist in a Pigmented Lesion Clinic. Volunteer dermatology residents will be asked to fill out a questionnaire before and after this multimodality curriculum to assess for any changes in their skills, knowledge base, and confidence levels. The primary outcome will be to determine if there are any changes in the residents’ pre- and posttraining knowledge score. Secondary outcome will be to determine their satisfaction with the educational program, and any perceived changes in competency and confidence levels. Results: Study currently in progress. Results are expected to be gathered by midsummer, with conclusions to be determined at that time. It is hoped that the use of multiple learning methods, including a visual computer-based curriculum followed by direct one-on-one hands-on teaching with patients will address the different learning styles that adult learners may require for optimal knowledge and skill acquisition. If this pilot program is effective, it could be replicated by other residency programs to aid in teaching the essential skill of dermatoscopy to dermatology residents. This information could have a broader educational significance and perhaps improve the way future dermatologists examine the skin. Commercial support: None identified.
J AM ACAD DERMATOL
AB91
P6563
Are dermatology residents adequately prepared for the business of medicine? Rajiv I. Nijhawan, MD, St. Luke’s-Roosevelt Hospital Centers and Beth Israel Medical Centers, New York, NY, United States; Kavita Mariwalla, MD, St. Luke’sRoosevelt Hospital Centers and Beth Israel Medical Center, New York, NY, United States; Lauren A. Smith, MD, New York University School of Medicine, New York, NY, United States; Thomas E. Rohrer, MD, SkinCare Physicians, Chestnut Hill, MA, United States New physicians of all specialties spend valuable time at the beginning of their careers learning the basics of practice management. To assess current dermatology residents’ knowledge, education, exposure, and comfort level as it relates to billing and coding, a 16-question survey was administered to all attendees of the Practice Management Symposium for Residents held at the 70th Annual Meeting of the American Academy of Dermatology. The majority of respondents (85/182; 46.7%) reported being only somewhat comfortable with coding for office visits and basic dermatologic procedures. Forty-nine out of 174 (28.2%) respondents reported not having any didactic sessions on how to code for dermatologic visits. Yet, the majority (117/179; 65.4%) reported completing their own billing 75% to 100% of the time. The majority of residents (113/178; 64.5%) reported receiving feedback from their attendings\25% of the time or never. Most residents (174/181; 96.1%) reported that learning billing and coding during residency as being somewhat or extremely important. Our study results suggest that a more standardized curriculum as it relates to the business of medicine is desired by current dermatology residents to guarantee well-prepared graduates as they enter the practice of medicine.
Dermpedia.org: An online project created to advance the field of dermatology by organizing the knowledge and experience acquired by clinicians worldwide Neal Kumar, Tufts University School of Medicine, Boston, MA, United States; Catherine Buzney, Tufts University School of Medicine, Boston, MA, United States Dermpedia.org (Dermpedia) is a web site devoted to collecting and disseminating the ever-expanding knowledge, science, and experience of dermatology across the globe. In creating a wiki-style, interactive, user-driven online community, Dermpedia uses the concept of ‘‘crowd sourcing’’ enabled by modern web technology to leverage mass collaboration. Cases posted online are organized by different criteria such as diagnosis and linked to various collections, research projects, and digital textbooks. Because these cases capture a wide range of clinical scenarios and diagnostic dilemmas, Dermpedia provides a platform for dermatologists, residents, and medical students to share as well as discuss experiences in the field, thus achieving the web site’s education goals. In contrast to printed textbooks which present dated, established knowledge, Dermpedia contains a wiki-style usereditable textbook which enables limitless case examples uploaded by clinicians and a previously unachievable depth of illustration for each disease entity. Furthermore, Dermpedia serves as an online community for clinicians, encouraging these individuals to create their own collections, present information about themselves or their institutions, publish teaching cases, and promote discussion around these examples. Dermpedia’s web technologies also enable users to host grand rounds, courses, seminars, self-assessment modules, and collaborative research projects. Dermpedia’s website technology, built with custom functionality on the Drupal platform, is managed by a medical student with support from an international physician advisory board. Within just 3 years following web site development, membership has rapidly grown to 2500 individuals. Dermpedia membership is free of charge to all users as the website is now entirely funded by revenue from an annual stationary Dermpedia Continuing Medical Education (CME) course. The web site also sees over 13,000 unique visitors each month, with 108,990 unique visitors in 2011. Its content currently includes 1296 cases and 9850 images; the top 5 search keywords of visitors are ‘‘lichen planus,’’ ‘‘granuloma annulare,’’ ‘‘pemphigus vulgaris,’’ ‘‘pityriasis rosea,’’ and ‘‘seborrheic dermatitis.’’ In creating a free, online, sustainable medical society, Dermpedia aims to harness the collective knowledge of clinicians worldwide in efforts to strengthen education and thus optimize patient care within the field of dermatology.
Commercial support: None identified.
Commercial support: None identified.
P6041 Dermatologic needs of an underserved patient population Danielle Tartar, PhD, University of Missouri-Columbia, Columbia, MO, United States; LeAnna Lane, MD, University of Missouri-Columbia, Columbia, MO, United States; Whitney Hovenic, MD, University of Missouri-Columbia, Columbia, MO, United States Background: In 2011, 16.3% of the US population lacked health insurance (US Census Bureau). Free health care clinics frequently are the sole means by which patients can access specialty care such as dermatology. The risk of dermatologic disease in the indigent population is high given greater sun exposure and lower emphasis on preventative care. MedZou Clinic offers free dermatology services to uninsured patients. This monthly clinic is staffed by medical students from the University of Missouri and is overseen by volunteer resident and attending physicians. Services available include diagnosis and management, free or low-cost prescriptions, laboratory testing and minor procedures. Methods: We performed a retrospective chart review of previously seen patients and a prospective study of new and return patient demographics including age, employment status, housing status, educational level achieved, and drug and alcohol use. Our goal was to describe the most common dermatologic conditions for which this population seeks care and to identify demographic factors to better serve patient needs. Results: Average patient age was 38.9 (range, 14-64 years) and 62% were female. Over a third (38.4%) of respondents chose housing status ‘‘homeless’’ versus ‘‘own’’ or ‘‘rent.’’ The most frequent diagnosis made was benign pigmented nevus (16%), second was eczema (13%) followed closely by acne (12%). The most common comorbidities in our patient population were psychiatric, with 23% of our patients having a diagnosed psychiatric condition including depression and bipolar disorder. Discussion: The diagnoses seen in our population were surprisingly similar to those of insured patients seen in dermatology clinics. This was despite the high proportion of homeless patients, who have previously been described to have more acute conditions, such as cutaneous infections. As dermatologists are available only monthly at MedZou clinic, it is likely that acute complaints are managed elsewhere. The most common diagnosis of benign pigmented nevus perhaps indicates that uninsured patients may wait to seek out dermatologic care until they are concerned about cancer such as melanoma. Our data indicate common needs between insured and uninsured patients. However, access to specialty dermatology care for the uninsured is woefully inadequate. There is clearly room for growth in our specialty to reach out to this population. Commercial support: None identified.
APRIL 2013
P6571 Efficacy of a multimodality curriculum in a pigmented lesion clinic to teach dermatoscopy to dermatology residents Amy Cao, The Ottawa Hospital, Ottawa, Canada; Jennifer Beecker, MD, The Ottawa Hospital, Ottawa, Canada Background: Dermatoscopy is a useful tool in assessing worrisome pigmented lesions, and its use has increased rapidly in recent years. It is particularly useful for assessing early melanoma, and determining the need for biopsy. As such, it has become a fundamental skill for dermatologists to acquire. Despite this, many sources note that dermatology residents often lack formal training in dermatoscopy. Objectives: This study aims to evaluate the efficacy of a novel multi-modality pilot learning program in which residents are trained in the use of dermatoscopy and total body imaging as a tool in the diagnosis of melanoma. Methods: A learning program will be designed to include the following components: a short educational computer based module, followed by a few sessions with an expert dermatologist in a Pigmented Lesion Clinic. Volunteer dermatology residents will be asked to fill out a questionnaire before and after this multimodality curriculum to assess for any changes in their skills, knowledge base, and confidence levels. The primary outcome will be to determine if there are any changes in the residents’ pre- and posttraining knowledge score. Secondary outcome will be to determine their satisfaction with the educational program, and any perceived changes in competency and confidence levels. Results: Study currently in progress. Results are expected to be gathered by midsummer, with conclusions to be determined at that time. It is hoped that the use of multiple learning methods, including a visual computer-based curriculum followed by direct one-on-one hands-on teaching with patients will address the different learning styles that adult learners may require for optimal knowledge and skill acquisition. If this pilot program is effective, it could be replicated by other residency programs to aid in teaching the essential skill of dermatoscopy to dermatology residents. This information could have a broader educational significance and perhaps improve the way future dermatologists examine the skin. Commercial support: None identified.
J AM ACAD DERMATOL
AB91