TO THE EDITOR: OBSERVATIONS
Integrating Outpatient Teledermatology Education Into the Dermatology Resident Curriculum
T
elemedicine has the potential to transform how we deliver tomorrow’s health care, and residents must learn how to practice on this platform. There is a shortage of dermatologists in the United States, particularly in rural areas, where 1 in 8 primary care visits is related to skin disease.1 Some of the benefits of teledermatology (TD) are the potential to increase access, reduce wait times, and provide costeffective care. In the outpatient setting, literature has consistently demonstrated a comparable accuracy of TD to in-person visits. Studies also suggest appropriate utilization of TD as an educational tool.2,3 We affirm this impression and advocate a standardized curriculum to enable dermatology residents to become adept at practicing TD. The TD program at Hampton Veterans Affairs Medical Center (VAMC) was implemented in 2012 using store-and-forward technology. From July 2013 to August 2015, a total of 2106 TD consults were reviewed from 3 rural outposts. In the program, a third-year resident reviews the history/images sent from the primary care physician and develops a diagnosis/ management strategy. The case is then presented to a faculty member who determines the final impression and plan. Using TD technology, our residents have evaluated a range of disorders from benign/malignant neoplasms to inflammatory diseases, such as atopic dermatitis and psoriasis. Prior to reading consults, all third-year residents and supervising attending physicians must undergo the national VAMC TD training modules, including TeleReader and VistA Imaging Display training. Each third-year resident spends 4 months on the TD rotation, averaging about 80 cases per month. Using TD, a recent study found a concordance rate of 53% and 65% for diagnosis and management plans between resident and attending dermatologists, respectively.2 This suggests that there are opportunities for educating residents, both on diagnoses and on treatDOI: http://dx.doi.org/10.4300/JGME-D-15-00792.1
468
Journal of Graduate Medical Education, July 1, 2016
ment. Another TD program at the Denver VAMC evaluated its role in resident and medical student education. Both groups agreed that TD was an important educational tool, particularly in areas of practice-based learning and medical knowledge.3 Teledermatology represents a unique tool to assess resident performance in accordance with the Accreditation Council for Graduate Medical Education competencies outlined in the Dermatology Milestone Project. With limited data as well as a lack of tactile and dermatoscopic examination, residents learn to triage lesions that require reassurance, topical/systemic treatments, or in-person visit for examination or biopsy. With TD, attending physicians can better assess a trainee’s knowledge, ability to adapt to various health care delivery systems, communication skills, and care coordination. Residents also learn about resources available at different sites and receive training on working effectively within an interprofessional team, as some cases require follow-up communication with consulting physicians. With telemedicine continuing to play an emerging role, training programs must become aware of the importance of TD. It uniquely enables residents to triage common skin conditions, while affording the faculty opportunities to evaluate the trainee’s knowledge base and management skills. Our experience has demonstrated benefits of integrating TD training into our curriculum. Through efforts such as the American Academy of Dermatology Young Physician Telemedicine Engagement and Education Workgroup, we hope to soon see a standardized curriculum, and we look forward to wider implementation of TD as a teaching tool.
Jigar Patel, BS Medical Student, Department of Dermatology, Eastern Virginia Medical School Medical Student, Dermatology Section, Hampton Veterans Affairs Medical Center Karina Parr, MD Assistant Professor, Department of Dermatology, Eastern Virginia Medical School Chief, Dermatology Section, Hampton Veterans Affairs Medical Center Tara Buehler-Bota, MD Resident, Department of Dermatology, Eastern Virginia Medical School Resident, Dermatology Section, Hampton Veterans Affairs Medical Center
Antoinette F. Hood, MD Professor, Department of Dermatology, Eastern Virginia Medical School Professor, Dermatology Section, Hampton Veterans Affairs Medical Center
References 1. Coates SJ, Kvedar J, Granstein RD. Teledermatology: from historical perspective to emerging techniques of the modern era: part 1: history, rationale,
and current practice. J Am Acad Dermatol. 2015;72(4):563–574. 2. Nelson CA, Wanat KA, Roth RR, James WD, Kovarik CL, Takeshita J. Teledermatology as pedagogy: diagnostic and management concordance between resident and attending dermatologists. J Am Acad Dermatol. 2015;72(3):555–557. 3. Boyers LN, Schultz A, Baceviciene R, Blaney S, Marvi N, Dellavalle RP, et al. Teledermatology as an educational tool for teaching dermatology to residents and medical students. Telemed J E Health. 2015;21(4):312–314.
Journal of Graduate Medical Education, July 1, 2016
469
Integrating Outpatient Teledermatology Education Into the Dermatology Resident Curriculum
T
elemedicine has the potential to transform how we deliver tomorrow’s health care, and residents must learn how to practice on this platform. There is a shortage of dermatologists in the United States, particularly in rural areas, where 1 in 8 primary care visits is related to skin disease.1 Some of the benefits of teledermatology (TD) are the potential to increase access, reduce wait times, and provide costeffective care. In the outpatient setting, literature has consistently demonstrated a comparable accuracy of TD to in-person visits. Studies also suggest appropriate utilization of TD as an educational tool.2,3 We affirm this impression and advocate a standardized curriculum to enable dermatology residents to become adept at practicing TD. The TD program at Hampton Veterans Affairs Medical Center (VAMC) was implemented in 2012 using store-and-forward technology. From July 2013 to August 2015, a total of 2106 TD consults were reviewed from 3 rural outposts. In the program, a third-year resident reviews the history/images sent from the primary care physician and develops a diagnosis/ management strategy. The case is then presented to a faculty member who determines the final impression and plan. Using TD technology, our residents have evaluated a range of disorders from benign/malignant neoplasms to inflammatory diseases, such as atopic dermatitis and psoriasis. Prior to reading consults, all third-year residents and supervising attending physicians must undergo the national VAMC TD training modules, including TeleReader and VistA Imaging Display training. Each third-year resident spends 4 months on the TD rotation, averaging about 80 cases per month. Using TD, a recent study found a concordance rate of 53% and 65% for diagnosis and management plans between resident and attending dermatologists, respectively.2 This suggests that there are opportunities for educating residents, both on diagnoses and on treatDOI: http://dx.doi.org/10.4300/JGME-D-15-00792.1
468
Journal of Graduate Medical Education, July 1, 2016
ment. Another TD program at the Denver VAMC evaluated its role in resident and medical student education. Both groups agreed that TD was an important educational tool, particularly in areas of practice-based learning and medical knowledge.3 Teledermatology represents a unique tool to assess resident performance in accordance with the Accreditation Council for Graduate Medical Education competencies outlined in the Dermatology Milestone Project. With limited data as well as a lack of tactile and dermatoscopic examination, residents learn to triage lesions that require reassurance, topical/systemic treatments, or in-person visit for examination or biopsy. With TD, attending physicians can better assess a trainee’s knowledge, ability to adapt to various health care delivery systems, communication skills, and care coordination. Residents also learn about resources available at different sites and receive training on working effectively within an interprofessional team, as some cases require follow-up communication with consulting physicians. With telemedicine continuing to play an emerging role, training programs must become aware of the importance of TD. It uniquely enables residents to triage common skin conditions, while affording the faculty opportunities to evaluate the trainee’s knowledge base and management skills. Our experience has demonstrated benefits of integrating TD training into our curriculum. Through efforts such as the American Academy of Dermatology Young Physician Telemedicine Engagement and Education Workgroup, we hope to soon see a standardized curriculum, and we look forward to wider implementation of TD as a teaching tool.
Jigar Patel, BS Medical Student, Department of Dermatology, Eastern Virginia Medical School Medical Student, Dermatology Section, Hampton Veterans Affairs Medical Center Karina Parr, MD Assistant Professor, Department of Dermatology, Eastern Virginia Medical School Chief, Dermatology Section, Hampton Veterans Affairs Medical Center Tara Buehler-Bota, MD Resident, Department of Dermatology, Eastern Virginia Medical School Resident, Dermatology Section, Hampton Veterans Affairs Medical Center
Antoinette F. Hood, MD Professor, Department of Dermatology, Eastern Virginia Medical School Professor, Dermatology Section, Hampton Veterans Affairs Medical Center
References 1. Coates SJ, Kvedar J, Granstein RD. Teledermatology: from historical perspective to emerging techniques of the modern era: part 1: history, rationale,
and current practice. J Am Acad Dermatol. 2015;72(4):563–574. 2. Nelson CA, Wanat KA, Roth RR, James WD, Kovarik CL, Takeshita J. Teledermatology as pedagogy: diagnostic and management concordance between resident and attending dermatologists. J Am Acad Dermatol. 2015;72(3):555–557. 3. Boyers LN, Schultz A, Baceviciene R, Blaney S, Marvi N, Dellavalle RP, et al. Teledermatology as an educational tool for teaching dermatology to residents and medical students. Telemed J E Health. 2015;21(4):312–314.
Journal of Graduate Medical Education, July 1, 2016
469
