Insights
Are medical students skint on skin? Shreena Suchak1*, Kosala DeSilva-Abeysinghe1*, Alia Ahmed2 and Piu Banerjee3 1
King’s College London School of Medicine, London, UK Department of Dermatology, Royal Free Hospital, London, UK 3 Department of Dermatology, University Hospital Lewisham, London, UK 2
*Joint first authors
T
he skin is the largest organ of the body, but medical students spend the least amount of time learning about it. Dermatology is largely taught through clinical teaching placements taking place in out-patient departments, and varies widely between medical schools in the UK, despite a standardised curriculum.1 The British Association of Dermatologists (BAD) recommends a minimum of 10 days (approximately 6 hours per day) to be spent on dermatology placements.1 In a 2008 report, approximately 84 per cent of junior doctors felt the need for greater exposure to dermatology during medical school.2 Clinical
experience in dermatology is imperative; however, it is becoming increasingly difficult to provide dedicated teaching clinics to address the recommended curriculum and to provide meaningful encounters with patients.3
aspects of the undergraduate curriculum: each station is allocated 20 minutes, and typically a session includes eight stations (including a ‘rest’ station). Nurses or doctors lead the stations. The format and the topics covered are described here.
We participated in a Dermatology Student Symposium designed to address the learning outcomes recommended by the BAD (Table 1).1 The structure of the programme includes supervised dermatological historytaking and examination of patients, as well as practical skills and tutorials covering key topics. Students rotate through ‘stations’ addressing different
NURSE-LED STATIONS
Junior doctors felt the need for greater exposure to dermatology during medical school
Station 1. Eczema practical This station covers treatment options and investigations in eczema, including: • application of emollients and topical steroids; • wet wraps; • secondary skin infection and skin swabs.
© 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2016; 13: 69–71 69
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The interaction with patients allows students to develop communication skills
This is an interactive session and can incorporate student assessment (e.g. placing topical steroids in order of potency and taking a skin swab). Complications of severe eczema, such as skin infection, and the principles of topical therapy are addressed. Station 2. Psoriasis practical This station covers topical treatment of psoriasis and involves the practical demonstration of: • topical treatment for scalp and body, e.g. emollients, topical steroids, combination treatments (calcipotriol and coal tar; • short contact treatment, e.g. dithranol.
DOCTOR-LED STATIONS Tutorial with or without practical These stations provide information about a dermatological subject and, where possible, teach practical skills. Patients can also be invited to these stations to show cutaneous signs and provide an insight into their skin disease. Station 3. Tutorial: viral warts This station gives an overview of the pathology and characteristic
features of warty lesions, and allows students to recognise and systematically describe cutaneous warts. Students are trained on the technique and safe use of cryotherapy. Station 4. Tutorial: skin cancer and screening Risk factors for melanoma and non-melanoma skin cancer are covered, as well as clinical signs and symptoms, and
management. The station also highlights the importance of patient support, advice and follow-up. Patients with evidence of sun damage or skin cancers are invited to this station to allow students to see clinical signs (e.g. actinic keratoses and basal cell carcinomas). Students are introduced to the basics of a dermoscopy and are encouraged to examine and describe lesions.
Table 1. Essential and important learning outcomes, as recommended by the British Association of Dermatologists1 Essential learning outcomes
Important learning outcomes
• Taking a dermatological history
• Background knowledge
• Explore patient’s concerns and expectations
• Skin failure and emergency dermatology
• Examine skin, hair, nails and mucous membranes systematically
• Inflammatory disease
• Describe cutaneous physical signs in skin, hair, nails and mucosa
• Skin infections
• Record findings accurately and in the patient’s records
• Common and important problems
• Interact sensitively with people with skin diseases
• Skin tumours • Signs of systemic disease • Preventative medicine • Drug eruptions • Management and therapeutics • Clinical skills
70 © 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2016; 13: 69–71
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Station 5. Tutorial: phototherapy and sun protection The basics of ultraviolet radiation therapy are covered, including the mechanism of action, indication for treatment and outcomes. Principles of sun protection are introduced and emphasis is placed on explaining these topics at an appropriate level for patients.
OBJECTIVE STRUCTURED CLINICAL EXAMINATION (OSCE) STATIONS These stations (stations 6 and 7) involve taking a focused history and performing a dermatological examination under supervision. Students take it in turns to ask questions and to examine a patient. Diagnosis, investigations and management options are also discussed. Patients with chronic dermatological problems are used for these stations (e.g. eczema and psoriasis). The interaction with patients allows students to
develop communication skills to explore the impact of skin disease.
CONCLUSION The practicalities of running a symposium will be unique to each department, depending on staffing levels, number of undergraduates and cost. With increased pressures on dermatology departments, it may be advisable to conduct a symposium in allocated teaching time using readily available resources and staff. Compensation for patients is another consideration, but does not need to be monetary: the willingness of patients to be involved in medical teaching should not be underestimated. The Dermatology Student Symposium addresses many of the essential and important learning outcomes outlined by the BAD,1 and has received highly positive feedback. The symposium model
can be used to provide patient encounters, develop clinical skills and evaluate knowledge. It also creates the opportunity to obtain feedback regarding teaching placements. We encourage the use of the described format on a wider basis as a means to teach and evaluate the dermatology curriculum in medical schools.
The symposium model can be used to provide patient encounters, develop clinical skills and evaluate knowledge
REFERENCES 1.
The British Association of Dermatologists. Dermatology in the undergraduate medical curriculum: Recommendations of the British Association of Dermatologists. Available at http://www.bad.org. uk/library-media/documents/ (Link2)%20Core%20curriculum(2). pdf. Accessed on 16 October 2014.
2.
Hussain W, Hafiji J, Stanley AG, Khan KM. Dermatology and junior doctors: an evaluation of education, perceptions and self-assessed competencies. Br J Dermatol 2008; 159:505–506.
3.
Burge SM. Teaching dermatology. Clin Exp Dermatol 2004;29: 206–210.
Corresponding author’s contact details: Alia Ahmed, Department of Dermatology, Royal Free Hospital, Pond Street, London, NW3 2QG, UK. E-mail: [email protected]
Funding: None. Conflict of interest: None. Acknowledgement: Staff of Department of Dermatology, University Hospital Lewisham, London, UK. Ethical approval: Not required as article details a teaching initiative. No participant data have been used in this report. doi: 10.1111/tct.12341
© 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2016; 13: 69–71 71
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1/14/2016 11:36:06 AM
Are medical students skint on skin? Shreena Suchak1*, Kosala DeSilva-Abeysinghe1*, Alia Ahmed2 and Piu Banerjee3 1
King’s College London School of Medicine, London, UK Department of Dermatology, Royal Free Hospital, London, UK 3 Department of Dermatology, University Hospital Lewisham, London, UK 2
*Joint first authors
T
he skin is the largest organ of the body, but medical students spend the least amount of time learning about it. Dermatology is largely taught through clinical teaching placements taking place in out-patient departments, and varies widely between medical schools in the UK, despite a standardised curriculum.1 The British Association of Dermatologists (BAD) recommends a minimum of 10 days (approximately 6 hours per day) to be spent on dermatology placements.1 In a 2008 report, approximately 84 per cent of junior doctors felt the need for greater exposure to dermatology during medical school.2 Clinical
experience in dermatology is imperative; however, it is becoming increasingly difficult to provide dedicated teaching clinics to address the recommended curriculum and to provide meaningful encounters with patients.3
aspects of the undergraduate curriculum: each station is allocated 20 minutes, and typically a session includes eight stations (including a ‘rest’ station). Nurses or doctors lead the stations. The format and the topics covered are described here.
We participated in a Dermatology Student Symposium designed to address the learning outcomes recommended by the BAD (Table 1).1 The structure of the programme includes supervised dermatological historytaking and examination of patients, as well as practical skills and tutorials covering key topics. Students rotate through ‘stations’ addressing different
NURSE-LED STATIONS
Junior doctors felt the need for greater exposure to dermatology during medical school
Station 1. Eczema practical This station covers treatment options and investigations in eczema, including: • application of emollients and topical steroids; • wet wraps; • secondary skin infection and skin swabs.
© 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2016; 13: 69–71 69
tct_12341.indd 69
1/14/2016 11:36:04 AM
The interaction with patients allows students to develop communication skills
This is an interactive session and can incorporate student assessment (e.g. placing topical steroids in order of potency and taking a skin swab). Complications of severe eczema, such as skin infection, and the principles of topical therapy are addressed. Station 2. Psoriasis practical This station covers topical treatment of psoriasis and involves the practical demonstration of: • topical treatment for scalp and body, e.g. emollients, topical steroids, combination treatments (calcipotriol and coal tar; • short contact treatment, e.g. dithranol.
DOCTOR-LED STATIONS Tutorial with or without practical These stations provide information about a dermatological subject and, where possible, teach practical skills. Patients can also be invited to these stations to show cutaneous signs and provide an insight into their skin disease. Station 3. Tutorial: viral warts This station gives an overview of the pathology and characteristic
features of warty lesions, and allows students to recognise and systematically describe cutaneous warts. Students are trained on the technique and safe use of cryotherapy. Station 4. Tutorial: skin cancer and screening Risk factors for melanoma and non-melanoma skin cancer are covered, as well as clinical signs and symptoms, and
management. The station also highlights the importance of patient support, advice and follow-up. Patients with evidence of sun damage or skin cancers are invited to this station to allow students to see clinical signs (e.g. actinic keratoses and basal cell carcinomas). Students are introduced to the basics of a dermoscopy and are encouraged to examine and describe lesions.
Table 1. Essential and important learning outcomes, as recommended by the British Association of Dermatologists1 Essential learning outcomes
Important learning outcomes
• Taking a dermatological history
• Background knowledge
• Explore patient’s concerns and expectations
• Skin failure and emergency dermatology
• Examine skin, hair, nails and mucous membranes systematically
• Inflammatory disease
• Describe cutaneous physical signs in skin, hair, nails and mucosa
• Skin infections
• Record findings accurately and in the patient’s records
• Common and important problems
• Interact sensitively with people with skin diseases
• Skin tumours • Signs of systemic disease • Preventative medicine • Drug eruptions • Management and therapeutics • Clinical skills
70 © 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2016; 13: 69–71
tct_12341.indd 70
1/14/2016 11:36:05 AM
Station 5. Tutorial: phototherapy and sun protection The basics of ultraviolet radiation therapy are covered, including the mechanism of action, indication for treatment and outcomes. Principles of sun protection are introduced and emphasis is placed on explaining these topics at an appropriate level for patients.
OBJECTIVE STRUCTURED CLINICAL EXAMINATION (OSCE) STATIONS These stations (stations 6 and 7) involve taking a focused history and performing a dermatological examination under supervision. Students take it in turns to ask questions and to examine a patient. Diagnosis, investigations and management options are also discussed. Patients with chronic dermatological problems are used for these stations (e.g. eczema and psoriasis). The interaction with patients allows students to
develop communication skills to explore the impact of skin disease.
CONCLUSION The practicalities of running a symposium will be unique to each department, depending on staffing levels, number of undergraduates and cost. With increased pressures on dermatology departments, it may be advisable to conduct a symposium in allocated teaching time using readily available resources and staff. Compensation for patients is another consideration, but does not need to be monetary: the willingness of patients to be involved in medical teaching should not be underestimated. The Dermatology Student Symposium addresses many of the essential and important learning outcomes outlined by the BAD,1 and has received highly positive feedback. The symposium model
can be used to provide patient encounters, develop clinical skills and evaluate knowledge. It also creates the opportunity to obtain feedback regarding teaching placements. We encourage the use of the described format on a wider basis as a means to teach and evaluate the dermatology curriculum in medical schools.
The symposium model can be used to provide patient encounters, develop clinical skills and evaluate knowledge
REFERENCES 1.
The British Association of Dermatologists. Dermatology in the undergraduate medical curriculum: Recommendations of the British Association of Dermatologists. Available at http://www.bad.org. uk/library-media/documents/ (Link2)%20Core%20curriculum(2). pdf. Accessed on 16 October 2014.
2.
Hussain W, Hafiji J, Stanley AG, Khan KM. Dermatology and junior doctors: an evaluation of education, perceptions and self-assessed competencies. Br J Dermatol 2008; 159:505–506.
3.
Burge SM. Teaching dermatology. Clin Exp Dermatol 2004;29: 206–210.
Corresponding author’s contact details: Alia Ahmed, Department of Dermatology, Royal Free Hospital, Pond Street, London, NW3 2QG, UK. E-mail: [email protected]
Funding: None. Conflict of interest: None. Acknowledgement: Staff of Department of Dermatology, University Hospital Lewisham, London, UK. Ethical approval: Not required as article details a teaching initiative. No participant data have been used in this report. doi: 10.1111/tct.12341
© 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2016; 13: 69–71 71
tct_12341.indd 71
1/14/2016 11:36:06 AM
