Louis A. Duhring 1845-1913: his life and legacy

Life--background, training, career and legacy of Louis A. Duhring, one of the most distinguished dermatologists on the international medical scene is presented. He was the first professor of dermatology in the University of Pennsylvania School of Medicine, and in 1876 along with several other permanent dermatologists organized the American Dermatological Association, the first national dermatology society in the World. Duhring was also scholar and prolific writer, which helped establish his international reputation.     

皮肤性病学临床实习教学模式体会

皮肤性病学病种多,用文字描述皮肤损害抽象且不易理解。当前在面临升学和择业双重压力下,作为临床小科室,学生在皮肤科的实习效果并不理想。传统的临床教学模式难以适应医学生的需求。本文结合临床实习带教经验,旨在探讨皮肤性病科实习教学的新模式,激发学生对皮肤性病学的兴趣,为社会培养适应时代需要、合格的皮肤科专业人才。     

The Prestige of Dermatologists

Dermatology generally has been rated low in past studies of the prestige of medical specialties when the raters have been doctors and/or medical students. This investigation considers whether dermatologists maintain their relatively unfavorable position in the specialty prestige hierarchy when the raters are members of the lay public. Four hundred respondents ranked dermatology last out of ten specialties in ascribed esteem, perceived income, and assigned social value, suggesting that dermatologists are less well regarded by the public than are other doctors. Moreover, the relatively low prestige of dermatology appears to be largely independent of a rater's personal experience.     

Medical student dermatology research in the United States

The development of academic researchers is important for the future success of dermatology, but few dermatology trainees are entering academic practice in the United States. Because many successful researchers begin to focus on research skills during medical school, an electronic survey was conducted to evaluate dermatology research opportunities and benchmarks for U.S. medical students. First- and second-year medical students participated in case studies, clinical research projects, and laboratory benchwork, but participation significantly increased during the third and fourth years. Funded programs had higher student participation than nonfunded programs and were also more likely to have medical students present their research at meetings. A wide variety of research opportunities are currently offered to U.S. medical students, so a lack of research opportunities in medical school does not explain the dwindling supply of academic dermatologists in the United States. Because funding appears to be an important factor for successful medical student research, new mechanisms of funding should be identified and developed.     

Videoconferencing journal club for dermatology residency training: an attitude study

The use of videoconferencing as a teaching modality in dermatology is not widespread. The objectives of this study were to introduce the videoconferencing format to dermatology journal clubs and to determine its effects on the training and satisfaction of house officers (residents). Ten dermatology house officers participated in this study. They were being trained at three university hospitals in rotation. A videoconferencing facility maintained by the hospitals for remote conferencing was used. After completing a 1-year journal club programme, house officers were asked about their satisfaction levels on a 5-point Likert scale using a questionnaire. Videoconferencing meant that the house officers and attending physicians from sister hospitals remained at their own hospitals, thus saving much time. Using videoconferencing the journal club could be held more frequently and more articles could be studied. In general the participants' satisfaction with the videoconferencing journal club was high. The adoption of videoconferencing produced promising results, increasing the efficiency of house officer training.     

Psychodermatology knowledge and awareness in Chinese dermatologists: Results of a survey study

To assess the knowledge, awareness, practice patterns, and attitudes of Chinese dermatologists toward psychocutaneous disorders and explore their interest in continuing medical education (CME) of psychodermatology. An online survey study was conducted from October to November 2019. The survey questionnaire link was sent to the members of the national and local association of dermatology through a social media App. After confirming the informed consent to enrol in the study, the participants filled out the online questionnaire anonymously. About 1047 dermatologists completed the survey. The most common diagnoses referred to the psychiatrist from Chinese dermatologists were venereal phobia (51.77%), delusion of parasitosis (44.03%), and trichotillomania (32.28%). Compared with dermatologists, Traditional Chinese Medicine (TCM) dermatologists had less training experience on psychodermatologic CME (4.21% vs 8.34% who had attending more than twice CME, P < .05). Although TCM dermatologist experience more frequency with psychodermatology (24.21% TCM vs 15.71% dermatologists), they had lower comfort level in treating psychodermatologic patients (51.58% TCM vs 58.89% dermatologist) (P > .05). While 818 (78.13%) dermatologists never received any training course, 84.53% of the dermatologists expressed interest in attending CME events on psychodermatology. The most popular CME themes of psychodermatology were emotional disorders related to skin diseases, delusion of parasitosis, and trichotillomania. Chinese dermatologists have insufficient knowledge and awareness toward psychodermatology. TCM dermatologists have higher awareness on psychocutaneous diseases compared with dermatologists. Psychodermatology continuing medical education programs should be carried out as soon as possible.     

Psychodermatology in Balkans: Knowledge,awareness, and practice patterns of dermatologists in Albania

The aim of this study is to find out the practice patterns, awareness, and knowledge about psychodermatology in Albanian dermatologists. A survey questionnaire was sent to Albanian dermatologists by mail and distributed during a regional dermatology conference. The dermatologists were requested to provide information on demographic variables, level of training, referral patterns, degree of comfort in managing psychocutaneous disorders, awareness of community resources, and interest in continuing medical educational activities. A total of 75 surveys were mailed in and 41 were returned for analysis. Only 13.2% of dermatologists reported clear understanding of psychodermatology and 41.5% reported being somewhat comfortable in diagnosing and treating psychocutaneous disorders, however requiring further help. Psoriasis, prurigo, and acne were the most common diagnoses associated with psychiatric involvement. The most common diagnoses referred by dermatologists to psychiatrists were psoriasis, prurigo, acne, and trichotillomania. Almost all 98% of dermatologists were not aware of any community resources. About 70% of dermatologists expressed interest in attending continuing medical educational activities. Albanian dermatologist have significant gap in the knowledge, training, awareness, and in treating psychocutaneous disease.     

www.dermatoweb.net. Una web docente para el aprendizaje de la Dermatología en el pregrado

Dermatoweb is a website to aid undergraduate dermatology training. It includes the dermatology program of the Lerida Faculty of Medicine, and is based principally on clinical presentations, tables with the differential diagnosis of the 20 most common reasons for dermatologic consultation, about 200 clinical test cases to stimulate self-training, and a subject list with the 32 topics that make up the dermatology syllabus in many faculties of medicine. Thanks to this website, some of our students achieve high marks in dermatology despite hardly coming to classes. In addition, therapeutic guidelines for the common dermatoses can be found on the site, and an atlas with more than 5,300 photographs and almost 100 videos on the more common dermatological procedures; these can serve as a visual aid for family doctors, residents in dermatology in the initial years, and practicing dermatologists.     

Canaries in the mineshaft: the dermatology workforce shortage in Eastern Ontario

BACKGROUND: The number of dermatology residency positions in Canada has not reflected the growing workforce shortage. Until 2005, all dermatology residents at the University of Ottawa were committed to return to their funding area at the completion of their training. This has left Eastern Ontario with a critical shortage of dermatologists. OBJECTIVE: To survey dermatologists practicing in Eastern Ontario to understand the basis of the workforce shortage and outlook for the future. METHODS: Mailed surveys sent in 1999, 2003, and 2006 to all dermatologists in Eastern Ontario requesting demographic information, workload data, and future career plans. RESULTS: There was a 100% response rate in each survey year. Between 1999 and 2006, the total number of practicing dermatologists decreased from 26 to 23, whereas the average age increased from 51.4 to 57.4 years. The waiting time to see new and returning patients increased, from 5.8 to 18.5 weeks and 4.9 to 11.8 weeks, respectively. Ten of the 23 dermatologists practicing in 2006 plan to retire within the next 5 years. CONCLUSIONS: The inadequate supply of dermatologists in Eastern Ontario will increasingly threaten patient care. This emphasizes the need for additional funding for dermatology training positions, continued mentorship, and improved dermatology training for nondermatologists.     

Preserving medical dermatology. A colleague lost, a call to arms, and a plan for battle.

Change within dermatology as a clinical discipline is expected and inevitable. However dermatology may change as a medical specialty in the new millennium, there will still be patients with medical dermatologic disease whose optimal care will depend on skin disease specialists' having the highest level of training and experience in medical dermatology. Dermatologists who have subspecialized in medical dermatology will provide the role models for new generations of dermatologists, perform the patient-oriented research, and care for the more complicated patients. Thus, if during its evolution, dermatology loses the ability to train and support medical dermatologists, it will be weakened as the discipline that can best care for skin disease. Clearly, the loss of talented academicians such as the person whose career was outlined in the case report presented at the beginning of this article should be a huge warning sign that the future of medical dermatology as a specialty is uncertain. The Medical Dermatology Society hopes to develop a coalition with all other leadership organizations within dermatology to deal with this problem effectively. There is a need for a broader discussion within organized dermatology of the growing crisis in this area and how all dermatology leadership organizations working together can develop an action plan for effectively dealing with this important but challenging problem. Dermatology must ask itself what it wants to look like as a medical specialty in the future. Without an steady stream of young clinician-investigators focused on the many challenging problems in medical dermatology, dermatology will not exist as the specialty it is today.     

What do general practitioners want from a dermatology department?

Summary Four hundred and fifty-six practitioners (GPs) in Avon were asked what they required from their department of dermatology, and what improvements to the present service they could suggest. Most GPs preferred to manage the majority of dermatological problems themselves, with support from the department where necessary. They referred to a hospital department because they lacked the necessary expertise, but would prefer to receive training, advice and support in managing their patients rather than surrender long-term care to a specialist department. Despite this expressed willingness to shoulder more of the dermatological burden, only 31% of the GPs had received any postgraduate training in dermatology. In fact 57% said they had little interest in the subject and had not attended any form of dermatology teaching since qualifying. GPs would also like more guidance in the form of regularly updated guidelines and protocols, and easy access to dermatologists for telephone advice at regular fixed times. Some also felt that consultants should aim to provide diagnosis, investigation, and management guidelines for referred patients after a single visit. These findings should prompt a re-appraisal of the relative roles of GP and dermatologist, and emphasize the need for vocational training and continuing medical education in dermatology for all GPs.     

Leadership training in dermatology: a narrative review

Effective leadership is imperative for dermatologists and clinically has been shown to improve team efficacy, patient outcomes, and staff engagement, as well as reduce physician burnout and medical errors. Dermatologists are expected to exercise leadership in a variety of contexts during their professional careers, but despite the demonstrated benefit of effective leadership on improving clinical outcomes and reducing burnout, there is a lack of formal leadership training in residency programs, especially in the field of dermatology. The purpose of this review is to elucidate the current understanding of effective leadership for dermatologists, with a focus on leadership models and select strategies that dermatologists may implement in their daily practice to become more efficacious leaders. This review also seeks to provide a summary of existing opportunities for leadership in the field of dermatology. A narrative review was performed in 2022 examining leadership models as determined by the top results in PubMed with search term “Leadership Models”. These models were then related to the field of dermatology. In addition, existing leadership opportunities, as determined through PubMed and Google searches, were reviewed and summarized. There are several medical and non-medical leadership models that can be applied to the field of dermatology. There are many opportunities to gain leadership experience for dermatologists and dermatologists in training; however, there is still a demonstrated need for more opportunities. Through the application of basic leadership principles, dermatologists will experience improved satisfaction and enhanced outcomes.     

Evaluation of educational methods in dermatology and confidence levels: a national survey of UK medical students

Background The high prevalence of skin conditions makes dermatology education an essential part of the undergraduate medical curriculum. The aim of this study was to assess the impact of different educational methods on confidence levels in dermatology among UK medical students. Methods A survey‐based study was carried out to establish: (i) educational experience in dermatology, and (ii) confidence levels in the British Association of Dermatologists core curriculum learning outcomes. Measures of confidence were rated using a five‐point Likert scale. Results Completed questionnaires were obtained from 449 final‐year medical students at 14 medical schools (12.9% of 3485 final‐year UK medical students). Students who received teaching from dermatologists (P ≤ 0.01), dermatology specialist nurses (P ≤ 0.001), and expert patients (P ≤ 0.001) reported higher levels of confidence. Learning in clinical settings (P ≤ 0.001) and small‐group settings (P ≤ 0.001) was associated with higher confidence levels. Student‐selected components in dermatology were associated with higher confidence levels (P ≤ 0.001). Confidence levels were consistently lower in dermatological emergencies compared with chronic conditions, reflecting the lack of clinical exposure. Overall, 64.9% of students were at least adequately confident in assessing, and 52.0% were similarly confident in managing patients with skin conditions. Conclusions The findings of this study show that specialist clinical experiences and small‐group learning had the most significant influence on confidence levels in dermatology. Many medical students nearing qualification were less than adequately confident in their abilities to assess and manage skin conditions, suggesting that a greater emphasis on dermatology is required.     

The prevalence of common skin conditions in Australian school students: 2. Atopic dermatitis

The prevalence of atopic dermatitis (AD) was recorded following examination by dermatologists and dermatology registrars of a random sample of 2491 school students throughout the State of Victoria, Australia. The overall prevalence, based on clinical examination, was 16.3% (95% confidence interval, CI 14.1-18.5), being higher in girls (17.7%; 95% CI 15.0-20.4) than boys (14.8%; 95% CI 11.8-17.8). Using the U.K. Working Party Diagnostic Criteria for AD reduced the prevalence to 10.8% (95% CI 9.3-12.3) with the prevalence in girls 12.3% (95% CI 10.1-14.4) and in boys 9.2% (95% CI 7.1-11.4). The prevalence was highest in 4-6 year olds (18.7% on clinical examination, 11.5% using the U.K. Working Party Criteria), decreasing with increasing age to 11.6% on clinical examination (8. 6% on U.K. Working Party Criteria) among 16-18 year olds. Most of those with AD were classified as having mild disease (54.1%), with 32.1% classified as having minimal and 13.8% as having moderate to severe disease. Over 80% of those who reported on the questionnaire that they had dermatitis that was then confirmed on examination had been using one or more products to treat it. Nearly 90% of these products were classified as efficacious, with medical practitioners being the major source of advice for their use (77%). Pharmacists (8%), family/friends (6%) and others (9%), including beauticians and naturopaths, made up the remainder of the persons from whom those affected had sought advice about their treatment. These data, the first community-based prevalence data on AD published from Australia, confirm that the condition is common among those of school age. There is a need for AD to be included among those conditions that are discussed in health education lessons in schools.     

Dermatology referrals in an East Asian tertiary hospital: a need for inpatient medical dermatology

Background. Within hospitals, there is a need for dermatological expertise, as hospitalized patients have a wider spectrum of severe and serious dermatological conditions, associated with significant morbidity. Aim. To characterize the patient profile and referral pattern of inpatient dermatology consultations, and to evaluate the diagnostic accuracy of non‐dermatologists. Methods. This was a retrospective study reviewing all inpatient referrals for dermatology consultations during a 1‐year period from July 2005 to June 2006 (inclusive), at the largest multi‐disciplinary tertiary hospital in Singapore. Results. Of the 731 referrals made for dermatology consultations, 26.9% of patients had ≥ 3 important underlying comorbidities. Eczema/dermatitis (33.1%; n = 242) and cutaneous infections (23.4%; n = 171) accounted for over half of the dermatological consultations, followed by cutaneous adverse drug reactions (12.3%; n = 90). The provisional diagnoses of the referring doctors agreed with the final diagnoses confirmed by dermatologists in only 30.2% of all referrals; incorrect diagnoses were made in 35.2% of cases, and no provisional diagnoses were made in the remaining 34.6% of cases. Most misdiagnosed skin diseases were in fact common dermatoses (such as eczemas, cutaneous infections, drug rash) that required only standard treatment. Conclusion. Our study reiterates the importance of inpatient medical dermatology in terms of both service and education. There should be continual efforts to ensure that dermatologists have the highest level of training and experience in medical dermatology, to provide collaborative optimum care for hospitalized patients with dermatological diseases.     

Teaching dermatology to medical students: a survey of current practice in the U.K

BACKGROUND: In 1993, the General Medical Council recommended that all medical schools should revise their curricula for undergraduate medical education and foster more interdisciplinary collaboration in teaching. In accordance with these recommendations, new curricula have been introduced in U.K. medical schools. OBJECTIVES: To assess the impact of changes in medical curricula on the teaching of dermatology to medical undergraduates. METHODS: A questionnaire was sent to the dermatologists responsible for organizing the teaching of undergraduate dermatology in each of the 24 medical schools in England, Scotland, Wales and Northern Ireland. RESULTS: Replies were received from all schools. Nineteen of the 24 schools had already introduced integrated curricula and the others were changing more slowly. Some dermatology was included in the core curriculum in all schools. Dermatologists in 14 schools contributed to the teaching of basic science and students in 18 schools were able in years 1 and 2 to see patients in primary care (14) and/or the hospital (13). In nine of these schools, students could meet dermatology patients in these early clinical sessions. Nine schools used some problem-based learning (PBL) in addition to other teaching methods, but PBL predominated in four schools and in two of these schools most students never met a dermatologist. Dermatology was a compulsory clinical attachment in 21 schools, but the length of attachments varied and was less than 5 days in four schools. Students had to pass a dermatology assessment at the end of the clinical attachment in 14 schools and there was assessment of knowledge of dermatology in final examinations in all schools. Students had an early opportunity to explore a dermatology topic in depth in 17 schools, and 20 schools offered or were planning to introduce special study modules in dermatology. Interdisciplinary teaching links were common. Resources for out-patient teaching were inadequate in 16 schools and university support poor in 10 schools. Few departments had direct access to the considerable health service funding that is paid to National Health Service Trusts to reimburse the costs of teaching medical students. CONCLUSIONS: In general, dermatology has maintained a reasonable profile in the new undergraduate curricula, but dermatology experience is inadequate in four schools. Dermatologists should maximize opportunities for introducing dermatology into the curriculum by familiarizing themselves with the forces that are driving curriculum reform, participating in curriculum development, keeping abreast of changes in medical education and using opportunities for interdisciplinary teaching.     

National survey of undergraduate dermatologic medical education

A survey of dermatology department or section chairmen was conducted to investigate the extent of undergraduate dermatologic training in US medical schools. The median number of required hours of dermatologic training was 14, which represents 0.24% of the overall medical school curriculum time. Required dermatologic training time varied greatly among schools, but most such training occurred in the fourth year of school. Students in 53% of the schools that responded to the survey were not involved in either clinical or basic dermatologic investigative activities.     

Dermatology elective curriculum: Birdwatching list and travel guide

Primary care physicians often see patients with dermatologic complaints, but do not perform as well as dermatologists in the diagnoses of common dermatologic conditions. This article describes a dermatology curriculum that aims to close the clinical practice gap by providing an efficient and effective way to teach dermatology to medical students and non-dermatology residents in the setting of a busy, outpatient dermatology practice.