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Jiang SW, Flynn MS, Kwock JT, Nicholas MW. Store-and-Forward Images in Teledermatology: Narrative Literature Review. JMIR DERMATOLOGY 2022; 5:e37517. [PMID: 35891983 PMCID: PMC9302578 DOI: 10.2196/37517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background Store-and-forward (SAF) teledermatology uses electronically stored information, including patient photographs and demographic information, for clinical decision-making asynchronous to the patient encounter. The integration of SAF teledermatology into clinical practice has been increasing in recent years, especially during the COVID-19 pandemic. Despite this growth, data regarding the outcomes of SAF teledermatology are limited. A key distinction among current literature involves comparing the quality and utility of images obtained by patients and trained clinicians, as these metrics may vary by the clinical expertise of the photographer. Objective This narrative literature review aimed to characterize the outcomes of SAF teledermatology through the lens of patient- versus clinician-initiated photography and highlight important future directions for and challenges of the field. Methods A literature search of peer-reviewed research was performed between February and April 2021. Key search terms included patient-initiated, patient-submitted, clinician-initiated, clinician-submitted, store-and-forward, asynchronous, remote, image, photograph, and teledermatology. Only studies published after 2001 in English were included. In total, 47 studies were identified from the PubMed electronic database and Google Scholar after omitting duplicate articles. Results Image quality and diagnostic concordance are generally lower and more variable with patient-submitted images, which may impact their decision-making utility. SAF teledermatology can improve the efficiency of and access to care when photographs are taken by either clinicians or patients. The clinical outcomes of clinician-submitted images are comparable to those of in-person visits in the few studies that have investigated these outcomes. Coinciding with the onset of the COVID-19 pandemic, asynchronous teledermatology helped minimize unnecessary in-person visits in the outpatient setting, as many uncomplicated conditions could be adequately managed remotely via images captured by patients and referring clinicians. For the inpatient setting, SAF teledermatology minimized unnecessary contact during dermatology consultations, although current studies are limited by the heterogeneity of their outcomes. Conclusions In general, photographs taken by trained clinicians are higher quality and have better and more relevant diagnostic and clinical outcomes. SAF teledermatology helped clinicians avoid unnecessary physical contact with patients in the outpatient and inpatient settings during the COVID-19 pandemic. Asynchronous teledermatology will likely play a greater role in the future as SAF images become integrated into synchronous teledermatology workflows. However, the obstacles summarized in this review should be addressed before its widespread implementation into clinical practice.
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Affiliation(s)
- Simon W Jiang
- Department of Dermatology Duke University School of Medicine Durham, NC United States
| | - Michael Seth Flynn
- Department of Dermatology Duke University School of Medicine Durham, NC United States
| | - Jeffery T Kwock
- Department of Dermatology Duke University School of Medicine Durham, NC United States
| | - Matilda W Nicholas
- Department of Dermatology Duke University School of Medicine Durham, NC United States
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2
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Lam M, Doiron PR. The Use of Teledermatology in Medical Education. MEDICAL SCIENCE EDUCATOR 2022; 32:243-246. [PMID: 34815891 PMCID: PMC8601370 DOI: 10.1007/s40670-021-01465-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/04/2021] [Indexed: 06/13/2023]
Abstract
Certain aspects of medical education have transitioned to virtual platforms since the start of the COVID-19 pandemic. This commentary explores advantages and barriers to teledermatology in medical education, which has the potential to reach an extensive pool of learners and preceptors but may be limited by logistical and security considerations of a virtual platform. Dermatology in particular lends itself to an online platform as a highly visual specialty, although clinical exam would be highly dependent on quality of images captured. With teledermatology, learners can begin developing an approach to delivering care remotely, and becoming accustomed to virtual platforms.
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Affiliation(s)
- Megan Lam
- Michael G. DeGroote School of Medicine, Faculty of Medicine, McMaster University, 1280 Main St. West, Hamilton, ON L8S 4L8 Canada
| | - Philip R. Doiron
- Division of Dermatology, Women’s College Hospital, Toronto, ON Canada
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3
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Ibrahim AE, Magdy M, Khalaf EM, Mostafa A, Arafa A. Teledermatology in the time of COVID-19. Int J Clin Pract 2021; 75:e15000. [PMID: 34714575 PMCID: PMC8646275 DOI: 10.1111/ijcp.15000] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 09/20/2021] [Accepted: 10/27/2021] [Indexed: 12/11/2022] Open
Abstract
AIMS The enormous spread of the novel Corona virus disease (COVID-19) represents a challenge to dermatological practice. Accumulating evidence has suggested a possible role of teledermatology in facing this challenge. In this article, we aimed to give a general overview of teledermatology in terms of models of practice, modes of delivery, advantages, limitations, ethical considerations and legislative challenges as well as discussing, using examples from literature, how dermatological practice can benefit from teledermatology during the time of the COVID-19 pandemic. DISCUSSION AND CONCLUSION Teledermatology could be an accessible, accurate and cost-effective substitute for conventional face-to-face dermatological consultations during the COVID-19 pandemic. However, teledermatology practice needs updated legislation and guidelines. More efforts should be done to encourage dermatologists, especially in underserved communities, to provide teledermatology services. Ethical issues and data security related to teledermatology have to be considered.
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Affiliation(s)
- Ahmed Elsayed Ibrahim
- Department of NeuropsychiatryFaculty of MedicineAlexandria UniversityAlexandriaEgypt
| | - Mayar Magdy
- Barnet HospitalThe Royal Free London NHS Foundation TrustLondonUK
| | - Eslam M. Khalaf
- Department of Critical MedicineFaculty of MedicineAlexandria UniversityAlexandriaEgypt
| | - Alshimaa Mostafa
- Department of DermatologyGraduate School of MedicineKyoto UniversityKyotoJapan
- Department of DermatologyFaculty of MedicineBeni‐Suef UniversityBeni‐SuefEgypt
| | - Ahmed Arafa
- Department of Public HealthGraduate School of MedicineOsaka UniversitySuitaJapan
- Department of Public HealthFaculty of MedicineBeni‐Suef UniversityBeni‐SuefEgypt
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4
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Nguyen VM, Bell C, Berseth V, Cvitanovic C, Darwent R, Falconer M, Hutchen J, Kapoor T, Klenk N, Young N. Promises and pitfalls of digital knowledge exchange resulting from the COVID-19 pandemic. SOCIO-ECOLOGICAL PRACTICE RESEARCH 2021; 3:427-439. [PMID: 34849455 PMCID: PMC8613463 DOI: 10.1007/s42532-021-00097-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 10/11/2021] [Indexed: 11/07/2022]
Abstract
In this article, we integrate our authorship experiences with insights from nine interviews of knowledge exchange practitioners at the Canadian Forest Service about challenges and opportunities of digital knowledge exchange (KE) brought on by the COVID-19 pandemic. We aim to inform how best to maintain effective KE practices and processes in a digital-first world. Interpersonal trust and relationships are pivotal to effective knowledge exchange; thus, removing these dimensions risks losing aspects of social learning, informal and meaningful discussions, and personal connections that affect how we interpret and respond to subtle affective and social cues. For KE practitioners, lack of in-person interactions risks internal KE coordination and relevance of KE work, and diminished ability to predict and respond to user needs. However, the accelerated digital adoption has increased reach and accessibility for diverse people to exchange knowledge, and enables more frequent and rapid response to issues and events by virtually gathering diverse people almost instantly. The acceleration in digital innovation and culture has thus resulted in new tools and diversified approaches for the KE toolbox to inform decisions and practices. The long-term sustainability and effectiveness of digital KE depend on two interconnected factors: addressing the persistence of the digital divide and people's abilities to make and maintain meaningful social connections in the absence of regular face-to-face contact. We thus offer three considerations to guide KE efforts and initiative in a digital-first world: (1) consider both digital divide and equity; (2) revisit user needs and preferences for KE to address the diversity of users, and (3) leverage the diversification of KE approaches and innovations.
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Affiliation(s)
- Vivian M. Nguyen
- Institute of Environmental and Interdisciplinary Science, Carleton University, 1125 Colonel By Drive, Ottawa, ON K1S5B6 Canada
- Biology Department, Carleton University, 1125 Colonel By Drive, Ottawa, ON K1S5B6 Canada
| | - Christina Bell
- School of Sociological and Anthropological Studies, University of Ottawa, 120 University Private, Ottawa, Canada
| | - Valerie Berseth
- Biology Department, Carleton University, 1125 Colonel By Drive, Ottawa, ON K1S5B6 Canada
| | - Christopher Cvitanovic
- Australian National Centre for the Public Awareness of Science, Australian National University, Canberra, Australia
| | - Ray Darwent
- Natural Resources Canada - Canadian Forest Service, Northern Forestry Centre, 5320-122nd Street, Edmonton, AB T6H 3S5 Canada
| | - Matthew Falconer
- Natural Resources Canada - Canadian Forest Service, 580 Booth St, Ottawa, ON Canada
| | - Jenna Hutchen
- Biology Department, Carleton University, 1125 Colonel By Drive, Ottawa, ON K1S5B6 Canada
| | - Tyreen Kapoor
- Biology Department, Carleton University, 1125 Colonel By Drive, Ottawa, ON K1S5B6 Canada
| | - Nicole Klenk
- Department of Physical and Environmental Sciences, University of Toronto Scarborough, 1065 Military Trail, Toronto, ON M1C 1A4 Canada
| | - Nathan Young
- School of Sociological and Anthropological Studies, University of Ottawa, 120 University Private, Ottawa, Canada
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Impact of COVID-19 on Dermatology Residency. Dermatol Clin 2021; 39:609-618. [PMID: 34556250 PMCID: PMC8320344 DOI: 10.1016/j.det.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
COVID-19 has created challenges across medicine, including in medical education, with deeply rooted impacts in the dermatology residency experience. Its effects are both acute and chronic, including: shifts to virtual education and conferences, skewed clinical experiences, negatively impacted wellness, and uncertainty in the future. As educators and mentors, it is important to recognize and address these issues so that we may remain transparent, adaptable, and engaged as we continue to build a better tomorrow for our resident trainees.
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Mahmood F, Cyr J, Keely E, Afkham A, Gugiani S, Walker J, DesGroseilliers JP, Kirshen C. Teledermatology Utilization and Integration in Residency Training Over the COVID-19 Pandemic. J Cutan Med Surg 2021; 26:135-142. [PMID: 34551623 PMCID: PMC8950709 DOI: 10.1177/12034754211045393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background During the 2019 Coronavirus (COVID-19) pandemic, the Division of Dermatology, University of Ottawa, adapted pre-existing local healthcare infrastructures to provide increased provider-to-provider teledermatology services as well as integrated teledermatology into the dermatology residency training program. Objectives (1) To assess the differences in utilization of provider-to-provider teledermatology services before and during the COVID-19 pandemic; and (2) to assess dermatology resident and faculty experiences with the integration of teledermatology into dermatology residency training at the University of Ottawa. Methods We conducted a cross-sectional analysis comparing provider-to-provider teledermatology consults submitted to dermatologists from April 2019 to October 2019 pre-pandemic with the same period during the pandemic in 2020. Two different questionnaires were also disseminated to the dermatology residents and faculty at our institution inquiring about their perspectives on teledermatology, education, and practice. Results The number of dermatologists completing consults, the number of providers submitting a case to Dermatology, and the number of consults initiated all increased during the pandemic period. Ninety-one percent of residents agreed that eConsults and teledermatology enhanced their residency education, enabled continuation of training during the pandemic, and that eConsult-based training should be incorporated into the curriculum. Ninety-six percent of staff incorporated a virtual dermatology practice model, and one-third used teledermatology with residents during the pandemic. Most staff felt there was value in providing virtual visits in some capacity during the pandemic. Conclusions Our study confirms that the use of teledermatology services continues to increase accessibility during the pandemic. Teledermatology enhances the education and training of residents and will be incorporated into dermatology residency programs.
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Affiliation(s)
- Farhan Mahmood
- 6363 Faculy of Medicine, University of Ottawa, ON, Canada
| | - Janelle Cyr
- Division of Dermatology, Department of Medicine, The Ottawa Hospital, ON, Canada
| | - Erin Keely
- Division of Endocrinology/Metabolism, Department of Medicine, The Ottawa Hospital, ON, Canada
| | - Amir Afkham
- 104255 The Champlain Local Health Integration Network, Ottawa, ON, Canada
| | - Sheena Gugiani
- 104255 The Champlain Local Health Integration Network, Ottawa, ON, Canada
| | - Jim Walker
- Division of Dermatology, Department of Medicine, The Ottawa Hospital, ON, Canada
| | | | - Carly Kirshen
- Division of Dermatology, Department of Medicine, The Ottawa Hospital, ON, Canada
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Gisondi P, Bellinato F, Piaserico S, Di Leo S, Cazzaniga S, Naldi L. Preference for Telemedicine Versus In-Person Visit Among Patients with Psoriasis Receiving Biological Drugs. Dermatol Ther (Heidelb) 2021; 11:1333-1343. [PMID: 34173220 PMCID: PMC8232561 DOI: 10.1007/s13555-021-00555-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 05/15/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction The use of telemedicine has significantly increased since the outbreak of the SARS-CoV-2 pandemic. In the dermatological setting, patients with stable plaque psoriasis on maintenance therapy with biological drugs may be suitable candidates for telemedicine, although their preference for telemedicine has not yet been investigated. The aim of this study was to investigate the preference for telemedicine versus in-person visit among patients with psoriasis receiving biological drugs and the reported reasons behind their preferences. Methods Consecutive adult patients with chronic plaque psoriasis in stable clinical remission (Psoriasis Area Severity Index [PASI] ≤ 3 for at least 12 months) receiving maintenance biological therapy answered a survey investigating whether they would choose telemedicine or in-person visit for the next scheduled visit and the reasons behind their preference. The survey was undertaken through a questionnaire that was developed according to a structured process. Results Of the 246 participants in the survey, 118 (48%) preferred telemedicine over an in-person visit for their next scheduled visit with a dermatologist. Multivariate logistic regression analysis revealed that previous experience with digital video-communication tools was a significant predictor for the preference for telemedicine (odds ratio [OR] 10.75; 95% confidence interval [CI] 3.61–32.03), while older age (< 60 years) was negatively associated with the preference for telemedicine (OR 0.30; 95% CI 0.10–0.90). The most common reasons (75%) for preferring telemedicine were saving time and safety in relation to the risk presented by the Sars-CoV-2 pandemic (38%). In contrast, 56% of the patients who preferred the in-person visit option declared that they were unable to use video-communication tools. Conclusion About half of the patients with stable psoriasis receiving biological drugs may be good candidates for telemedicine. Graphic abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s13555-021-00555-3.
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Affiliation(s)
- Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy.
| | - Francesco Bellinato
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - Stefano Piaserico
- Section of Dermatology, Department of Medicine, University of Padua, Padua, Italy
| | - Sara Di Leo
- Division of Dermatology, San Bortolo Hospital, Vicenza, Italy
| | - Simone Cazzaniga
- Centro Studi GISED, Bergamo, Italy.,Department of Dermatology, Inselspital University Hospital of Bern, Bern, Switzerland
| | - Luigi Naldi
- Division of Dermatology, San Bortolo Hospital, Vicenza, Italy.,Centro Studi GISED, Bergamo, Italy
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8
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Kopp AR, Rikin S, Cassese T, Berger MA, Raff AC, Gendlina I. Medical student remote eConsult participation during the COVID-19 pandemic. BMC MEDICAL EDUCATION 2021; 21:120. [PMID: 33618711 PMCID: PMC7897886 DOI: 10.1186/s12909-021-02562-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 02/03/2021] [Indexed: 05/09/2023]
Abstract
BACKGROUND Undergraduate medical education was severely impacted by the COVID-19 pandemic. As traditional clinical rotations were suspended, medical students quickly began alternative, novel educational experiences. Third-year medical students at an academic medical center were given the opportunity to join inpatient eConsult teams within the department of medicine. This study describes the development and implementation of this program as well as the experiences of student and faculty participants. METHODS Student eConsult participation was rapidly developed and implemented within medical subspecialty teams in either infectious diseases (ID) or nephrology. Twelve third-year medical students and 15 subspecialty attendings participated in this program during an eight-week period from April 6 through May 29, 2020. Breadth of student clinical experience was assessed via review of clinical documentation and surveys. Participating students and attending physicians completed surveys to reflect upon their impressions of the program. Surveys were returned by nine students and eight faculty members. Survey responses were summarized with descriptive statistics. RESULTS Over an eight-week period, student consultants wrote 126 notes on 100 patients; 74 of these patients (74%) were hospitalized with COVID-19. Student experiences were largely positive with most strongly agreeing that attendings promoted interactive and engaged learning (N = 8 of 8, 100%), that the experience helped to expand their knowledge about consultant roles (N = 6, 75%), and that they would participate in a remote eConsult program again if given the opportunity (N = 6, 75%). Faculty also were largely positive about the experience with most agreeing or strongly agreeing with the importance of teaching medical students about telehealth (N = 7 of 8, 88%) and eConsults (N = 6, 75%). In narrative responses, students and faculty agreed that teaching was a strength of the program whereas lack of in-person contact was a challenge. CONCLUSIONS Rapid development of an inpatient eConsult-based educational experience for third-year medical students was feasible and successful. Student-consultants saw a range of pathology including COVID-19 and related complications. Students were satisfied with the program. They were able to develop a strong relationship with attendings while learning about the role of a consultant. Faculty agreed with the importance of teaching students about telehealth and eConsults specifically.
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Affiliation(s)
- Adam R Kopp
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Sharon Rikin
- Department of Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Todd Cassese
- Department of Medicine, Division of Hospital Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Matthew A Berger
- Department of Medicine, Division of Hospital Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Amanda C Raff
- Department of Medicine, Division of Nephrology, Albert Einstein College of Medicine and Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Inessa Gendlina
- Department of Medicine, Division of Infectious Diseases, Albert Einstein College of Medicine and Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA.
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Abstract
The first cases of coronavirus disease 2019 (COVID-19) in Iran were detected on February 19, 2020. Soon the entire country was hit with the virus. Although dermatologists were not immediately the frontline health care workers, all aspects of their practice were drastically affected. Adapting to this unprecedented crisis required urgent appropriate responses. With preventive measures and conserving health care resources being the most essential priorities, dermatologists, as an integral part of the health system, needed to adapt their practices according to the latest guidelines. The spectrum of the challenges encompassed education, teledermatology, lasers, and other dermatologic procedures, as well as management of patients who were immunosuppressed or developed drug reactions and, most importantly, the newly revealed cutaneous signs of COVID-19. These challenges have paved the way for new horizons in dermatology.
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Affiliation(s)
- Maryam Daneshpazhooh
- Department of Dermatology, Tehran University of Medical Sciences, Tehran, Iran; Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - HamidReza Mahmoudi
- Department of Dermatology, Tehran University of Medical Sciences, Tehran, Iran; Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Ashrafzadeh S, Imadojemu SE, Vleugels RA, Buzney EA. Strategies for effective medical student education in dermatology during the COVID-19 pandemic. J Am Acad Dermatol 2020; 84:e33-e34. [PMID: 32828857 PMCID: PMC7439964 DOI: 10.1016/j.jaad.2020.08.068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/14/2020] [Accepted: 08/14/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | - Sotonye E Imadojemu
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ruth Ann Vleugels
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Elizabeth A Buzney
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.
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