Dermatology Curriculum for Internal Medicine Residents: A Randomized Trial

摘要

What was known Physicians in specialties other than dermatology care for the majority of patients with skin disease, yet most receive little training in dermatology given limited time available for added training.;What is new A 1-month didactics-only curriculum resulted in a 20% improvement in residents' dermatology knowledge as measured by a multiple-choice test.;Limitations Small sample size, short follow-up period, and testing by means of a single outcome.;Bottom line A didactic curriculum can be an efficient and effective way to improve internal medicine residents' knowledge in the management of skin disease.;Editor's Note: The online version of this article contains tables of descriptive statistics for the analyses performed in this study.;Introduction Physicians other than dermatologists manage two-thirds of skin disease–related visits, and many of these physicians are internists,1 yet nearly two-thirds of internists do not feel competent in diagnosing and treating common skin diseases,2 and there is a substantial need to improve their education.3 Unfortunately, dermatology education is a substantial weakness for many internal medicine residencies, and the Accreditation Council for Graduate Medical Education has cited programs for their lack of dermatology training.4 To our knowledge, there were no validated assessments to show which of the traditional curricula, namely didactic and clinical, is most effective.;Methods We conducted a randomized controlled trial between July 2010 and June 2011 at the University of Texas Southwestern Medical Center at Dallas (UT Southwestern). The study incorporated a 1-month block of dermatology education that used 3 different curricula: a didactic, a clinical, and a didactic plus clinical curriculum combined. Residents completed the 1-month block at different times throughout the year. The didactic curriculum was composed of weekly 2-hour presentations lasting 4?weeks (total of 8 hours). The presentations covered emergency dermatology, skin cancer, leg ulcers, infections, infestations, and inflammatory dermatoses. The topics had been identified from a needs assessment based on the format proposed by Kern et al5 that is integral to medical curriculum development. Our needs assessment used the core competencies outlined by Hansra et al,2 and a focus group that included internal medicine chief residents, internal medicine residents, and dermatology faculty. This sought to ensure that our 13 competencies focused on topics internists, dermatologists, residents, and faculty deemed important to the education of internal medicine residents and avoided focusing on the isolated needs of internists or dermatologists.6,7 The clinical curriculum consisted of 9?days of outpatient dermatology clinic at a county hospital and 5?days on dermatology consultation service at the university, county, and pediatric teaching hospitals affiliated with UT Southwestern. Typical diagnoses encountered in the outpatient clinics included psoriasis, acne, blistering disease, skin cancer, sarcoidosis, lichen planus, eczema, contact dermatitis, mycosis fungoides, and warts. The most common consultations on the inpatient service were simple drug rashes, Stevens-Johnson syndrome, toxic epidermal necrolysis, disseminated bacterial and deep fungal infections, and vasculitis. Residents had an observer role in the clinic and consultation service. Diagnoses seen were consistent with topics covered by the Medical Knowledge Self-Assessment Program (MKSAP) test questions. The dermatology clinic had a consistent schedule and similar exposure to common dermatologic diagnoses, and the consult service can be assumed to have provided a similar experience for all residents. The combined curriculum involved completion of both the full didactic and clinical curricula. The time requirements for the clinical and combined curricula were 52?hours and 60?hours, respectively. Participants were selected from the 2010–2011 class of internal medici