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Deoghare S, Sarkar R, Arora A, Mohta A, Narayan RV. A Cross-Sectional Observational Study to Assess Prevalence and Patterns of Use of Dermoscope among Indian Dermatology Residents and Ability to Identify Common Pigmentary Dermatoses of Face. Indian Dermatol Online J 2024; 15:649-651. [PMID: 39050067 PMCID: PMC11265759 DOI: 10.4103/idoj.idoj_277_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 01/11/2024] [Accepted: 01/21/2024] [Indexed: 07/27/2024] Open
Affiliation(s)
- Shreya Deoghare
- Department of Dermatology, N. K. P. Salve Medical College and Hospital, Nagpur, Maharahstra, India
| | - Rashmi Sarkar
- Department of Dermatology, Lady Hardinge Medical College and Hospital, New Delhi, India
| | - Aakanksha Arora
- Department of Dermatology, Sardar Patel Medical College, Bikaner, Rajasthan, India
| | - Alpana Mohta
- Department of Dermatology, Sardar Patel Medical College, Bikaner, Rajasthan, India
| | - R. Vignesh Narayan
- MS, Department of Dermatology, Ramaiah Medical College, Bengaluru, Karnataka, India
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Schuh S, Schiele S, Thamm J, Kranz S, Welzel J, Blum A. Implementation of a dermatoscopy curriculum during residency at Augsburg University Hospital in Germany. J Dtsch Dermatol Ges 2023; 21:872-879. [PMID: 37235503 DOI: 10.1111/ddg.15115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 04/04/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND AND OBJECTIVES To date, there is no structured program for dermatoscopy training during residency in Germany. Whether and how much dermatoscopy training is acquired is left to the initiative of each resident, although dermatoscopy is one of the core competencies of dermatological training and daily practice. The aim of the study was to establish a structured dermatoscopy curriculum during residency at the University Hospital Augsburg. PATIENTS AND METHODS An online platform with dermatoscopy modules was created, accessible regardless of time and place. Practical skills were acquired under the personal guidance of a dermatoscopy expert. Participants were tested on their level of knowledge before and after completing the modules. Test scores on management decisions and correct dermatoscopic diagnosis were analyzed. RESULTS Results of 28 participants showed improvements in management decisions from pre- to posttest (74.0% vs. 89.4%) and in dermatoscopic accuracy (65.0% vs. 85.6%). Pre- vs. posttest differences in test score (7.05/10 vs. 8.94/10 points) and correct diagnosis were significant (p < 0.001). CONCLUSIONS The dermatoscopy curriculum increases the number of correct management decisions and dermatoscopy diagnoses. This will result in more skin cancers being detected, and fewer benign lesions being excised. The curriculum can be offered to other dermatology training centers and medical professionals.
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Affiliation(s)
- Sandra Schuh
- Department of Dermatology and Allergology, University Hospital Augsburg, Augsburg, Germany
| | - Stefan Schiele
- Institute of Mathematics, University of Augsburg, Augsburg, Germany
| | - Janis Thamm
- Department of Dermatology and Allergology, University Hospital Augsburg, Augsburg, Germany
| | - Stefanie Kranz
- Department of Dermatology and Allergology, University Hospital Augsburg, Augsburg, Germany
| | - Julia Welzel
- Department of Dermatology and Allergology, University Hospital Augsburg, Augsburg, Germany
| | - Andreas Blum
- Public, Private and Teaching Practice of Dermatology, Konstanz, Germany
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Schuh S, Schiele S, Thamm J, Kranz S, Welzel J, Blum A. Implementierung eines Dermatoskopie-Curriculums in der Facharztausbildung am Universitätsklinikum Augsburg. J Dtsch Dermatol Ges 2023; 21:872-881. [PMID: 37574685 DOI: 10.1111/ddg.15115_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 04/04/2023] [Indexed: 08/15/2023]
Abstract
ZusammenfassungHintergrund und ZieleBislang gibt es in Deutschland kein strukturiertes Programm für die Dermatoskopieausbildung während der Facharztausbildung. Es bleibt der Initiative des einzelnen Assistenzarztes überlassen, ob und in welchem Umfang er sich in der Dermatoskopie weiterbildet, obwohl die Dermatoskopie zu den Kernkompetenzen der dermatologischen Ausbildung und der täglichen Praxis gehört. Ziel der Studie war die Etablierung eines strukturierten Dermatoskopie‐Curriculums während der dermatologischen Facharztausbildung am Universitätsklinikum Augsburg.Patienten und MethodikEs wurde eine Online‐Plattform mit Dermatoskopie‐Modulen geschaffen, auf die von überall und jederzeit zugegriffen werden kann. Praktische Fertigkeiten wurden unter individueller Anleitung eines Dermatoskopie‐Experten erworben. Die Teilnehmer wurden vor und nach Abschluss der Module auf ihren Wissensstand getestet. Die Testergebnisse zum therapeutischen Management und zur korrekten dermatoskopischen Diagnose wurden analysiert.ErgebnisseDie Ergebnisse der 28 Teilnehmer verbesserten sich vom Eingangs‐ zum Abschlusstest bei der Managemententscheidung (74,0% vs. 89,4%) und bei der dermatoskopischen Genauigkeit (65,0% vs. 85,6%). Die Unterschiede zwischen Eingangs‐ und Abschlusstest bei der Gesamtpunktzahl (7,05/10 vs. 8,94/10 Punkte) und bei der richtigen Diagnose waren signifikant (p < 0,001).SchlussfolgerungenDas Dermatoskopie‐Curriculum verbessert die Managemententscheidungen und die dermatoskopische Diagnostik der Teilnehmer. Das wird dazu führen, dass mehr Hautkrebsfälle erkannt werden und weniger gutartige Läsionen reseziert werden müssen. Das Curriculum kann anderen dermatologischen Ausbildungszentren und Gesundheitsberufen angeboten werden.
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Affiliation(s)
- Sandra Schuh
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Augsburg
| | | | - Janis Thamm
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Augsburg
| | - Stefanie Kranz
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Augsburg
| | - Julia Welzel
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Augsburg
| | - Andreas Blum
- Hautarzt- und Lehrpraxis für Dermatologie, Konstanz
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Lu MD, Usatine R, Holt J, Harper DM, Verdieck A. Dermoscopy Training in Family Medicine Residencies: A CERA Survey of Program Directors. Fam Med 2023; 55:259-262. [PMID: 37043187 PMCID: PMC10622031 DOI: 10.22454/fammed.2023.368813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND AND OBJECTIVES Diagnosing skin disorders is a core skill in family medicine residency. Accurate diagnosis of skin cancers has a significant impact on patient health. Dermoscopy improves a physician's accuracy in diagnosing skin cancers. We aimed to quantify the current state of dermoscopy use and training in family medicine residencies. METHODS We included questions on dermoscopy training in the 2021 Council of Academic Family Medicine Educational Research Alliance (CERA) survey of family medicine residency program directors. The survey asked about access to a dermatoscope, the presence of faculty with experience using dermoscopy, the amount of dermoscopy didactic time, and the amount of hands-on dermoscopy training. RESULTS Of 631 programs, 275 program directors (43.58% response rate) responded. Half of the responding programs (50.2%) had access to a dermatoscope, and 54.2% had a faculty member with experience using dermoscopy. However, only 6.8% of residents had 4 or more hours of didactics on dermoscopy over their entire training. Only 16.2% had 4 or more hours of hands-on dermoscopy use. Over half (58.9%) of programs planned to add more dermoscopy training. We did not find any correlations between the program's size/type/location and dermoscopy training opportunities. CONCLUSIONS Despite reasonable access to a dermatoscope and the presence of at least one faculty member with dermoscopy experience, most family medicine residency programs provided limited dermoscopy training opportunities. Research is needed to better understand how to facilitate dermoscopy training in family medicine residencies.
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Affiliation(s)
- Miranda D. Lu
- Department of Family Medicine, Swedish Medical CenterSeattle, WA
| | - Richard Usatine
- Department of Family Medicine, University of Texas HealthSan Antonio, TX
| | - James Holt
- Department of Family Medicine, East Tennessee State University HealthJohnson City, TN
| | - Diane M. Harper
- Department of Family Medicine, Obstetrics and Gynecology, and Women's and Gender Studies, University of MichiganAnn Arbor, MI
| | - Alexandra Verdieck
- Department of Family Medicine, Oregon Health & Science UniversityPortland, OR
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Lovis C, Weber J, Liopyris K, Braun RP, Marghoob AA, Quigley EA, Nelson K, Prentice K, Duhaime E, Halpern AC, Rotemberg V. Agreement Between Experts and an Untrained Crowd for Identifying Dermoscopic Features Using a Gamified App: Reader Feasibility Study. JMIR Med Inform 2023; 11:e38412. [PMID: 36652282 PMCID: PMC9892985 DOI: 10.2196/38412] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 09/28/2022] [Accepted: 10/16/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Dermoscopy is commonly used for the evaluation of pigmented lesions, but agreement between experts for identification of dermoscopic structures is known to be relatively poor. Expert labeling of medical data is a bottleneck in the development of machine learning (ML) tools, and crowdsourcing has been demonstrated as a cost- and time-efficient method for the annotation of medical images. OBJECTIVE The aim of this study is to demonstrate that crowdsourcing can be used to label basic dermoscopic structures from images of pigmented lesions with similar reliability to a group of experts. METHODS First, we obtained labels of 248 images of melanocytic lesions with 31 dermoscopic "subfeatures" labeled by 20 dermoscopy experts. These were then collapsed into 6 dermoscopic "superfeatures" based on structural similarity, due to low interrater reliability (IRR): dots, globules, lines, network structures, regression structures, and vessels. These images were then used as the gold standard for the crowd study. The commercial platform DiagnosUs was used to obtain annotations from a nonexpert crowd for the presence or absence of the 6 superfeatures in each of the 248 images. We replicated this methodology with a group of 7 dermatologists to allow direct comparison with the nonexpert crowd. The Cohen κ value was used to measure agreement across raters. RESULTS In total, we obtained 139,731 ratings of the 6 dermoscopic superfeatures from the crowd. There was relatively lower agreement for the identification of dots and globules (the median κ values were 0.526 and 0.395, respectively), whereas network structures and vessels showed the highest agreement (the median κ values were 0.581 and 0.798, respectively). This pattern was also seen among the expert raters, who had median κ values of 0.483 and 0.517 for dots and globules, respectively, and 0.758 and 0.790 for network structures and vessels. The median κ values between nonexperts and thresholded average-expert readers were 0.709 for dots, 0.719 for globules, 0.714 for lines, 0.838 for network structures, 0.818 for regression structures, and 0.728 for vessels. CONCLUSIONS This study confirmed that IRR for different dermoscopic features varied among a group of experts; a similar pattern was observed in a nonexpert crowd. There was good or excellent agreement for each of the 6 superfeatures between the crowd and the experts, highlighting the similar reliability of the crowd for labeling dermoscopic images. This confirms the feasibility and dependability of using crowdsourcing as a scalable solution to annotate large sets of dermoscopic images, with several potential clinical and educational applications, including the development of novel, explainable ML tools.
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Affiliation(s)
| | - Jochen Weber
- Dermatology Section, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Konstantinos Liopyris
- Department of Dermatology, Andreas Syggros Hospital of Cutaneous and Venereal Diseases, University of Athens, Athens, Greece
| | - Ralph P Braun
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Ashfaq A Marghoob
- Dermatology Section, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Elizabeth A Quigley
- Dermatology Section, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Kelly Nelson
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | | | | | - Allan C Halpern
- Dermatology Section, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Veronica Rotemberg
- Dermatology Section, Memorial Sloan Kettering Cancer Center, New York, NY, United States
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Farahbakhsh N, Della Porta A, Monir RL, Guo W, Grant-Kels JM, Motaparthi K. Training dermatology residents in dermatoscopy: A case control lecture series assessment. Clin Dermatol 2022; 40:782-787. [PMID: 35948236 DOI: 10.1016/j.clindermatol.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
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.
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Affiliation(s)
- Navid Farahbakhsh
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | | | - Reesa L Monir
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Wanru Guo
- Department of Biostatistics, University of Florida College of Public Health and Health Professions, Gainesville, Florida, USA
| | - Jane M Grant-Kels
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA.
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Rogers T, McCrary MR, Yeung H, Krueger L, Chen SC. Dermoscopic Photographs Impact Confidence and Management of Remotely Triaged Skin Lesions. Dermatol Pract Concept 2022; 12:e2022129. [PMID: 36159122 PMCID: PMC9464534 DOI: 10.5826/dpc.1203a129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 12/14/2022] Open
Abstract
Introduction Improving remote triage is crucial given expansions in tele-dermatology and with limited in-person care during COVID-19. In addition to clinical pictures, dermoscopic images may provide utility for triage. Objectives To determine if dermoscopic images enhance confidence, triage accuracy, and triage prioritization for tele-dermatology. Methods In this preliminary parallel convergent mixed-methods study, a cohort of dermatologists and residents assessed skin lesions using clinical and dermoscopic images. For each case, participants viewed a clinical image and determined diagnostic category, management, urgency, and decision-making confidence. They subsequently viewed the associated dermoscopy and answered the same questions. A moderated focus group discussion followed to explore perceptions on the role of dermoscopy in tele-dermatology. Results Dermoscopy improved recognition of malignancies by 23% and significantly reduced triage urgency measures for non-malignant lesions. Participants endorsed specific utilities of tele-dermoscopy, such as for evaluating pigmented lesions, with limitations including poor image quality. Conclusions Dermoscopic images may be useful when remotely triaging skin lesions. Standardized imaging protocols are needed.
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Affiliation(s)
- Tova Rogers
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia, USA,Regional Telehealth Service, VISN 7, Duluth, Georgia, USA
| | - Loren Krueger
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Suephy C Chen
- Regional Telehealth Service, VISN 7, Duluth, Georgia, USA,Department of Dermatology, Duke University, Durham, North Carolina, USA
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Percival G, Nicholas C, Webb CE, Temple-Oberle CF. Assessing exposure to dermoscopy in plastic surgery training programs. JPRAS Open 2021; 29:178-183. [PMID: 34258367 PMCID: PMC8255500 DOI: 10.1016/j.jpra.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/07/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Dermoscopy is a noninvasive tool that improves the diagnostic accuracy of melanoma and other cutaneous malignancies; yet, it is not widely used by plastic surgeons, who commonly manage skin lesions. Thus, the purpose of this study was to explore current practice patterns and knowledge of dermoscopy among plastic surgeons and postgraduate plastic surgery trainees. Additionally, interest to establish a formal dermoscopy curriculum as part of plastic surgery residency training was evaluated. METHODS An online electronic questionnaire was developed and distributed through email to practicing plastic surgeons and plastic surgery trainees at two Canadian universities. RESULTS Of the 59 potential participants, 27 (46%) responded. While the majority of participants were familiar with dermoscopy (n = 26; 96%), only one respondent reported using dermoscopy in clinical practice. However, all respondents reported exposure to melanoma clinically (n = 26; one participant did not provide a response). A lack of training, along with lack of access to dermatoscopes, were the most frequently cited reasons for not using dermoscopy. Knowledge scores with regard to dermoscopic features were also low; coupled with a noted propensity toward diagnostic or excisional biopsy, whichcould raise the benign to malignant ratio. Overall, 89% (n = 24) of respondents expressed interest in dermoscopy training in plastic surgery postgraduate training. CONCLUSIONS Few responding plastic surgeons or plastic surgery residents currently use dermoscopy in training or practice but are interested in formal dermoscopy training in residency.
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Affiliation(s)
- Gemma Percival
- Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary Alberta T2N 4N1, Canada
| | - Christine Nicholas
- Department of Surgery, Divisions of Plastic Surgery and Surgical Oncology, University of Calgary, Tom Baker Cancer Centre, 1331 29 Street NW, Calgary, Alberta T2A 4N2, Canada
| | - Carmen E. Webb
- Department of Surgery, Divisions of Plastic Surgery and Surgical Oncology, University of Calgary, Tom Baker Cancer Centre, 1331 29 Street NW, Calgary, Alberta T2A 4N2, Canada
| | - Claire F. Temple-Oberle
- Department of Surgery, Divisions of Plastic Surgery and Surgical Oncology, University of Calgary, Tom Baker Cancer Centre, 1331 29 Street NW, Calgary, Alberta T2A 4N2, Canada
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Fried LJ, Tan A, Berry EG, Braun RP, Curiel-Lewandrowski C, Curtis J, Ferris LK, Hartman RI, Jaimes N, Kawaoka JC, Kim CC, Lallas A, Leachman SA, Levin A, Lucey P, Marchetti MA, Marghoob AA, Miller D, Nelson KC, Prodanovic E, Seiverling EV, Swetter SM, Savory SA, Usatine RP, Wei ML, Polsky D, Stein JA, Liebman TN. Dermoscopy Proficiency Expectations for US Dermatology Resident Physicians: Results of a Modified Delphi Survey of Pigmented Lesion Experts. JAMA Dermatol 2021; 157:189-197. [PMID: 33404623 DOI: 10.1001/jamadermatol.2020.5213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Dermoscopy education in US dermatology residency programs varies widely, and there is currently no existing expert consensus identifying what is most important for resident physicians to know. Objectives To identify consensus-based learning constructs representing an appropriate foundational proficiency in dermoscopic image interpretation for dermatology resident physicians, including dermoscopic diagnoses, associated features, and representative teaching images. Defining these foundational proficiency learning constructs will facilitate further skill development in dermoscopic image interpretation to help residents achieve clinical proficiency. Design, Setting, and Participants A 2-phase modified Delphi surveying technique was used to identify resident learning constructs in 3 sequential sets of surveys-diagnoses, features, and images. Expert panelists were recruited through an email distributed to the 32 members of the Pigmented Lesion Subcommittee of the Melanoma Prevention Working Group. Twenty-six (81%) opted to participate. Surveys were distributed using RedCAP software. Main Outcomes and Measures Consensus on diagnoses, associated dermoscopic features, and representative teaching images reflective of a foundational proficiency in dermoscopic image interpretation for US dermatology resident physicians. Results Twenty-six pigmented lesion and dermoscopy specialists completed 8 rounds of surveys, with 100% (26/26) response rate in all rounds. A final list of 32 diagnoses and 116 associated dermoscopic features was generated. Three hundred seventy-eight representative teaching images reached consensus with panelists. Conclusions and Relevance Consensus achieved in this modified Delphi process identified common dermoscopic diagnoses, associated features, and representative teaching images reflective of a foundational proficiency in dermoscopic image interpretation for dermatology residency training. This list of validated objectives provides a consensus-based foundation of key learning points in dermoscopy to help resident physicians achieve clinical proficiency in dermoscopic image interpretation.
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Affiliation(s)
- Lauren J Fried
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
| | - Andrea Tan
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
| | - Elizabeth G Berry
- Department of Dermatology and Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Ralph P Braun
- Department of Dermatology, University Hospital Zurich, Zürich, Switzerland
| | - Clara Curiel-Lewandrowski
- The Skin Cancer Institute-University of Arizona Cancer Center, Tucson.,Division of Dermatology at the University of Arizona College of Medicine, Tucson
| | - Julia Curtis
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City
| | - Laura K Ferris
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Rebecca I Hartman
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.,Melanoma Program, Dana-Farber Cancer Institute, Boston, Massachusetts.,VA Integrated Service Network (VISN-1), Jamaica Plain, Massachusetts
| | - Natalia Jaimes
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, and Sylvester Comprehensive Cancer Center, University of Miami, Florida
| | - John C Kawaoka
- Department of Dermatology, Brown Medical School, Providence, Rhode Island
| | - Caroline C Kim
- Melanoma and Pigmented Lesion Program, Department of Dermatology, Tufts Medical Center, Boston, Massachusetts
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Sancy A Leachman
- Department of Dermatology and Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Alan Levin
- Division of Dermatology, University of Arizona College of Medicine, Tucson
| | - Patricia Lucey
- Inova Schar Cancer Institute Melanoma Center, Fairfax, Virginia
| | - Michael A Marchetti
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ashfaq A Marghoob
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Debbie Miller
- Department of Dermatology and Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Kelly C Nelson
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston
| | - Edward Prodanovic
- Department of Dermatology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Elizabeth V Seiverling
- Tufts University School of Medicine, Department of Dermatology, Portland, Maine.,Maine Medical Center Division of Dermatology, Portland, Maine
| | - Susan M Swetter
- Department of Dermatology, Stanford University, Medical Center and Cancer Institute, Stanford, California
| | - Stephanie A Savory
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas
| | - Richard P Usatine
- Department of Dermatology and Cutaneous Surgery, University of Texas Health, San Antonio
| | - Maria L Wei
- Department of Dermatology, University of California-San Francisco, San Francisco.,Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - David Polsky
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
| | - Jennifer A Stein
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
| | - Tracey N Liebman
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
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10
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Wang DM, Petitt CE, Goel NS, Ash MM, Mervak JE. Confidence and competency in the use of dermoscopy among new first-year dermatology residents: A repeated-pairs pre-/postassessment study of an online learning module. J Am Acad Dermatol 2020; 85:1585-1587. [PMID: 33248068 DOI: 10.1016/j.jaad.2020.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/19/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Affiliation(s)
- David M Wang
- Department of Dermatology, University of North Carolina at Chapel Hill
| | | | - Nikita S Goel
- Department of Dermatology, University of North Carolina at Chapel Hill
| | - Mark M Ash
- Department of Dermatology, University of North Carolina at Chapel Hill
| | - Julie E Mervak
- Department of Dermatology, University of North Carolina at Chapel Hill.
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11
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Nelson KC, Brown AE, Herrmann A, Dorsey C, Simon JM, Wilson JM, Savory SA, Haydu LE. Validation of a Novel Cutaneous Neoplasm Diagnostic Self-Efficacy Instrument (CNDSEI) for Evaluating User-Perceived Confidence With Dermoscopy. Dermatol Pract Concept 2020; 10:e2020088. [PMID: 33150029 DOI: 10.5826/dpc.1004a88] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2020] [Indexed: 01/14/2023] Open
Abstract
Background Accurate medical image interpretation is an essential proficiency for multiple medical specialties, including dermatologists and primary care providers. A dermatoscope, a ×10-×20 magnifying lens paired with a light source, enables enhanced visualization of skin cancer structures beyond standard visual inspection. Skilled interpretation of dermoscopic images improves diagnostic accuracy for skin cancer. Objective Design and validation of Cutaneous Neoplasm Diagnostic Self-Efficacy Instrument (CNDSEI)-a new tool to assess dermatology residents' confidence in dermoscopic diagnosis of skin tumors. Methods In the 2018-2019 academic year, the authors administered the CNDSEI and the Long Dermoscopy Assessment (LDA), to measure dermoscopic image interpretation accuracy, to residents in 9 dermatology residency programs prior to dermoscopy educational intervention exposure. The authors conducted CNDSEI item analysis with inspection of response distribution histograms, assessed internal reliability using Cronbach's coefficient alpha (α) and construct validity by comparing baseline CNDSEI and LDA results for corresponding lesions with one-way analysis of variance (ANOVA). Results At baseline, residents respectively demonstrated significantly higher and lower CNDSEI scores for correctly and incorrectly diagnosed lesions on the LDA (P = 0.001). The internal consistency reliability of CNDSEI responses for the majority (13/15) of the lesion types was excellent (α ≥ 0.9) or good (0.8≥ α <0.9). Conclusions The CNDSEI pilot established that the tool reliably measures user dermoscopic image interpretation confidence and that self-efficacy correlates with diagnostic accuracy. Precise alignment of medical image diagnostic performance and the self-efficacy instrument content offers opportunity for construct validation of novel medical image interpretation self-efficacy instruments.
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Affiliation(s)
- Kelly C Nelson
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ashley E Brown
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Amanda Herrmann
- Department of Pathology, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Chloe Dorsey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Julie M Simon
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Janice M Wilson
- Department of Dermatology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Stephanie A Savory
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lauren E Haydu
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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12
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Kaushik A, Natsis N, Gordon SC, Seiverling EV. A practical review of dermoscopy for pediatric dermatology part I: Melanocytic growths. Pediatr Dermatol 2020; 37:789-797. [PMID: 32748996 DOI: 10.1111/pde.14291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The value of dermoscopy in the detection of skin cancer is well established. Less is published on the utility of dermoscopy in the evaluation of pediatric skin disease. Our review (in two parts) aims to serve as an update on pediatric dermoscopy and to provide readers with a practical application for the use of dermoscopy in pediatric dermatology clinics. In part I, we propose a dermoscopy algorithm for pediatric skin disease and melanocytic growths, and in part II, we address vascular growths, common skin infections, and inflammatory conditions for which dermoscopy is valuable.
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Affiliation(s)
- Anshika Kaushik
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital-San Diego, San Diego, CA, USA.,Department of Dermatology, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Nicola Natsis
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital-San Diego, San Diego, CA, USA.,University of California San Diego School of Medicine, San Diego, CA, USA
| | | | - Elizabeth V Seiverling
- Department of Dermatology, Tufts Medical Center, Boston, MA, USA.,Division of Dermatology, Maine Medical Center & Maine Medical Partners, Portland, ME, USA
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13
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Ternov NK, Vestergaard T, Hölmich LR, Karmisholt K, Wagenblast AL, Klyver H, Hald M, Schøllhammer L, Konge L, Chakera AH. Reliable test of clinicians' mastery in skin cancer diagnostics. Arch Dermatol Res 2020; 313:235-243. [PMID: 32596742 DOI: 10.1007/s00403-020-02097-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/17/2020] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Niels Kvorning Ternov
- Department of Plastic Surgery, Herlev and Gentofte University Hospital, Herlev Ringvej 75, Herlev, 2730, Copenhagen, Denmark. .,Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark. .,Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark.
| | - T Vestergaard
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark.,Faculty of Health Sciences, University of Southern Denmark, Copenhagen, Denmark
| | - L Rosenkrantz Hölmich
- Department of Plastic Surgery, Herlev and Gentofte University Hospital, Herlev Ringvej 75, Herlev, 2730, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - K Karmisholt
- Department of Dermatology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - A L Wagenblast
- Department of Plastic Surgery, Breast Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - H Klyver
- Department of Plastic Surgery, Breast Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - M Hald
- Department of Dermatology, Herlev and Gentofte University Hospital, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - L Schøllhammer
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - L Konge
- Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - A H Chakera
- Department of Plastic Surgery, Herlev and Gentofte University Hospital, Herlev Ringvej 75, Herlev, 2730, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
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14
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Sadeghi M, Chilana P, Yap J, Tschandl P, Atkins MS. Using content-based image retrieval of dermoscopic images for interpretation and education: A pilot study. Skin Res Technol 2019; 26:503-512. [PMID: 31845429 DOI: 10.1111/srt.12822] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 11/09/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Dermoscopic content-based image retrieval (CBIR) systems provide a set of visually similar dermoscopic (magnified and illuminated) skin images with a pathology-confirmed diagnosis for a given dermoscopic query image of a skin lesion. Although recent advances in machine learning have spurred novel CBIR algorithms, we have few insights into how end users interact with CBIRs and to what extent CBIRs can be useful for education and image interpretation. MATERIALS AND METHODS We developed an interactive user interface for a CBIR system with dermoscopic images as a decision support tool and investigated users' interactions and decisions with the system. We performed a pilot experiment with 14 non-medically trained users for a given set of annotated dermoscopic images. RESULTS Our pilot showed that the number of correct classifications and users' confidence levels significantly increased with the CBIR interface compared with a non-CBIR interface, although the timing also increased significantly. The users found the CBIR interface of high educational value, engaging and easy to use. CONCLUSION Overall, users became more accurate, found the CBIR approach provided a useful decision aid, and had educational value for learning about skin conditions.
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Affiliation(s)
- Mahya Sadeghi
- School of Computing Science, Simon Fraser University, Burnaby, BC, Canada
| | - Parmit Chilana
- School of Computing Science, Simon Fraser University, Burnaby, BC, Canada
| | - Jordan Yap
- MetaOptima Technology Inc., Vancouver, BC, Canada
| | - Philipp Tschandl
- School of Computing Science, Simon Fraser University, Burnaby, BC, Canada.,Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - M Stella Atkins
- School of Computing Science, Simon Fraser University, Burnaby, BC, Canada.,School of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
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