National Appraisal of Dermatology Residency Training

What do dermatologists and dermatology residents think about their residency training in dermatology?

Introduction

In Spain, graduates in medicine take a state exam which, depending on their result, enables them choose a speciality in a specific hospital. Becoming a specialist in dermatology involves 4 years of training in a hospital. The content of the speciality is government regulated, although it can vary slightly in different hospitals. Feedback about this training period could provide key information to improve any failings. The aim of the study was to evaluate the perspectives of dermatologists and dermatology residents toward residency training.

Materials and methods

Resident dermatologists in their final 2 years and recently qualified dermatologists answered a survey regarding the residency, and personal perspectives and objectives within dermatology.

Results

A total of 54 participants answered the survey. Their mean age was 29.26 years old. Around 74% of them had had at least 3 clinical sessions per week during their residency and 87% of them considered these clinical sessions to have been useful for their training. The main shortcomings in their training were perceived as laser and esthetics, followed by trichology then research and contact dermatitis. However, 85.2% of them had done external rotations to progress in the areas they felt they needed to improve. Around 55% of the participants had considered specializing in research. Regarding research doctorates, 20.4% were doing their PhD or had already finished it, and of the remaining, 62.79% were interested in doing one.

Conclusion

The opinions, feelings and aspirations of the dermatology residents are an important barometer for the future of the speciality. Training in research, laser and esthetics was perceived as a weakness by the participants, while clinical sessions and external rotations were considered good for their training. The information from this survey establishes a reference point from which present needs and future trends can be gauged.

Pediatric Dermatology in Canada: A Broad Review of Population Needs, Workforce and Training With Proposed Solutions

INTRODUCTION

The need for pediatric dermatology services is increasing across Canada. In parallel, the complexity of treatment with novel targeted therapeutics has increased. Currently, there is no accredited and limited non-accredited fellowship training access to pediatric dermatology in Canada.

HYPOTHESIS

Understanding the current state of pediatric dermatology training in Canada will provide insight into opportunities for strategic improvement.

METHODS

A survey was distributed to 44 pediatric dermatology providers. In addition, a review of the burden of pediatric skin disease and education/training in Canada was performed.

RESULTS

Thirty-four specialists responded to the survey (77% response rate). One third of current pediatric dermatology providers are over 50 years old and half of these (15%) plan to retire within the next 5 years. Half of respondents were dermatologists, 35% were pediatricians, and 11% were double boarded. Almost all respondents practiced in an academic setting (94%). Most had further fellowship training in pediatric dermatology (82.4%) but only 57% achieved this training in Canada, due to lack of accredited or non-accredited funded fellowship positions.

CONCLUSION

There is a high and growing need for pediatric dermatology specialty care in a diverse range of settings. The current provider population and training programs are insufficient to meet current and future demands. We highlighted solutions to close this gap between supply and demand including increased double board certification in Pediatrics and Dermatology, a protected pediatric stream within existing Dermatology residency training programs and accredited fellowships in Pediatric Dermatology for both dermatologists and pediatricians.

Training dermatology residents in dermatoscopy: A case control lecture series assessment

Lack of standardized dermatoscopy training limits confidence and accuracy. We assessed the effect of a dermatoscopy lecture series on the diagnostic accuracy of dermatology residents' biopsies. Additionally, we evaluated resident comfort with and knowledge of dermatoscopy before and after the curriculum. Twelve dermatology residents were enrolled in a 5-month dedicated dermatoscopy curriculum. To assess knowledge of and comfort with dermatoscopy, residents were given a 50-question assessment and 21-question survey before and after the curriculum. Change in diagnostic accuracy was assessed by comparing the suspected clinical diagnosis to the final histopathologic diagnosis of lesions biopsied by residents before and after the course. Upon completion of the curriculum, residents felt significantly more comfortable performing dermatoscopy (P = .002) and using dermatoscopy to identify melanocytic nevi (P = .037) and melanomas (invasive and in situ) (P = .012). Postgraduate year 2 residents also showed significantly improved diagnostic accuracy after the training course (odds ratio, 1.33; 95% confidence interval, 1.06-1.67; P = .013). Our study was limited by a small sample size of 12 residents from a single academic institution. A formal dermatoscopy course can effectively improve dermatology residents' knowledge, confidence, and diagnostic accuracy when using dermatoscopy.

The Evolution of Live Patient Viewing in the Era of COVID-19: Survey Study

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The impact of gender in mentor-mentee success: Results from the Women's Dermatologic Society Mentorship Survey

Background

Mentorship can have a profound impact on the success and happiness of a mentee while also providing a sense of fulfillment and enrichment for the mentor. Both officially designated and spontaneously chosen mentors can be useful for protégés as they navigate through their training and professional work environment while striving to obtain the optimal work–life balance. Different genders can have variable experiences, in both their personal lives managing family obligations and their professional lives as dermatologists, which may affect the advice and guidance offered.

Objective

We studied the impact of gender on the mentor–mentee relationship for both official and spontaneous mentorships through a voluntary survey with a focus on reported outcomes from the perspective of the mentee.

Methods

Participants were selected through e-mail invitation via the Women's Dermatologic Society and program directors of the Association of Professors of Dermatology membership lists and given a link to the anonymous survey tool. The survey included 13 questions looking at official and spontaneous mentorships, the role of gender, and success in the dermatology field.

Results

Of the 288 respondents, 202 (69.9%) were women, 86 (29.8%) were men, and one identified as other. Of the survey participants, 81% had official mentors and 91% had spontaneous mentors, with the overlap indicating that there may have been a history of multiple mentors per individual. Mentoring had an overall significant positive impact, and 98.5% of those in the spontaneous-mentor group rated the mentor as helpful compared with 87.6% in the official-mentor cohort. For official mentorships, 60.1% involved gender-similar mentors, and of those who had officially designated mentors of any type, 55% indicated a preference for mentors of the same gender. When specifically looking at respondents who participated in same-gender official mentorships, 65.5% preferred this type; of those who had a gender-dissimilar equivalent, only 36.7% indicated a preference for gender similarity in a mentor. Comparably, 59% of protégés with spontaneous mentors had a gender-similar one, and of those who had spontaneous mentors of any type, 59.2% preferred gender similarity. When considering only those in gender-similar spontaneous mentorships, 74.5% favored a same-gender pairing compared with 32.9% of those in the gender-dissimilar group. For female–female official mentorships, 75% preferred a female mentor, similar to 80.5% of the spontaneous-mentor cohort.

Conclusion

Spontaneous mentors may provide a greater benefit than officially designated ones. For the majority of the categories, there was no statistical difference between female same-gender mentorships and gender-dissimilar relationships, which is in contrast with previously published literature. Overall, based on the feedback provided, the respondents believed that the quality of the relationship was the most important defining factor, but some noted that same-gender mentorships can provide additional benefit geared toward similar interests and experiences in life.

Attaining full professor: Women's and men's experiences in medical education

INTRODUCTION

The underrepresentation of women among senior faculty members in medical education is a longstanding problem. The purpose of this international qualitative investigation was to explore women and men's experiences of attaining full professorship and to investigate why women remain underrepresented among the senior faculty ranks.

METHODS

Conducted within a social constructionist orientation, our qualitative study employed narrative analysis. Two female and two male participants working in medical education were recruited from five nations: Australia, Canada, the Netherlands, United Kingdom and United States. All participants held an MD or PhD. During telephone interviews, participants narrated the story of their careers. The five faculty members on the research team were also interviewed. Their narratives were included in analysis, rendering their experiences equal to those of the participants.

RESULTS

A total of 24 full professors working in medical education were interviewed (n = 15 females and n = 9 males). While some aspects were present across all narratives (ie personal events, career milestones and facilitating and/or impeding factors), participants' experience of those aspects differed by gender. Men did not narrate fatherhood as a role navigated professionally, but women narrated motherhood as intimately connected to their professional roles. Both men and women narrated career success in terms of hard work and overcoming obstacles; however, male participants described promotion as inevitable, whereas women narrated promotion as a tenuous navigation of social structures towards uncertain outcomes. Female and male participants encountered facilitators and inhibitors throughout their careers but described acting on those experiences differently within the cultural contexts they faced.

DISCUSSION

Our data suggest that female and male participants had different experiences of the work involved in achieving full professor status. Understanding these gendered experiences and their impact on career progression is an important advancement for better understanding what leads to the underrepresentation of women among senior faculty members in medical education.

Psychodermatology in Canada: A National Survey Assessment of Dermatologists' Perception, Practice Patterns, and Challenges

OBJECTIVES

We aimed to assess the perception of psychodermatology, practice patterns, and challenges reported by Canadian dermatologists.

METHODS

We designed an online questionnaire based on previous literature, including questions about practitioners' perceptions, practice patterns, training, and challenges in psychodermatology. We solicited their opinions on desired training, research needs, and clinical approach recommendations. Our survey was distributed nationally by the Canadian Dermatology Association (CDA).

RESULTS

Of the total of 78 participating dermatologists, >75% reported treating patients with psychodermatological conditions, with higher frequencies of secondary than primary psychodermatological conditions. While practitioners had some confidence in their understanding of psychodermatology (median = 4 on a 5-point scale), their comfort levels to approach these patients were lower (median = 3), and their confidence in prescribing psychotropic medication was markedly low (median = 2). A total of 50% reported that a "multidisciplinary approach" would be best for these patients. Poor access to psychiatry was the most reported (26.9%) challenge, together with time constraints, lack of training, poor communication with patients, and lack of patient insight and resources. While 46.2% reported having never participated in psychodermatology training, 55.1% expressed interest in doing so.

CONCLUSION

We identified several challenges with knowledge, awareness, and healthcare delivery in psychodermatological practice in Canada. Increasing dermatologists' access to psychiatric consultations/services, a multidisciplinary approach with dermatologists and psychiatrists co-providing care, and more specialized training in this area are recommended to narrow the identified gaps.

Reliable test of clinicians' mastery in skin cancer diagnostics

Differentiating between benign and malignant skin lesions can be very difficult and should only be done by sufficiently trained and skilled clinicians. To our knowledge there are no validated tests for reliable assessments of clinicians' ability to perform skin cancer diagnostics. To develop and gather validity evidence for a test in skin cancer diagnostics, a multiple-choice questionnaire (MCQ) was developed based on informal interviews with seven content experts from five skin cancer centers in Denmark. Validity evidence for the test was gathered from May until July 2019 using Messick's validity framework (content, response process, internal structure, relationship to other variables and consequences). Item content was revised through a Delphi-like review process and then piloted on 36 medical students and 136 doctors using a standardized response process. Results enabled an analysis of the internal structure and relationship to other variables of the test. Finally, the contrasting groups method was used to investigate the test's consequences (pass-fail standard). The initial 90-item MCQ was reduced to 40 items during the Delphi-like review process. Item analysis revealed that 25 of the 40 selected items were level I-III quality items with a high internal consistency (Cronbach's α = 0.83) and highly significant (P ≤ 0.0001) differences in test scores between participants with different occupations or levels of experience. A pass-fail standard of 12 (48%) correct answers was established using the contrasting groups' method. The skin cancer diagnostics MCQ developed in this study can be used for reliable assessments of clinicians' competencies.

Residency training in Ghana: the residents' perspective

Background

Prior to 1973, West African citizens completed postgraduate medical and surgical training abroad, particularly in the United Kingdom. In 2003, the Ghana College of Physicians and Surgeons were established respectively and began to offer specialized training locally. The aim of this study was to obtain and evaluate the views of Medical and Surgical Residents of the GCPS on their training in Ghana.

Method

A descriptive cross-sectional study was undertaken whereby a 25 item, self-administered questionnaire, was distributed to 170 residents of Korle Bu and Komfo Anokye Teaching Hospitals in Ghana. Information regarding the residents' sociodemographic characteristics, level of residency, and satisfaction with the programs in terms of clinical supervision, didactic teaching, program duration and research training was collected.

Results

117 residents completed the survey, yielding a response rate of 68.8%. 59.8% were males and 40.2% females. The age of the residents ranged from 25 to 40 years with a mean age of 32.7+1.4 years. Majority of residents (92.3%) were satisfied with the duration of the programs . Slightly more than half of the residents (50.4%) were satisfied with the clinical supervision, however only a third of the respondents (33.3%) were satisfied with the didactic teaching and an even smaller percentage (17.1%) with research training.

Conclusion

Whilst majority of residents were satisfied with the duration of the residency program, the perspective of the respondents was that trainees would benefit from additional didactic teaching and increased research exposure.

Funding

None

Dermatologic Training and Practice in Canada: A Historical Overview

The specialty of dermatology is constantly changing to meet the medical needs of our society. The discipline is in flux because of a variety of factors such as growing population needs, technological advancements, fiscal restraint, and demographic changes. As part of an in-depth review of the specialty, the Dermatology Working Group (DWG) for the Royal College of Physicians and Surgeons of Canada sought to determine whether the current training configuration is suitably preparing graduates to meet the societal health needs of dermatology patients. In this first of a 2-part series, the authors conducted comprehensive literature and historical reviews and a jurisdictional analysis to understand the current state of dermatology practice in Canada. Herein, they explore trends in the dermatology workforce, population needs, accessibility, and wait times, as well as issues in undergraduate and postgraduate medical education. In a subsequent publication, the DWG will utilize information gained from this historical analysis and jurisdictional review, stakeholder perspectives, and a national survey to shape the future of dermatology training in Canada.

Aesthetic Dermatologic Surgery Training in Canadian Residency Programs

BACKGROUND:

The public and other physicians expect dermatologists to be experts on aesthetic dermatology services. In Canada, current challenges may limit residents from achieving competency in aesthetic dermatology during their training. This may adversely affect patient safety, create medicolegal risks, and deter graduates from offering aesthetic procedures.

OBJECTIVES:

The objective of this article is to characterize the curriculum, hands-on learning opportunities, and perceptions of aesthetic dermatologic training in Canadian dermatology residency training programs.

METHODS:

An online survey of faculty and residents within Canadian dermatology residency programs was performed. The main outcome measures were the hours of formal aesthetic dermatology teaching, the frequency of hands-on dermatology resident training with injectables and devices, and comparing faculty and resident perspectives regarding resident aesthetic dermatology training.

RESULTS:

Thirty-six faculty members (40%) and 47 residents (34%) responded to the survey. Lasers, fillers, neuromodulators, and mole removal were most commonly taught in the 10 hours or fewer of formal instruction. Residents commonly observed rather than performed procedures. High dissatisfaction among residents was reported with the quality and quantity of aesthetic dermatology training. Faculty and resident respondents supported increasing aesthetic dermatology education, and approximately 70% of residents plan to offer aesthetic services. Discounted pricing or resident-led clinics were felt to be ways to increase resident hands-on experience.

CONCLUSIONS:

The standardization of core competencies in aesthetic dermatologic procedures is essential to ensure patient safety and practitioner competence. At present, formal aesthetic dermatology training in residency may be insufficient for hands-on training. The majority of dermatology faculty and resident respondents support increasing aesthetic dermatology training.

Why do women choose or reject careers in academic medicine? A narrative review of empirical evidence

Women are under-represented in academic medicine. We reviewed the empirical evidence focusing on the reasons for women's choice or rejection of careers in academic medicine. Using a systematic search, we identified 52 studies published between 1985, and 2015. More than half had methodological limitations and most were from North America. Eight main themes were explored in these studies. There was consistent evidence for four of these themes: women are interested in teaching more than in research; participation in research can encourage women into academic medicine; women lack adequate mentors and role models; and women experience gender discrimination and bias. The evidence was conflicting on four themes: women are less interested in research than men; women lose commitment to research as their education and training progress; women are deterred from academic careers by financial considerations; and women are deterred by concerns about work-life balance. Inconsistency of findings across studies suggests significant opportunities to overcome barriers by providing a more enabling environment. We identified substantial gaps in the scientific literature that could form the focus of future research, including shifting the focus from individuals' career choices to the societal and organisational contexts and cultures within which those choices are made; extending the evidence base to include a wider range of countries and settings; and testing the efficacy of interventions.

Practice Gaps in Dermatology: Melanocytic Lesions and Melanoma

Early detection remains the most important strategy to reduce melanoma mortality. The identification and evaluation of new or changing skin lesions are important components of melanoma screening and are best performed today using complementary noninvasive imaging technologies, such as total body photography (TBP), dermoscopy, sequential digital dermoscopic imaging (SDDI), and reflectance confocal microscopy (RCM). Despite strong evidence showing that these screening techniques improve diagnostic accuracy for melanoma, they are not widely used by dermatologists. In this practice gaps review, the authors highlight the use, evidence, and rationale for TBP, dermoscopy, SDDI, and RCM.

Pediatric dermatology: past, present, and future

Up to 30% percent of pediatric primary care visits include a skin-related problem, and referrals are hampered by appointment wait times among the longest of any pediatric subspecialty. Despite the clear demand for pediatric dermatologists, there has been a long-standing shortage of providers, leaving dermatology as one of the most underserved pediatric subspecialties. Another consequence of the workforce shortage is the limited opportunity for pediatric dermatology training for residents and postgraduate general pediatricians and dermatologists. This review includes the evolution of the subspecialty from conception through the present, along with obstacles to workforce expansion and potential solutions to improve access to care for children with skin diseases.

The light and the dark of dermatoscopy in the early diagnosis of melanoma: facts and controversies

Early diagnosis remains the best method to reduce melanoma and non-melanoma skin cancer-related mortality and morbidity. Dermatoscopy was first introduced at the end of the last century, and besides the strict criticism that it initially received, the majority of the scientific community presently considers it revolutionary in the field of melanocytic lesion diagnostics. Cumulative evidence provides definite data that dermatoscopy improves the clinicians' diagnostic accuracy for melanoma compared with other clinical diagnostic approaches. There remain some barriers for its use such as lack of training, lack of time, and lack of reimbursement, as well as persisting skepticism about its true utility. In the current contribution, we focus on false beliefs and facts concerning dermatoscopy in the early diagnosis of melanoma and shed some light on some of the remaining "dark sides" of this issue.

Tool to visualize and evaluate operator proficiency in laser hair-removal treatments

BACKGROUND

The uniform delivery of laser energy is particularly important for safe and effective laser hair removal (LHR) treatment. Although it is necessary to quantitatively assess the spatial distribution of the delivered laser, laser spots are difficult to trace owing to a lack of visual cues. This study proposes a novel preclinic tool to evaluate operator proficiency in LHR treatment and applies this tool to train novice operators and compare two different treatment techniques (sliding versus spot-by-spot).

METHODS

A simulation bed is constructed to visualize the irradiated laser spots. Six novice operators are recruited to perform four sessions of simulation while changing the treatment techniques and the presence of feedback (sliding without feedback, sliding with feedback, spot-by-spot without feedback, and spot-by-spot with feedback). Laser distribution maps (LDMs) are reconstructed through a series of images processed from the recorded video for each simulation session. Then, an experienced dermatologist classifies the collected LDMs into three different performance groups, which are quantitatively analyzed in terms of four performance indices.

RESULTS

The performance groups are characterized by using a combination of four proposed indices. The best-performing group exhibited the lowest amount of randomness in laser delivery and accurate estimation of mean spot distances. The training was only effective in the sliding treatment technique. After the training, omission errors decreased by 6.32% and better estimation of the mean spot distance of the actual size of the laser-emitting window was achieved. Gels required operators to be trained when the spot-by-spot technique was used, and imposed difficulties in maintaining regular laser delivery when the sliding technique was used.

CONCLUSIONS

Because the proposed system is simple and highly affordable, it is expected to benefit many operators in clinics to train and maintain skilled performance in LHR treatment, which will eventually lead to accomplishing a uniform laser delivery for safe and effective LHR treatment.

Mentoring and role models in recruitment and retention: a study of junior medical faculty perceptions

PURPOSE

This study explored the views of junior faculty toward informing mentorship program development.

METHOD

Mixed sampling methodologies including questionnaires (n = 175), focus groups (female, n = 4; male, n = 4), and individual interviews (female n = 10; male, n = 9) of junior faculty were conducted in clinical departments at one academic health sciences center.

RESULTS

Questionnaire results indicated that having role models increased commitment to an academic career; mentorship experience during residency training was a high incentive to pursue an academic career; and junior faculty did have identifiable mentorship experiences. Focus group results revealed that mentoring as well as the presence of role models a few years ahead of the junior faculty would promote career development. Females preferred similar age role models who spoke the same language, particularly in the area of promotion. Females identified several challenges and issues including a lack of researcher role models, a range of perceptions regarding the merits of formal versus informal mentoring, and the idea that mentors should provide advice on promotion and grants. Males valued advice on finances while females wanted advice on work-life balance.

CONCLUSIONS

Mentorship emerged as an important factor in academic faculty recruitment and retention, with varying perceptions of how it should be institutionalized. Role models were viewed as important for retention, and a paucity of mid-career, female researcher role models suggests a gap to be filled in future programmatic efforts.

Impediments to research in pediatric dermatology: the results of a survey of the members of the society for pediatric dermatology

A research task force of the Society for Pediatric Dermatology (SPD) was established to investigate the barriers to expanding research in the field of pediatric dermatology. A survey was designed to address constraints limiting research activities among members of the SPD. A nine-question survey was distributed to SPD members at the annual meeting in 2007. Of the 70 respondents, 99% reported limitations to research activities. Of those, 90% (62/69) cited time constraints as a cause, 71% lack of funding, 38% lack of training, 35% lack of research infrastructure, 10% (7/69) lack of mentoring, and 25% (17/69) cited other reasons. SPD members face many challenges that curtail their bench and clinical research, although time constraints are most common. The high demand for clinic-directed activity and continuing workforce issues in the specialty likely contribute to the time constraints.

Use of and beliefs about total body photography and dermatoscopy among US dermatology training programs: an update

BACKGROUND

Total body photography (TBP) and dermatoscopy are imaging techniques used to treat patients with pigmented lesions.

OBJECTIVE

We sought to describe use, training, logistics, and beliefs about these tools among residency programs and to assess changes during a 10-year period.

METHODS

Surveys were sent to all directors (n = 111) and chief residents (n = 109) of US dermatology training programs.

RESULTS

A total of 83 (74.8%) attendings answered the questionnaire. In all, 59 (71.1%) reported using TBP, an 11.9% increase (P = .2484) over the past decade. Reasons for using TBP included: reduces patient anxiety (81.4%), helps detect early melanoma (78.0%), and leads to fewer biopsies (66.1%). Logistical (79.2%) and financial (45.8%) constraints were reasons for not using TBP. Seventy respondents (84.3%) reported using dermatoscopy, a 40.0% increase (P = .0001) over the 10-year period. Reasons for dermatoscopy use were consistent over time: helps find melanoma in curable stage (75.7%), reduces patient anxiety (61.4%), and leads to fewer biopsies (57.1%). The most common reason for not using dermatoscopy remained lack of training (38.5%). A total of 92 (84.4%) residents completed their survey, of which 41 (44.6%) and 81 (88.0%) reported using TBP and dermatoscopy, respectively. In all, 62 (67.4%) and 79 (85.9%) respondents would prefer additional training in TBP and dermatoscopy, respectively.

LIMITATIONS

Results may not be applicable to the general dermatology community.

CONCLUSIONS

Use of dermatoscopy among residency programs has increased significantly during the last decade. A more modest increase in the use of TBP was observed. Barriers to diffusion of these technologies into practice persist, including insufficient logistics and training.

Sun protection and skin self-examination in melanoma survivors

OBJECTIVES

Patients diagnosed with melanoma are at risk for developing recurrent and second primary disease. Skin self-examination (SSE) and sun protection are standard clinical recommendations to minimize risk. In this study we examined performance of these behaviors in individuals with melanoma drawn from the general population.

METHODS

Potential participants (N=148) with a first primary melanoma diagnosed in 2000 were identified through a population-based cancer registry in New Jersey, USA. One hundred and fifteen individuals participated in a 30 min telephone interview concerning behavioral adherence with SSE and sun protection, self-efficacy for performing these behaviors, and perceived risk of developing another skin cancer. We utilized logistic regression to estimate potential associations of demographic, medical, and psychosocial factors with SSE and sun protection, respectively.

RESULTS

Seventeen percent of subjects reported performing comprehensive SSE at least once every two months and 23% engaged in regular sun protection. Utilization of SSE was related to the presence of moles (OR=4.2, 95% CI: 1.1-15) and higher SSE self-efficacy (OR=14.4, 95% CI: 1.9-112). Regular sun protection was related to older age (>60 years; OR=3.3, 95% CI: 1.3-8.7), being female (OR=2.8, 95% CI: 1.1-7.3), and higher sun protection self-efficacy (OR=5.0, 95% CI: 1.4-18). These factors remained significant in multivariate models.

CONCLUSION

In this group of primary melanoma survivors, the rates of SSE and sun protection are comparable to, but do not exceed, general population estimates. This study provides justification for further research to address barriers to prevention and control behaviors in melanoma survivors.

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.

Skin of color education in dermatology residency programs: does residency training reflect the changing demographics of the United States?

BACKGROUND

It is projected that by the year 2050, close to 50% of the US population will comprise people with skin of color.

OBJECTIVE

We sought to assess whether future dermatologists will be prepared to treat patients with skin of color.

METHODS

An e-mail with a link to a brief 9-question survey was sent to 109 program directors and chief residents.

RESULTS

A total of 41 (37.6%) program directors and 63 (50.0%) chief residents completed the online survey. In all, 14.3% (P<.001) of chief residents and 14.6% (P<.001) of program directors recognized an expert at their institutions who conducted a skin of color clinic. In all, 25.4% (P<.001) of chief residents and 19.5% (P<.001) of program directors reported having lectures on skin of color from an acknowledged expert. In all, 30.2% (P<.001) of chief residents and 12.2% (P<.001) of program directors reported a specific rotation in which residents gained specific experience in treating patients with skin of color. In all, 52.4% (P=.70) of chief residents and 65.9% (P<.02) of program directors reported to have either lectures or didactic sessions focusing on diseases in skin of color incorporated into their curriculums. In all, 84.1% (P<.001) of chief residents and 90.2% (P<.001) of program directors reported having training programs in which residents gained experience treating patients with central centrifugal cicatricial alopecia. In all, 100% (P<.001) of both chief residents and program directors reported having training programs in which residents gained experience treating patients with keloids and melasma.

LIMITATIONS

The limitations of this study included recall bias, an incomplete response rate, unsure respondents, and questions that may not have applied to certain programs.

CONCLUSION

The results indicate a need for increased exposure, educational sessions, and overall training in diseases pertaining to skin of color in US dermatology residencies.