Pediatric Dermatology Vol. 32 No. 3 327–332, 2015
Pediatric Dermatology Training During Residency: A Survey of the 2014 Graduating Residents Alaleh Akhavan, M.D.,*,† Blair Murphy-Chutorian, M.D.,‡ and Adam Friedman, M.D.*,– *Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, †Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, ‡School of Medicine, University of California Irvine, Irvine, California, –Department of Physiology and Biophysics, Albert Einstein College of Medicine, Bronx, New York
Abstract Background: Knowledge of pediatric dermatology is considered a core competency of dermatology training and should be expected of all practicing dermatologists. While the numbers of both pediatric dermatology fellowships and board certified pediatric dermatologists in the workforce have increased over the years, recent reports suggest that there is a gap in pediatric dermatology education during dermatology residency. The goal of this study is to assess the current state of pediatric education during residency, as well as the clinical experience, satisfaction and expectations of graduating dermatology residents. Methods: A 31-question self-report survey was distributed electronically to 294 third-year dermatology residents with questions pertaining to demographics, didactic education, resident experience in pediatric dermatology training, satisfaction with pediatric training and future plans. Results: One hundred and twenty-three residents responded (41.8% response rate) representing approximately 29.1% of the total number of graduating residents. 69 (56.1%) residents reported academic time specifically devoted to pediatric dermatology, the majority (79.7%) of which was led by pediatric dermatologists. 82% of residents reported dedicated pediatric dermatology clinics at their program. 86.8% of respondents felt that their training in pediatric dermatology will allow them to confidently see pediatric dermatology patients in practice. Conclusions: This survey highlights a promising state of pediatric dermatology training among current graduating dermatology residents. The majority of current graduating dermatology residents are satisfied with their pediatric dermatology education, feel confident treating pediatric patients, and plan to see pediatric patients in clinical practice.
Address correspondence to Adam Friedman, M.D., Division of Dermatology, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, or e-mail: adfriedm@montefiore.org. DOI: 10.1111/pde.12565
© 2015 Wiley Periodicals, Inc.
327
328 Pediatric Dermatology Vol. 32 No. 3 May/June 2015
A shortage of pediatric dermatologists in the workforce has been described (1,2). Although there is now an increasing number of pediatric dermatology fellowships and board-certified pediatric dermatologists, all dermatologists are expected to be able to treat and prevent skin disease in patients of all ages, including infants and children. In a study of educational conferences in dermatology residency programs, chief residents cited pediatric didactics as one of two conferences they most wanted to establish at their program (3), suggesting that there may be a need for a more formal pediatric curriculum. The quality of dermatopathology and procedural training in residency has been examined by administering resident surveys (4,5). Similarly surveys have been used in identifying educational deficiencies in patch testing (6), nanotechnology (7), and leadership training (8) during dermatology residency. At the onset of our study, training in pediatric dermatology during residency had yet to be assessed in the peerreviewed literature. Recently, in the March/April 2014 issue of Pediatric Dermatology, a study was published that surveyed dermatology residents graduating in 2012, as well as residency and fellowship directors, to assess the pediatric dermatology curriculum and experience in residency (9). The authors concluded that their survey results demonstrated the need for dermatology residency programs to continue to strengthen their pediatric dermatology curricula. With nearly twice the response rate solely from current graduating dermatology residents, our study serves to elucidate the current state of pediatric education during residency as well as the clinical experience, satisfaction, and expectations of graduating dermatology residents. MATERIALS AND METHODS One hundred fourteen U.S. dermatology residency programs were identified on the Accreditation Council for Graduate Medical Education (ACGME) website (10). The number of third-year dermatology residents for the 2013–2014 academic year was not available; we estimated the number as 422 from the published number of second-year residents during the 2012–2013 academic year. To obtain e-mail addresses of the target population, a letter was sent via e-mail to each residency program director or program coordinator stating the study goals and requesting the e-mail addresses of each program’s third-year dermatology residents. Follow-up requests were made 2 weeks later to program directors who did not initially
respond; 294 residents’ e-mail addresses were obtained from the 84 responding programs. A self-report survey questionnaire was designed with questions pertaining to demographic characteristics, didactic education, resident experience in pediatric dermatology training, satisfaction with pediatric training, and future plans. The Albert Einstein College of Medicine institutional review board approved the survey. A link to the 31-question survey was sent via SurveyMonkey (http://www.surveymon key.com) to each of the 294 residents with a cover letter describing the study goals and its voluntary nature. The surveys were initially sent in October 2013. Nonresponders were e-mailed again 3 weeks later via SurveyMonkey’s automatic resend function, without compromising anonymity. Responses were received through December 1, 2013. Content validity and test–retest reliability were evaluated using a sample of dermatologists training at Albert Einstein College of Medicine who were administered the survey twice without significant variation in responses received. As an incentive for participation, all residents who completed the survey were given the option to provide their e-mail addresses to be included in a drawing for a nominal gift certificate to an online retailer. Participation in the survey was voluntary. Measures were taken to protect the privacy of each subject and to maintain the anonymity of responses. RESULTS One hundred twenty-three graduating third-year residents of the 294 polled responded to the survey (41.8% response rate), representing approximately 29.1% (123/422) of the entire class of graduating third-year residents; 36 (29.3%) resident respondents were male and 87 (70.7%) were female. The resident and program characteristics are detailed in Table 1. Resident Didactic Experience Table 2 details residents’ didactic experience in pediatric dermatology; 56.1% reported academic time specifically devoted to pediatric dermatology, with 79.7% of respondents reporting that full-time, parttime, or voluntary pediatric dermatologists led the majority of their pediatric dermatology didactics. Thirteen percent of respondents reported at least weekly pediatric dermatology academic sessions and 35.8% reported reviewing focused pediatric dermatology topics less than once monthly.
Akhavan et al: A Survey of the 2014 Graduating Residents
TABLE 1. Demographic and Program Characteristics
TABLE 2. Resident Didactic Experience
Characteristic
Experience
n (%)
Sex Male 36 (29.3) Female 87 (70.7) Geographic region of residency program Northeast 38 (30.9) Midwest 33 (26.8) Southeast 22 (17.9) West 17 (13.8) Southwest 13 (10.4) Residency program is within 5 miles of a major urban city Yes 96 (78.1) No 27 (22.0) Residency program is affiliated with a children’s hospital Yes 92 (74.8) No 31 (25.2) Residency program has a pediatric dermatology fellowship program Yes 41 (33.6) No 81 (66.4) Residency program has a full-time board-certified pediatric dermatologist Yes 84 (68.3) No 39 (31.7) Residency program has a board-certified pediatric dermatologist as voluntary staff with whom residents interact Yes 60 (48.8) No 63 (51.2)
329
n (%)
Number of faculty-led lectures held weekly 0–1 2–3 4–5 >5 Number of resident-led lectures held weekly 0–1 2–3 4–5 ≥6 There is academic time specifically dedicated to pediatrics Yes No The majority of academic time specifically dedicated to pediatrics is led by (if answered “yes” to previous question) Pediatric dermatologists (full time, part time, or voluntary) Full-time, part-time, or voluntary faculty (not pediatric dermatologists) Residents How often do you review specifically pediatrics topics during your didactic sessions? Never Less than once monthly Monthly Weekly
40 56 16 11
(32.5) (45.5) (13.0) (8.9)
37 (30.1) 59 (48.0) 19 (15.5) 8 (6.5) 69 (56.1) 54 (43.9)
55 (79.7) 4 (5.8) 10 (14.5) 4 (3.3) 44 (35.8) 59 (48.0) 16 (13.0)
Resident Clinical Experience Eighty-two percent of residents reported the presence of dedicated pediatric dermatology clinics at their program and 69% reported that their program had more than one clinic per week entirely dedicated to pediatric patients (Table 3). The attending physician preceptors of these clinics were primarily pediatric dermatologists for 60.7% of respondents. Table 4 details the cumulative experience of graduating residents with specific pediatric dermatology scenarios. Forty percent or more of graduating residents had personally participated in the care of more than 10 patients with propranolol for hemangiomas (41.3%), systemic therapies for atopic dermatitis (42.2%), systemic therapies for psoriasis (43.8%), and intralesional therapy for verruca vulgaris (43.0%). A smaller percentage of residents had experience with more than 10 pediatric patients with excisional surgery (11.6%) and managing genodermatoses (28.1%). Resident Satisfaction and Future Plans Table 5 details survey questions pertaining to resident satisfaction with their pediatric dermatology training in residency and personal future career plans; 86.8% felt that their training in pediatric
dermatology would allow them to confidently see pediatric dermatology patients in practice (Fig. 1). Ten percent of respondents reported plans to pursue a pediatric dermatology fellowship. One hundred nine of 121 graduating residents were at least somewhat satisfied with their pediatric training during residency. Only 9.9% reported feeling not at all satisfied with pediatric training. Ninety percent of graduating residents expected to see pediatric patients in their future practices, and the majority anticipated that pediatric patients would constitute 6% to 25% of their practice. DISCUSSION These survey results demonstrate a promising state of pediatric dermatology training among current graduating dermatology residents; 86.8% of respondents believed that their training in pediatric dermatology was adequate to allow them to confidently see pediatric dermatology patients in practice, and 90.1% of respondents planned to see pediatric patients in their future practices. One factor that may account for the reported confidence of the graduating class is their didactic experience; 56.1% of residents reported that their
330 Pediatric Dermatology Vol. 32 No. 3 May/June 2015
TABLE 3. Resident Clinical Experience Experience
n (%)
Program has dedicated pediatric dermatology clinics Yes 100 (82.0) No 22 (18.0) Number of clinics per week dedicated entirely to pediatric patients (if answered “yes” to previous question) 1 30 (30.9) 2 17 (17.5) 3 12 (12.4) ≥4 38 (39.2) In pediatric dermatology clinics, the majority of attending physician preceptors are pediatric dermatologists Yes 85 (60.7) No 37 (30.3) Residency program has a dedicated pediatric dermatology rotation Yes 66 (54.1) No 56 (45.9) Residency program has an inpatient consultation service Yes 116 (95.1) No 6 (4.9) Average number of pediatric inpatient consultations per week (if answered “yes” to previous question) 0–2 54 (46.6) 3–5 38 (32.8) 5–7 13 (11.2) ≥8 11 (9.5)
program offered academic time specifically dedicated to pediatrics, and 79.7% of those with dedicated pediatric academic time had pediatric dermatologists leading the majority of their didactic sessions. The majority of graduating dermatology residents were satisfied (30.6%) or very satisfied (35.5%) with their pediatric dermatology education. Residents also appeared to have had considerable clinical exposure to pediatric patients, with 82.0% of respondents reporting dedicated pediatric clinics in their programs and 54.1% reporting a dedicated pediatric dermatology rotation. Lack of a pediatric dermatology rotation correlated most closely with resident dissatisfaction; all 12 of the residents reporting that they were not at all satisfied with their pediatric dermatology experience did not have dedi-
cated pediatric dermatology rotations in their program. The majority of residents had also personally participated in the care of at least one patient in all of the clinical scenarios presented in the survey. In the Nijhawan et al study (9), 92.2% of respondents felt at least somewhat or very competent independently managing pediatric patients, which is in line with our findings. They found that all residents who were somewhat or extremely dissatisfied with their pediatric dermatology training (8/51) were from programs that lacked a full-time pediatric dermatologist. In our study, 9 of the 12 residents who were not at all satisfied were from programs with no full-time pediatric dermatologists. Our study found a higher percentage of pediatricspecific clinics (82.1%) than the 2012 study (9) (56.5%), which may support a possible trend in improved clinical exposure in pediatric dermatology training during residency. Limitations of this study include that the respondents are a minority (
Pediatric Dermatology Training During Residency: A Survey of the 2014 Graduating Residents Alaleh Akhavan, M.D.,*,† Blair Murphy-Chutorian, M.D.,‡ and Adam Friedman, M.D.*,– *Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, †Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, ‡School of Medicine, University of California Irvine, Irvine, California, –Department of Physiology and Biophysics, Albert Einstein College of Medicine, Bronx, New York
Abstract Background: Knowledge of pediatric dermatology is considered a core competency of dermatology training and should be expected of all practicing dermatologists. While the numbers of both pediatric dermatology fellowships and board certified pediatric dermatologists in the workforce have increased over the years, recent reports suggest that there is a gap in pediatric dermatology education during dermatology residency. The goal of this study is to assess the current state of pediatric education during residency, as well as the clinical experience, satisfaction and expectations of graduating dermatology residents. Methods: A 31-question self-report survey was distributed electronically to 294 third-year dermatology residents with questions pertaining to demographics, didactic education, resident experience in pediatric dermatology training, satisfaction with pediatric training and future plans. Results: One hundred and twenty-three residents responded (41.8% response rate) representing approximately 29.1% of the total number of graduating residents. 69 (56.1%) residents reported academic time specifically devoted to pediatric dermatology, the majority (79.7%) of which was led by pediatric dermatologists. 82% of residents reported dedicated pediatric dermatology clinics at their program. 86.8% of respondents felt that their training in pediatric dermatology will allow them to confidently see pediatric dermatology patients in practice. Conclusions: This survey highlights a promising state of pediatric dermatology training among current graduating dermatology residents. The majority of current graduating dermatology residents are satisfied with their pediatric dermatology education, feel confident treating pediatric patients, and plan to see pediatric patients in clinical practice.
Address correspondence to Adam Friedman, M.D., Division of Dermatology, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, or e-mail: adfriedm@montefiore.org. DOI: 10.1111/pde.12565
© 2015 Wiley Periodicals, Inc.
327
328 Pediatric Dermatology Vol. 32 No. 3 May/June 2015
A shortage of pediatric dermatologists in the workforce has been described (1,2). Although there is now an increasing number of pediatric dermatology fellowships and board-certified pediatric dermatologists, all dermatologists are expected to be able to treat and prevent skin disease in patients of all ages, including infants and children. In a study of educational conferences in dermatology residency programs, chief residents cited pediatric didactics as one of two conferences they most wanted to establish at their program (3), suggesting that there may be a need for a more formal pediatric curriculum. The quality of dermatopathology and procedural training in residency has been examined by administering resident surveys (4,5). Similarly surveys have been used in identifying educational deficiencies in patch testing (6), nanotechnology (7), and leadership training (8) during dermatology residency. At the onset of our study, training in pediatric dermatology during residency had yet to be assessed in the peerreviewed literature. Recently, in the March/April 2014 issue of Pediatric Dermatology, a study was published that surveyed dermatology residents graduating in 2012, as well as residency and fellowship directors, to assess the pediatric dermatology curriculum and experience in residency (9). The authors concluded that their survey results demonstrated the need for dermatology residency programs to continue to strengthen their pediatric dermatology curricula. With nearly twice the response rate solely from current graduating dermatology residents, our study serves to elucidate the current state of pediatric education during residency as well as the clinical experience, satisfaction, and expectations of graduating dermatology residents. MATERIALS AND METHODS One hundred fourteen U.S. dermatology residency programs were identified on the Accreditation Council for Graduate Medical Education (ACGME) website (10). The number of third-year dermatology residents for the 2013–2014 academic year was not available; we estimated the number as 422 from the published number of second-year residents during the 2012–2013 academic year. To obtain e-mail addresses of the target population, a letter was sent via e-mail to each residency program director or program coordinator stating the study goals and requesting the e-mail addresses of each program’s third-year dermatology residents. Follow-up requests were made 2 weeks later to program directors who did not initially
respond; 294 residents’ e-mail addresses were obtained from the 84 responding programs. A self-report survey questionnaire was designed with questions pertaining to demographic characteristics, didactic education, resident experience in pediatric dermatology training, satisfaction with pediatric training, and future plans. The Albert Einstein College of Medicine institutional review board approved the survey. A link to the 31-question survey was sent via SurveyMonkey (http://www.surveymon key.com) to each of the 294 residents with a cover letter describing the study goals and its voluntary nature. The surveys were initially sent in October 2013. Nonresponders were e-mailed again 3 weeks later via SurveyMonkey’s automatic resend function, without compromising anonymity. Responses were received through December 1, 2013. Content validity and test–retest reliability were evaluated using a sample of dermatologists training at Albert Einstein College of Medicine who were administered the survey twice without significant variation in responses received. As an incentive for participation, all residents who completed the survey were given the option to provide their e-mail addresses to be included in a drawing for a nominal gift certificate to an online retailer. Participation in the survey was voluntary. Measures were taken to protect the privacy of each subject and to maintain the anonymity of responses. RESULTS One hundred twenty-three graduating third-year residents of the 294 polled responded to the survey (41.8% response rate), representing approximately 29.1% (123/422) of the entire class of graduating third-year residents; 36 (29.3%) resident respondents were male and 87 (70.7%) were female. The resident and program characteristics are detailed in Table 1. Resident Didactic Experience Table 2 details residents’ didactic experience in pediatric dermatology; 56.1% reported academic time specifically devoted to pediatric dermatology, with 79.7% of respondents reporting that full-time, parttime, or voluntary pediatric dermatologists led the majority of their pediatric dermatology didactics. Thirteen percent of respondents reported at least weekly pediatric dermatology academic sessions and 35.8% reported reviewing focused pediatric dermatology topics less than once monthly.
Akhavan et al: A Survey of the 2014 Graduating Residents
TABLE 1. Demographic and Program Characteristics
TABLE 2. Resident Didactic Experience
Characteristic
Experience
n (%)
Sex Male 36 (29.3) Female 87 (70.7) Geographic region of residency program Northeast 38 (30.9) Midwest 33 (26.8) Southeast 22 (17.9) West 17 (13.8) Southwest 13 (10.4) Residency program is within 5 miles of a major urban city Yes 96 (78.1) No 27 (22.0) Residency program is affiliated with a children’s hospital Yes 92 (74.8) No 31 (25.2) Residency program has a pediatric dermatology fellowship program Yes 41 (33.6) No 81 (66.4) Residency program has a full-time board-certified pediatric dermatologist Yes 84 (68.3) No 39 (31.7) Residency program has a board-certified pediatric dermatologist as voluntary staff with whom residents interact Yes 60 (48.8) No 63 (51.2)
329
n (%)
Number of faculty-led lectures held weekly 0–1 2–3 4–5 >5 Number of resident-led lectures held weekly 0–1 2–3 4–5 ≥6 There is academic time specifically dedicated to pediatrics Yes No The majority of academic time specifically dedicated to pediatrics is led by (if answered “yes” to previous question) Pediatric dermatologists (full time, part time, or voluntary) Full-time, part-time, or voluntary faculty (not pediatric dermatologists) Residents How often do you review specifically pediatrics topics during your didactic sessions? Never Less than once monthly Monthly Weekly
40 56 16 11
(32.5) (45.5) (13.0) (8.9)
37 (30.1) 59 (48.0) 19 (15.5) 8 (6.5) 69 (56.1) 54 (43.9)
55 (79.7) 4 (5.8) 10 (14.5) 4 (3.3) 44 (35.8) 59 (48.0) 16 (13.0)
Resident Clinical Experience Eighty-two percent of residents reported the presence of dedicated pediatric dermatology clinics at their program and 69% reported that their program had more than one clinic per week entirely dedicated to pediatric patients (Table 3). The attending physician preceptors of these clinics were primarily pediatric dermatologists for 60.7% of respondents. Table 4 details the cumulative experience of graduating residents with specific pediatric dermatology scenarios. Forty percent or more of graduating residents had personally participated in the care of more than 10 patients with propranolol for hemangiomas (41.3%), systemic therapies for atopic dermatitis (42.2%), systemic therapies for psoriasis (43.8%), and intralesional therapy for verruca vulgaris (43.0%). A smaller percentage of residents had experience with more than 10 pediatric patients with excisional surgery (11.6%) and managing genodermatoses (28.1%). Resident Satisfaction and Future Plans Table 5 details survey questions pertaining to resident satisfaction with their pediatric dermatology training in residency and personal future career plans; 86.8% felt that their training in pediatric
dermatology would allow them to confidently see pediatric dermatology patients in practice (Fig. 1). Ten percent of respondents reported plans to pursue a pediatric dermatology fellowship. One hundred nine of 121 graduating residents were at least somewhat satisfied with their pediatric training during residency. Only 9.9% reported feeling not at all satisfied with pediatric training. Ninety percent of graduating residents expected to see pediatric patients in their future practices, and the majority anticipated that pediatric patients would constitute 6% to 25% of their practice. DISCUSSION These survey results demonstrate a promising state of pediatric dermatology training among current graduating dermatology residents; 86.8% of respondents believed that their training in pediatric dermatology was adequate to allow them to confidently see pediatric dermatology patients in practice, and 90.1% of respondents planned to see pediatric patients in their future practices. One factor that may account for the reported confidence of the graduating class is their didactic experience; 56.1% of residents reported that their
330 Pediatric Dermatology Vol. 32 No. 3 May/June 2015
TABLE 3. Resident Clinical Experience Experience
n (%)
Program has dedicated pediatric dermatology clinics Yes 100 (82.0) No 22 (18.0) Number of clinics per week dedicated entirely to pediatric patients (if answered “yes” to previous question) 1 30 (30.9) 2 17 (17.5) 3 12 (12.4) ≥4 38 (39.2) In pediatric dermatology clinics, the majority of attending physician preceptors are pediatric dermatologists Yes 85 (60.7) No 37 (30.3) Residency program has a dedicated pediatric dermatology rotation Yes 66 (54.1) No 56 (45.9) Residency program has an inpatient consultation service Yes 116 (95.1) No 6 (4.9) Average number of pediatric inpatient consultations per week (if answered “yes” to previous question) 0–2 54 (46.6) 3–5 38 (32.8) 5–7 13 (11.2) ≥8 11 (9.5)
program offered academic time specifically dedicated to pediatrics, and 79.7% of those with dedicated pediatric academic time had pediatric dermatologists leading the majority of their didactic sessions. The majority of graduating dermatology residents were satisfied (30.6%) or very satisfied (35.5%) with their pediatric dermatology education. Residents also appeared to have had considerable clinical exposure to pediatric patients, with 82.0% of respondents reporting dedicated pediatric clinics in their programs and 54.1% reporting a dedicated pediatric dermatology rotation. Lack of a pediatric dermatology rotation correlated most closely with resident dissatisfaction; all 12 of the residents reporting that they were not at all satisfied with their pediatric dermatology experience did not have dedi-
cated pediatric dermatology rotations in their program. The majority of residents had also personally participated in the care of at least one patient in all of the clinical scenarios presented in the survey. In the Nijhawan et al study (9), 92.2% of respondents felt at least somewhat or very competent independently managing pediatric patients, which is in line with our findings. They found that all residents who were somewhat or extremely dissatisfied with their pediatric dermatology training (8/51) were from programs that lacked a full-time pediatric dermatologist. In our study, 9 of the 12 residents who were not at all satisfied were from programs with no full-time pediatric dermatologists. Our study found a higher percentage of pediatricspecific clinics (82.1%) than the 2012 study (9) (56.5%), which may support a possible trend in improved clinical exposure in pediatric dermatology training during residency. Limitations of this study include that the respondents are a minority (
