Bridging the Dermoscopy Training Gap

Dermoscopy is a useful tool for improving accuracy in skin cancer diagnosis, yet there is no standard educational curriculum for using it, and most US dermatology residents do not receive extensive training. Obtaining a new pattern recognition skill can be challenging once beyond residency training, and there are several barriers to implementation with independent study (Table 1). 

To address this gap, Janice Wilson, MD, assistant professor of dermatology at the University of Texas Medical Branch, Stephanie Savory, MD, associate professor of dermatology at the University of Texas Southwestern, and I formed DERM:EMD (Dermatology Early Melanoma Detection) to provide telementoring-based dermoscopy education across the state of Texas. Here are some of the strides the program has made over the past year, as well as future endeavors to improve early melanoma detection.

The Need For Better Training

The majority of evidence on the current state of dermoscopy training for US residencies comes from a handful of survey-based populations. In a survey conducted by Patel et al, which included 122 residents and 22 program directors, 38% received no dermoscopy training1; in another small study by Chen et al, the average US resident dermoscopy instruction per academic year was 2 hours.2 

Table 1

Our program is designed to help dermatology residents develop dermoscopic skills to improve their ability to successfully distinguish skin cancers from mimics. The telementoring platform Project ECHO (Extension for Community Health Care Outcomes) supports the development of new clinical skill sets and strengthens health systems through partnerships. It has been the key infrastructure around which we built our dermoscopy curriculum. 

Our curriculum uses video conferencing to connect participating dermatology residency programs across the broad geography of Texas; we provide monthly teleconference lectures with peer-reviewed content, accompanied by an educational handout, with educational quizzes to monitor participant improvement over time. 

We are currently on our second academic year, and we have learned important lessons on flexibility, innovation, and the specific needs of adult learners. This year, we shifted our content and educational metrics to focus on clinical comparators to more closely parallel clinical decisions that are made at a patient’s bedside. For example, it can be hard to distinguish sebaceous hyperplasia on the face from an early nodular basal cell carcinoma. During our lectures, we show these 2 entities side by side and discuss specific reasons why a lesion is “x” and not “y.” 

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