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Teaching Dermatology to PA Students with a Peer-reviewed Virtual Curriculum P. Eugene Jones, PhD, PA-C Patrick McCleskey, MD, FAAD

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Page 1: Paea 2012 aad course10.17.2012

Teaching Dermatology to PA Students with a

Peer-reviewed Virtual Curriculum

P. Eugene Jones, PhD, PA-C

Patrick McCleskey, MD, FAAD

Page 2: Paea 2012 aad course10.17.2012

6. Evaluation and Feedback

1. Problem Identification and General Needs Assessment

2. Targeted Needs Assessment

3. Goals and Objectives

4. Educational Strategies

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5. Implementation

WHY?

WHO?WHAT?

WHAT?

HOW? WHEN?WHERE?

HOW WELL?

JUST DO IT

Page 3: Paea 2012 aad course10.17.2012

Step 2: Targeted Needs Assessment

Acne

Seborrheic dermatitis

Warts

Rosacea

Atopic dermatitis

Superficial dermatophytoses

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McCleskey PE, Gilson RT, Devillez R. Medical student core curriculum in dermatology survey. J Am AcadDermatol2009;61(1):30-35.

Page 4: Paea 2012 aad course10.17.2012

Goals and Objectives

• The AAD working group through a modified Delphi process identified Goals and Objectives they felt all medical students should learn

– Only 33 dermatology diagnoses covered, to avoid pitfall of “trying to teach too much”

– All rated important or very important by primary care providers were included

Page 6: Paea 2012 aad course10.17.2012

UCSF Med Student Study

• Students learned during rotation

• Students liked the modules and preferred them to other learning methods

• But question remains: did they learn because of the modules or because they were in a dermatology rotation?– Need to study a group that has internal controls

– Variability of derm exposure among PA students and residents?

Page 7: Paea 2012 aad course10.17.2012

Military Virtual Derm Study

• Four-week dermatology rotations

• Variables:

– Age, gender, level of training

– Number of half-days in clinic were highly variable

– Website allowed tracking of activity

– Pre-test, 33 learning modules, Post-test

Page 8: Paea 2012 aad course10.17.2012

All Levels Benefit

0

10

20

30

40

50

60

70

80

90

PA Students* PGY1* PGY2* PGY3

Pre-Test Score

Post-test Score

*p-value <0.05

Page 9: Paea 2012 aad course10.17.2012

Use of website correlates with higher post-test scores

p 0.003 trend p 0.003

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Page 10: Paea 2012 aad course10.17.2012

Summary of Military Study

• All types of learners have statistically significant improvement in knowledge

– PA students using this curriculum perform as well at end-of-rotation as physicians

• Increased website activity correlates with higher post-test scores

– Proves the core curriculum is effective

• High acceptance and preference of curriculum

Page 11: Paea 2012 aad course10.17.2012

Summary of Core Curriculum

• Standardized curriculum made publically available by the AAD

• Goals & learning outcomes based on evidence, aligned with needs of PAs in practice

• Online learning modules– Case-based

– Builds through repetition

• Peer-reviewed

• Effective

Page 12: Paea 2012 aad course10.17.2012

Intro to MSCC on AAD website

Page 13: Paea 2012 aad course10.17.2012

UT Southwestern Justification for Implementation

• Increasing difficulty scheduling dermatology clinicians due to clinical time demands and loss of income

• Time and location inflexibility of traditional lecture-learner model

• Quality of AAD content developed by academic dermatologists

• Student desire for any time, any place learning

• Opportunity to blend delivery to accommodate differing learning styles

Page 14: Paea 2012 aad course10.17.2012

The UT Southwestern Decision

• The AAD module content titles were compared to the PANCE disease list.

• The two-week version of the AAD Core Curriculum was selected as it closely reflected previous dermatology lecture-learner contact hours.

Page 15: Paea 2012 aad course10.17.2012

28/47 PANCE Disease List in

AAD MSCC• Dermatitis• Dyshidrosis• Lichen simplex chronicus• Drug eruptions• Lichen planus• Psoriasis• Pityriasisrosea• Erythemamultiforme• Stevens-Johnson

syndrome• Toxic epidermal

necrolysis• Bullouspemphigoid• Acne vulgaris• Rosacea• Actinic keratosis• Seborrheickeratosis• Lice

• Scabies• Spider bites• Basal cell carcinoma• Kaposi sarcoma• Melanoma• Squamous cell

carcinoma• Alopecia• Onychomycosis• Paronychia• Condylomaacuminatum• Exanthems• Herpes simplex• Molluscumcontagiosum• Varicella zoster• Verruca• Cellulitis• Erysipelas

• Impetigo• Candidiasis• Dermatophytes• Acanthosisnigricans• Burns• Hidradenitissuppurativa• Lipomas/EICs• Melasma• Pilonidal disease• Pressure ulcers• Urticaria• Vitiligo

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Page 16: Paea 2012 aad course10.17.2012

Supplemental Instruction

• PowerPoint® podcasts were recorded and posted for Alopecia, Onychomycoses, Paronychia, and Genodermatoses

• Two 2-hour supplemental Q&A sessions were provided by local Dermatology PAs

• A one-hour hands-on liquid nitrogen cryosurgery lab was provided

Page 17: Paea 2012 aad course10.17.2012

Course Examination Outcomes

• Class of 2013

– N=36 students

– Mean exam score 92.3

– Range 81-98

• Class of 2014

– N=38 students

– Mean exam score 91.05

– Range 80-97

Page 18: Paea 2012 aad course10.17.2012

Course Feedback: Effort Required

0%

10%

20%

30%

40%

50%

60%

70%

great deal more

somewhat more

about the same somewhat less a lot less

Page 19: Paea 2012 aad course10.17.2012

Course Feedback: Module Number

0%

10%

20%

30%

40%

50%

60%

much too many somewhat too many

right amount somewhat too few

Much too few

Page 20: Paea 2012 aad course10.17.2012

Course Feedback: Satisfaction

very satisfied somewhat satisfied

neutral somewhat dissatisfied

very dissatisfied

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Page 21: Paea 2012 aad course10.17.2012

Course Feedback: Intellectual Challenge

0%

10%

20%

30%

40%

50%

60%

very easy easy average difficult very difficult

Page 22: Paea 2012 aad course10.17.2012

Course Feedback: Derm PA Value

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

extremely helpful

somewhat helpful

undecided somewhat unhelpful

extremely unhelpful

Page 23: Paea 2012 aad course10.17.2012

Course Feedback: Online Effectiveness

0%

10%

20%

30%

40%

50%

60%

extremely effective

somewhat effective

neutral somewhat ineffective

extremely ineffective

Page 24: Paea 2012 aad course10.17.2012

Course Feedback: Knowledge Increase

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

strongly agree agree neutral disagree strongly disagree

Page 25: Paea 2012 aad course10.17.2012

Course Feedback: Would Recommendto Other PA Students

0%

10%

20%

30%

40%

50%

60%

70%

definitely recommend

probably recommend

uncertain probably not recommend

definitely not recommend

Page 26: Paea 2012 aad course10.17.2012

UT Southwestern Course Summary

• Well-received

• Minimal faculty oversight or time requirements

• Consistent, high-quality instruction

• Knowledge acquisition (as measured by post-test) equivalent to face-to-face instruction

Page 27: Paea 2012 aad course10.17.2012

Medical Student Core Curriculum

• Ideal for PA students or early practice PAs

• Agree that name might be off-putting for PA students and PAs in practice

– influenced by AAD politics

• Designed to teach up to level of primary care providers

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Page 28: Paea 2012 aad course10.17.2012

How to Use the Curriculum

• Know what’s on the MSCC website

• Suggestions in the Educator’s Guide and handout for this session

• Direct the learner’s study based on their level

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Page 29: Paea 2012 aad course10.17.2012

Be a Coach: follow-through

• Need to have follow-up to make sure the learning process is complete

• Examples for tineaversicolor:

– PA Student: differential diagnosis of light rashes, or performing KOH exam

– New PA-C: bring back a paper prescription for treatment of tineaversicolor

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Page 31: Paea 2012 aad course10.17.2012

Incorporating the Core Curriculum into PA instruction

Discussion about how you might use this curriculum in your program or office

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Page 32: Paea 2012 aad course10.17.2012

Use of Curriculum: Clinic

• Designed to be used as independent modules for review at home by learners

• Self-paced

• Interactive with questions throughout and after each module

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Page 33: Paea 2012 aad course10.17.2012

Use of Curriculum: Small Groups

• Each module can be used in group setting

– “Lecture” with questions interspersed

– Group discussion for each case

• With discussion, each module is perfect length for 40-60 minute session

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Page 34: Paea 2012 aad course10.17.2012

Use of Curriculum: Other Specialties

• These lectures can be given on other rotations• Pediatrics

– Atopic dermatitis, molluscum, pediatric fungal

• Internal medicine– Bacterial and fungal infections, vasculitis, drug

eruptions

• Surgery– Ulcers, the red leg

• Pathology– Skin cancers, biopsy techniques, path requests

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Page 35: Paea 2012 aad course10.17.2012

Flow of Dermatology Learning

PA-C IN PRACTICE

GENERAL*: CME/PANRE DERM*: DLI

MSCC LEARNING MODULES AS TEST PREP / DERM PRIMER

PACKRAT* PANCE*

PA SCHOOL

LECTURES* DERM ELECTIVE*

* POSSIBLE USES OF AAD CORE CURRICULUM

Page 36: Paea 2012 aad course10.17.2012

Open Discussion and Questions

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Page 37: Paea 2012 aad course10.17.2012

Discussion

• How can this be used as an adjunct to current curriculum at your program?

• How might you use this to orient new PAscoming into your practice?

• Could you now convince local dermatologists to take on PA students?

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Page 38: Paea 2012 aad course10.17.2012

Thank You

Members of the American Academy of Dermatology Medical Student Core Curriculum Workgroup

Tim Berger, Sarah Cipriano (UCSF)

PAEA leadership and membership

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Page 39: Paea 2012 aad course10.17.2012

Please visit www.aad.org for

more information on the core

curriculum

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