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Evaluation of continuity clinic structure in dermatology residency programs in the United States and Canada
1072
1947
Assessing frequency and quality of US dermatologist sunscreen recommendations to their patients Richard Winkelmann, DO, Rigel Dermatology, New York, NY, United States; Darrell Rigel, MD, MS, New York University, New York, NY, United States
Determining the quality of the medical educational environment at a Saudi medical school using the DREEM inventory Sahar H. Al-Natour, MD, Department of Dermatology, University of Dammam, Dammam, Saudi Arabia
Background: UV light exposure is the only modifiable risk factor for melanoma. Patient communication about how to minimize risk via UV avoidance, sunscreen, and protective clothing is paramount. A recent study reports dermatologists (Derms) discuss sunscreen in 1.6% of patient visits. This short-term retrospective study aims to clarify the frequency and nature of sunscreen recommendations from Derms. Methods: A link to our survey was sent via email in July 2014 to practicing American Derms. Questions were limited to how many patients were seen in the last two days of practice, how many received sunscreen counseling, SPF recommendation, preferred vehicle, years in practice, and zip code. Data were analyzed overall, based on latitude and years of practice. Results: Invitations were sent to 6177 dermatologists with a 9% response rate (n ¼ 530). Overall, Derms discussed sunscreen with 18,090 of 31,253 (58%) patients over two practice days. Most Derms (72%, n ¼ 379) recommend SPF 30-49 to patients followed by SPF 50-69 (16%, n ¼ 87), and SPF 70+ (8%, n ¼ 42). 59% (n ¼ 312) of Derms had no vehicle preference. 23% (n ¼ 123) favored cream formulations, followed by lotion (8%, n ¼ 44), sport (5%, n ¼ 25), and spray (5%, n ¼ 24). Most respondents had been in practice 10-20 years (29%, n ¼ 152). 28% (n ¼ 146) had been in practice 20-30 years, 26% (n ¼ 137) for 30+, 15% (n ¼ 78) for 5-10, and 3% (n ¼ 17) for 0-5 years. Derms from latitudes in the lowest tercile (21-368) of respondents were 4% more likely to discuss sunscreen (59% vs. 55%, P \.0001). No significant difference was observed for SPF or vehicle preference based on latitude. Derms practicing 30+ years discussed sunscreen much less frequently than those in practice 0-5 years (47% vs. 70%, P \.0001). Derms practicing 0-10 years were 12% less likely to have a vehicle preference (15% vs. 27%, P ¼ .02). Derms practicing 10+ years were 9% more likely to prefer lotion (11% vs. 2%, P ¼ .02).
Background: Students’ perceptions of their educational environment have a significant impact on their behavior and academic progress. Aim: To assess the perceptions of medical students concerning their educational environment at the University of Dammam. Methods: Year 5 medical students (n ¼ 121) at the University of Dammam completed the Dundee Ready Educational Environment Measure (DREEM) questionnaire which comprised 50 items based on the Likert scale (score range 0-200). The mean scores for each individual DREEM item and for the 5 contributing DREEM domains were calculated: perception of learning, perception of teaching, academic self-perception, perception of atmosphere, and social self-perception. Data were analyzed by SPSS 16 software. Results: The year group (n ¼ 121) comprised 65.3 % males and 34.7% % females. The mean total score was 126.4 out of a maximum of 200 (63%) indicating relative satisfaction with the educational environment but with room for improvement. Their perceptions being more positive than negative compare favorably with similar studies. The 2 lowest scoring contributory domains were academic self-perception and perception of learning with scores of 19.2/32 and 29.3/48 respectively. No areas of excellence were identified. Four main problem areas were identified, receiving scores of #2.0. Conclusion: The DREEM is a useful tool to assess the overall teaching climate and identify areas of strength and weakness. Overall, the respondents assessed their educational environment as average. Therefore, improvements are required on all 5 domains of educational environment. Commercial support: None identified.
Limitations: Potential recall bias, selection bias, and social correctness influencing response. Conclusions: Although there is always room for improvement regarding physicianepatient communication, this study indicates dermatologists provide more sunscreen information to their patients than previously thought. Commercial support: None identified.
1928 950 Deficiencies of phototherapy training in dermatology residency education Daniel Butler, MD, Harvard University, Cambridge, MA, United States; Ethan Levin, MD, UCSF, San Francisco, CA, United States; Danielle Tartar, MD, PhD, University of California Davis, Davis, CA, United States; Rishu Gupta, MD, Washington University in Saint Louis, Saint Louis, MO, United States; John Koo, MD, UCSF, San Francisco, CA, United States Background: Phototherapy is one of the safest ways to treat patients with generalized psoriasis. Unfortunately, a large proportion of psoriasis patients are not offered phototherapy by their dermatologist. One possible contributor is a lack of phototherapy specific education during dermatology residency training. Methods: US dermatology residents were asked to participate in an online, multiplechoice survey that assessed familiarity and comfort with prescribing and managing the various modalities of phototherapy. Results: Response rate was approximately 10% of all US dermatology residents. 17% of responders reported 0 hours of phototherapy specific didactic time per year. Over 50% of residents reported no hands-on training sessions whatsoever. Only 17% of residents received two or more hands on sessions per year. When asked which forms of phototherapy had been observed during residency, over 40% of residents had never physically observed any type of phototherapy. Broadband UVB was the least observed form at 8%. Aside from narrowband UVB therapy, no other form of phototherapy was observed by [25% of dermatology residents. When asked ‘‘if the residents were hypothetically running a busy phototherapy practice, which therapeutic options would they be comfortable administering without supervision?,’’ the highest comfort level was reported with narrowband UVB phototherapy, yet only 50% of residents felt comfortable enough to supervise narrowband UVB phototherapy. The next highest comfort level dropped to 25% of residents with excimer laser therapy, and only 15% felt comfortable with PUVA or broadband UVB. Lastly, only 33% of residents reported that if issues were to arise during a patient’s treatment, such as burning or dose adjustments due to medications, they would feel comfortable troubleshooting these issues. Conclusion: The results of the survey illustrate uniformly low comfort levels amongst residents regarding the administration and supervision of various phototherapeutic modalities. The overwhelming lack of education and comfort level amongst residents signifies a substantial gap in training. The importance of early and adequate exposure in the career of dermatologists is essential to develop comfort with phototherapy. If residents are not appropriately exposed and educated on phototherapy as a part of residency programs, it is unlikely that they will acquire a comfort later in their career. Commercial support: None identified.
MAY 2015
Evaluation of continuity clinic structure in dermatology residency programs in the United States and Canada Tiffany Loh, University of California, San Diego, San Diego, CA, United States; Aria Vazirnia, MS, University of California, San Diego, San Diego, CA, United States; Maryam Afshar, MD, University of California, San Diego, San Diego, CA, United States; Robert Dorschner, MD, University of California, San Diego, San Diego, CA, United States; Taraneh Paravar, MD, University of California, San Diego, San Diego, CA, United States Background: As established by the Accreditation Council for Graduate Medical Education (ACGME) and Royal College of Physicians and Surgeons of Canada (RCPSC), dermatology residents in the United States (US) and Canada must participate in continuity clinic in order to complete their training. Per ACGME guidelines, residents must follow ‘‘a core group of individual patients throughout the majority of the program in a minimum of a once-monthly continuity of care clinic setting, as well as in follow-up of inpatients and patients seen as consults or during night or weekend call.’’ However, this requirement may be achieved through a range of methods, allowing for variation among residency programs. In order to better understand the role of continuity clinic in resident learning, more data on this component of graduate medical education are needed. Methods: We conducted an anonymous online survey of all dermatology residents in the US and Canada to assess continuity clinic organization, setting, frequency, and patient and preceptor characteristics, as well as to compare resident satisfaction and learning. Results: Preliminary results were obtained. There were 115 respondents, of which 93% had a continuity clinic. 90.0% (n ¼ 99) reported having continuity clinic each week, 3.6% (n ¼ 4) every other week, 2.7% (n ¼ 3) monthly, and 0.9% (n ¼ 1) only during certain blocks. 76.4% (n ¼ 84) described their clinics as ‘‘resident-run with attending,’’ while 11.8% (n ¼ 13) were attending-run. The rest described their clinics as ‘‘resident-run with no attending’’ (2 responses, 1.8%), both resident and attendingrun (3, 2.7%), and ‘‘other’’ (5, 4.5%). More trainees in resident-run clinics reported enhancement in history taking and physical examination skills, compared to those in attending-run clinics (73.8% and 77.4%, respectively versus 53.8% and 61.5%, respectively). Significantly, better teaching was reported with attending presence in or out of the examination room than with attending presence only when concerns were raised (P \ .02). Residents also reported better feedback with attending presence in the room than when out of the room (P ¼.027). Conclusions: Resident-run clinics appear to promote greater enhancement of abilities in taking history and performing physical examinations. Continuity clinic with a focus on resident leadership may be a more effective model to promote learning. Attending presence appears to be more beneficial for teaching. Commercial support: None identified.
J AM ACAD DERMATOL
AB93
1947
Assessing frequency and quality of US dermatologist sunscreen recommendations to their patients Richard Winkelmann, DO, Rigel Dermatology, New York, NY, United States; Darrell Rigel, MD, MS, New York University, New York, NY, United States
Determining the quality of the medical educational environment at a Saudi medical school using the DREEM inventory Sahar H. Al-Natour, MD, Department of Dermatology, University of Dammam, Dammam, Saudi Arabia
Background: UV light exposure is the only modifiable risk factor for melanoma. Patient communication about how to minimize risk via UV avoidance, sunscreen, and protective clothing is paramount. A recent study reports dermatologists (Derms) discuss sunscreen in 1.6% of patient visits. This short-term retrospective study aims to clarify the frequency and nature of sunscreen recommendations from Derms. Methods: A link to our survey was sent via email in July 2014 to practicing American Derms. Questions were limited to how many patients were seen in the last two days of practice, how many received sunscreen counseling, SPF recommendation, preferred vehicle, years in practice, and zip code. Data were analyzed overall, based on latitude and years of practice. Results: Invitations were sent to 6177 dermatologists with a 9% response rate (n ¼ 530). Overall, Derms discussed sunscreen with 18,090 of 31,253 (58%) patients over two practice days. Most Derms (72%, n ¼ 379) recommend SPF 30-49 to patients followed by SPF 50-69 (16%, n ¼ 87), and SPF 70+ (8%, n ¼ 42). 59% (n ¼ 312) of Derms had no vehicle preference. 23% (n ¼ 123) favored cream formulations, followed by lotion (8%, n ¼ 44), sport (5%, n ¼ 25), and spray (5%, n ¼ 24). Most respondents had been in practice 10-20 years (29%, n ¼ 152). 28% (n ¼ 146) had been in practice 20-30 years, 26% (n ¼ 137) for 30+, 15% (n ¼ 78) for 5-10, and 3% (n ¼ 17) for 0-5 years. Derms from latitudes in the lowest tercile (21-368) of respondents were 4% more likely to discuss sunscreen (59% vs. 55%, P \.0001). No significant difference was observed for SPF or vehicle preference based on latitude. Derms practicing 30+ years discussed sunscreen much less frequently than those in practice 0-5 years (47% vs. 70%, P \.0001). Derms practicing 0-10 years were 12% less likely to have a vehicle preference (15% vs. 27%, P ¼ .02). Derms practicing 10+ years were 9% more likely to prefer lotion (11% vs. 2%, P ¼ .02).
Background: Students’ perceptions of their educational environment have a significant impact on their behavior and academic progress. Aim: To assess the perceptions of medical students concerning their educational environment at the University of Dammam. Methods: Year 5 medical students (n ¼ 121) at the University of Dammam completed the Dundee Ready Educational Environment Measure (DREEM) questionnaire which comprised 50 items based on the Likert scale (score range 0-200). The mean scores for each individual DREEM item and for the 5 contributing DREEM domains were calculated: perception of learning, perception of teaching, academic self-perception, perception of atmosphere, and social self-perception. Data were analyzed by SPSS 16 software. Results: The year group (n ¼ 121) comprised 65.3 % males and 34.7% % females. The mean total score was 126.4 out of a maximum of 200 (63%) indicating relative satisfaction with the educational environment but with room for improvement. Their perceptions being more positive than negative compare favorably with similar studies. The 2 lowest scoring contributory domains were academic self-perception and perception of learning with scores of 19.2/32 and 29.3/48 respectively. No areas of excellence were identified. Four main problem areas were identified, receiving scores of #2.0. Conclusion: The DREEM is a useful tool to assess the overall teaching climate and identify areas of strength and weakness. Overall, the respondents assessed their educational environment as average. Therefore, improvements are required on all 5 domains of educational environment. Commercial support: None identified.
Limitations: Potential recall bias, selection bias, and social correctness influencing response. Conclusions: Although there is always room for improvement regarding physicianepatient communication, this study indicates dermatologists provide more sunscreen information to their patients than previously thought. Commercial support: None identified.
1928 950 Deficiencies of phototherapy training in dermatology residency education Daniel Butler, MD, Harvard University, Cambridge, MA, United States; Ethan Levin, MD, UCSF, San Francisco, CA, United States; Danielle Tartar, MD, PhD, University of California Davis, Davis, CA, United States; Rishu Gupta, MD, Washington University in Saint Louis, Saint Louis, MO, United States; John Koo, MD, UCSF, San Francisco, CA, United States Background: Phototherapy is one of the safest ways to treat patients with generalized psoriasis. Unfortunately, a large proportion of psoriasis patients are not offered phototherapy by their dermatologist. One possible contributor is a lack of phototherapy specific education during dermatology residency training. Methods: US dermatology residents were asked to participate in an online, multiplechoice survey that assessed familiarity and comfort with prescribing and managing the various modalities of phototherapy. Results: Response rate was approximately 10% of all US dermatology residents. 17% of responders reported 0 hours of phototherapy specific didactic time per year. Over 50% of residents reported no hands-on training sessions whatsoever. Only 17% of residents received two or more hands on sessions per year. When asked which forms of phototherapy had been observed during residency, over 40% of residents had never physically observed any type of phototherapy. Broadband UVB was the least observed form at 8%. Aside from narrowband UVB therapy, no other form of phototherapy was observed by [25% of dermatology residents. When asked ‘‘if the residents were hypothetically running a busy phototherapy practice, which therapeutic options would they be comfortable administering without supervision?,’’ the highest comfort level was reported with narrowband UVB phototherapy, yet only 50% of residents felt comfortable enough to supervise narrowband UVB phototherapy. The next highest comfort level dropped to 25% of residents with excimer laser therapy, and only 15% felt comfortable with PUVA or broadband UVB. Lastly, only 33% of residents reported that if issues were to arise during a patient’s treatment, such as burning or dose adjustments due to medications, they would feel comfortable troubleshooting these issues. Conclusion: The results of the survey illustrate uniformly low comfort levels amongst residents regarding the administration and supervision of various phototherapeutic modalities. The overwhelming lack of education and comfort level amongst residents signifies a substantial gap in training. The importance of early and adequate exposure in the career of dermatologists is essential to develop comfort with phototherapy. If residents are not appropriately exposed and educated on phototherapy as a part of residency programs, it is unlikely that they will acquire a comfort later in their career. Commercial support: None identified.
MAY 2015
Evaluation of continuity clinic structure in dermatology residency programs in the United States and Canada Tiffany Loh, University of California, San Diego, San Diego, CA, United States; Aria Vazirnia, MS, University of California, San Diego, San Diego, CA, United States; Maryam Afshar, MD, University of California, San Diego, San Diego, CA, United States; Robert Dorschner, MD, University of California, San Diego, San Diego, CA, United States; Taraneh Paravar, MD, University of California, San Diego, San Diego, CA, United States Background: As established by the Accreditation Council for Graduate Medical Education (ACGME) and Royal College of Physicians and Surgeons of Canada (RCPSC), dermatology residents in the United States (US) and Canada must participate in continuity clinic in order to complete their training. Per ACGME guidelines, residents must follow ‘‘a core group of individual patients throughout the majority of the program in a minimum of a once-monthly continuity of care clinic setting, as well as in follow-up of inpatients and patients seen as consults or during night or weekend call.’’ However, this requirement may be achieved through a range of methods, allowing for variation among residency programs. In order to better understand the role of continuity clinic in resident learning, more data on this component of graduate medical education are needed. Methods: We conducted an anonymous online survey of all dermatology residents in the US and Canada to assess continuity clinic organization, setting, frequency, and patient and preceptor characteristics, as well as to compare resident satisfaction and learning. Results: Preliminary results were obtained. There were 115 respondents, of which 93% had a continuity clinic. 90.0% (n ¼ 99) reported having continuity clinic each week, 3.6% (n ¼ 4) every other week, 2.7% (n ¼ 3) monthly, and 0.9% (n ¼ 1) only during certain blocks. 76.4% (n ¼ 84) described their clinics as ‘‘resident-run with attending,’’ while 11.8% (n ¼ 13) were attending-run. The rest described their clinics as ‘‘resident-run with no attending’’ (2 responses, 1.8%), both resident and attendingrun (3, 2.7%), and ‘‘other’’ (5, 4.5%). More trainees in resident-run clinics reported enhancement in history taking and physical examination skills, compared to those in attending-run clinics (73.8% and 77.4%, respectively versus 53.8% and 61.5%, respectively). Significantly, better teaching was reported with attending presence in or out of the examination room than with attending presence only when concerns were raised (P \ .02). Residents also reported better feedback with attending presence in the room than when out of the room (P ¼.027). Conclusions: Resident-run clinics appear to promote greater enhancement of abilities in taking history and performing physical examinations. Continuity clinic with a focus on resident leadership may be a more effective model to promote learning. Attending presence appears to be more beneficial for teaching. Commercial support: None identified.
J AM ACAD DERMATOL
AB93