Bridging the Dermoscopy Training Gap

Our educational metrics include a dermoscopy quiz and a “self-efficacy instrument,” at both baseline and curriculum end. The dermoscopy quiz includes dermoscopic images, for which we ask the specific diagnosis, and the self-efficacy instrument measures how comfortable a resident feels diagnosing specific skin lesions with a regular clinical examination or with the assistance of dermoscopy. In addition, we have lecture-specific quizzes that are delivered via Kahoot! to gauge learning in real time.  

There are several larger scale metrics that are also important but challenging to capture, including the number needed to biopsy for melanoma. We would also like to examine the average depth of diagnosed melanomas biopsied by residents, and whether residents who complete the program are finding melanomas earlier. While we are still analyzing the data from last year, we have received a lot of enthusiastic responses from our participants who say they feel more comfortable using their dermoscopes after going through our course. 

Best Practices for Dermoscopy

Using dermscopy during routine skin checks allows dermatologists to refine their clinical skills. As part of our curriculum, we recommend participants have their dermoscopes out and on for every skin exam, and to include it as a part of hand hygiene to minimize possible nosocomial transmission of bacteria. We also recommend using the dermatoscope to provide tangential lighting to pick up the pearly glint of basal cell carcinomas more easily, and to see into patients’ nooks and crannies. 

As providers’ skill and comfort improve, we recommend incorporating dermoscopic photography into clinical practice. An unanticipated pathology result (eg, when a lesion clinically consistent with a basal cell carcinoma returns as an amelanotic melanoma), becomes an educational opportunity when a dermoscopic photograph is available. 

Next Steps for Dermoscopy Education

The next steps for our dermosopy education program are to refine the educational content and develop a tool kit for other institutions who would want to replicate our educational process. In addition, we are developing an efficient web-based education platform for busy practicing dermatologists who want access to similar materials but might not have the time during the work week to join a 1 hour scheduled video conference.

Practicing dermatologists have access to other resources on the use of dermoscopy, which are outlined in Table 2. These include virtual and online courses, as well as in-person courses, including ones offered at the American Academy of Dermatology meetings. 

table 2

 

Dr NelsonDr Nelson is a clinical associate professor of dermatology at The University of Texas MD Anderson Cancer Center and co-director of the MD Anderson Moonshot Melanoma Prevention and Early Detection Platform in Houston, TX.

Disclosure: The author reports no relevant financial relationships.

References

1. Patel P, Sarika Khanna S, Beth McLellan B, Krishnamurthy K. The need for improved dermoscopy training in residency: a survey of US dermatology residents and program directors. Dermatol Pract Concept. 2017;7(2):17-22.

2. Chen YA, Rill J, Seiverling EV. Analysis of dermoscopy teaching modalities in United States dermatology residency programs. Dermatol Pract Concept. 2017;7(3):38-43.



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