By Patrick McCleskey, MD
Many educators have created outstanding dermatology curricula at their institutions in the past, but there had been no standardized curriculum for teaching dermatology to students. Additionally, primary care learners complain that academic dermatologists “try to teach too much,” so we wanted to limit the scope of a dermatology curriculum based on the needs of primary care learners. The AAD’s Medical Student Core Curriculum (MSCC) work group approached this challenge using an evidence-based collaborative process with extensive peer review.
When we began the project, we performed two needs assessments. First, we asked primary care doctors to tell us what dermatologic conditions were most important in their daily practice. We also asked educators at what level students should learn about specific diseases, including whether they should know how to diagnose, treat, or just describe them.
After these assessments were complete, we built modules for 33 diagnoses with related goals and objectives. We included the most common dermatoses and a few critical, dangerous ones they should know. The modules are question-based and include photos and videos. Peer review was performed by two to four dermatologists for each module. We propose a certain order for two to four weeks of study. The entire MSCC is freely available to anyone who visits the AAD website.
The MSCC was a large undertaking, with nearly 40 contributors who developed it over three years and tested it with medical students at the University of California San Francisco, as well as primary care residents and physician assistant (PA) students rotating in military dermatology clinics. The results of the study of primary care residents and PA students are available online in the Articles In Press section of the JAAD. Only one of the 10 factors studied affected post-test scores: how much the students interacted with the curriculum. Since this was the only factor associated with higher test scores, it shows that the curriculum content, not merely being in the dermatology clinic, influenced students’ knowledge gains. The more they used it, the more they learned. This shows the curriculum effectively teaches the material it aims to teach.
There are many ways that this curriculum can be used, from teaching medical students to mid-level providers to primary care physicians in practice — even your office staff.
Some medical schools that already have robust dermatology curricula are using the MSCC as pre-reading. Students on their dermatology block are assigned modules the night before to get them ready for class. At medical schools with a problem-based curriculum design, the modules such as The Red Leg or Blisters are a great starting point for stimulating discussion in small groups.
Institutions without much dermatology curriculum could use the MSCC as a primary teaching source, or for students to access outside the standard curriculum if curriculum time cannot be made available.
The curriculum is especially useful during clinical rotations. Students can use the MSCC to learn about conditions they’ve seen that day, obviating the need for a “mini-lecture” in the middle of clinic. This takes away the anxiety of having to create a curriculum from scratch. My hope is that more private-practice dermatologists will consider having medical students rotate in their clinics, letting these modules do the teaching for you.
Students at Travis Air Force Base in Fairfield, Calif., use the Medical Student Core Curriculum to learn more about dermatologic skin diseases.
The curriculum also has great utility for training mid-level providers. For example, the PA program at the University of Texas Southwestern Medical Center usually covers dermatology in a two-week block. This year, they used the MSCC as a primary teaching source and thus cut 20 hours of lecture down to three. Students scored just as well with the virtual curriculum as the prior lecture curriculum, and they liked it better because they could review the modules whenever they wanted.
Feedback from students has shown that they love the pictures and vignettes, and they like being able to study it on their own time.
The curriculum is flexible and can be used to teach people in your office and your community. You might want your patch test nurses to learn about contact dermatitis, or your medical assistants to know more about skin cancer. For mid-level staff, the modules are a good place to start when joining your practice. You can also use them if you are asked to give a talk in the local community.
The modules can also help if you provide feedback to a referring provider who could use more background in dermatology. If they make a referral that could easily have been managed at the primary care level, you might tactfully mention that there is a lot of variability in primary care training, and they may find these free modules helpful to optimize care for their patients.
We have gotten a lot of great feedback on the MSCC, but the AAD is committed to its continued growth and evolution.
We’ve had more than 40,000 unique visitors and 200,000 pageviews since it went online in March 2012. Students have indicated that they love the pictures and vignettes, and they like being able to study it on their own time.
If you do any kind of teaching, and we all do, check out the curriculum. Share it with your colleagues, your mid-levels, your staff, and your primary care colleagues.
We also want you to share your questions, impressions, and concerns, so we can continue to improve. The website asks for feedback after each module, but you can also just email me at Patrick.firstname.lastname@example.org if you think you see an error. We’re continually revising the MSCC to make sure it’s of the highest quality.
You can access the MSCC on the AAD website at www.aad.org/mscc. Take a look, and think about how you might use it in your practice. Most importantly, tell colleagues about it!
Dr. McCleskey is the chair of the Medical Student Core Curriculum work group and chief of dermatology at the David Grant USAF Medical Center at Travis Air Force Base in Fairfield, Calif. The views expressed in this material are those of the author, and do not reflect the official policy or position of the U.S. Government, the Department of Defense, or the Department of the Air Force.