Erik J. Stratman

Analysis of dermatology resident self-reported successful learning styles and implications for core competency curriculum development

Background: There are different teaching styles for delivering competency-based curricula. The education literature suggests that learning is maximized when teaching is delivered in a style preferred by learners. Aims: To determine if dermatology residents report learning style preferences aligned with adult learning. Method: Dermatology residents attending an introductory cutaneous biology course completed a learning styles inventory assessing self-reported success in 35 active and passive learning activities. The 35 learning activities were ranked in order of preference by learners. Results: Mean overall ratings for active learning activities were significantly higher than for passive learning activities (P = 0.002). Conclusions: Trends in dermatology resident learning style preferences should be considered during program curriculum development. Programs should integrate a variety of curriculum delivery methods to accommodate various learning styles, with an emphasis on the active learning styles preferred by residents.

Skin biopsy: Biopsy issues in specific diseases

Misdiagnosis may result from biopsy site selection, technique, or choice of transport media. Important potential sources of error include false-negative direct immunofluorescence results based on poor site selection, uninformative biopsy specimens based on both site selection and technique, and spurious interpretations of pigmented lesions and nonmelanoma skin cancer based on biopsy technique. Part I of this 2-part continuing medical education article addresses common pitfalls involving site selection and biopsy technique in the diagnosis of bullous diseases, vasculitis, panniculitis, connective tissue diseases, drug eruptions, graft-versus-host disease, staphylococcal scalded skin syndrome, hair disorders, and neoplastic disorders. Understanding these potential pitfalls can result in improved diagnostic yield and patient outcomes.

The current state of dermatopathology education: a survey of the association of professors of dermatology

Background:  Dermatology training programs develop program‐specific dermatopathology (DP) curricula. We summarize the current state of DP education in dermatology residency programs and identify opportunities for DP education resource development.

Carotenemia associated with green bean ingestion

Abstract:  Carotenemia is a condition characterized by yellow discoloration of the skin and elevated blood carotene levels. Excessive and prolonged ingestion of carotene‐rich, yellow‐ or orange‐colored foods such as carrots and winter squash is the most common cause, but more rarely it may be associated with consumption of other foods as well as with hypothyroidism, diabetes mellitus, anorexia nervosa, liver disease, or kidney disease. Though not uncommon in children, there are few reports in the pediatric literature since its early descriptions in the late 1800s and early 1900s. Awareness of carotenemia can help the provider resolve confusion with jaundice and avoid unnecessary worry and costly tests. Herein we describe carotenemia in an 8‐month‐old Caucasian girl secondary to increased consumption of commercial infant food green beans.

Primary Care and Specialty Care Delays in Diagnosing Trichophyton verrucosum Infection Related to Cattle Exposure

ABSTRACT The objective of this study was to identify exposure risks, body site of presentation, length of time from symptom onset to definitive diagnosis, initial and eventual treatment courses, and the number of medical visits between initial assessment and definitive diagnosis for patients with culture-proven Trichophyton verrucosum (T. verrucosum) skin infection, and to report the specialties of physicians making the initial assessment and the eventual correct diagnosis. Chart data were abstracted from patients diagnosed with culture-proven T. verrucosum in the Marshfield Clinic system from May 1996 to August 2009. Fifty-one patients were identified and included in the study. Of the 51 patients studied, 39 had a documented history of cattle exposure. The average length of time from symptom onset to diagnosis was 41.5 days. Prior to a culture-positive T. verrucosum diagnosis, 35 patients were treated with topical medications, 10 received oral antibiotics, and 6 received no initial treatment. After a culture-positive T. verrucosum diagnosis was obtained, all documented treatments were either oral or topical antifungal medications. In 68.6% of cases, the physician making the initial assessment was different than the physician making the final diagnosis. Health care providers who care for patients in rural populations presenting with recalcitrant inflammatory skin lesions should include occupational and exposure histories and include cutaneous fungal infections in the differential diagnosis of chronic inflammatory skin lesions, particularly in patients with a history of contact with cattle. Fungal cultures may aid in the definitive diagnosis when cattle ringworm is suspected. Increased awareness of the condition among all care providers may decrease the number of medical visits required, avoid unnecessary drug therapy, shorten the time to make the correct diagnosis, and hasten the onset of appropriate antifungal therapy.

Clouston syndrome and eccrine syringofibroadenomas.

Clouston syndrome and eccrine syringofibroadenoma are uncommon disorders that have been reported together rarely and only before the discovery of the GJB6 gene for Clouston syndrome. This case reports eccrine syringofibroadenoma in a patient with genetically confirmed Clouston syndrome.

Core competencies in dermatopathology

Abstract:  Medical education has traditionally focused on imparting medical knowledge, delivering quality patient care, and teaching research methodology. Various measures of success, including standardized testing, have been developed to assess the achievement of those goals. These measures then served as documentation of the effectiveness of individual training programs. However, in 1999, the Accreditation Council for Graduate Medical Education (ACGME) changed the way we measure the success of medical education. They developed six core competencies for medical education and assigned the task of enforcing them to the individual Residency Review Committees. By July 2006, all accredited programs, including dermatopathology fellowships, must use measurable, competency‐based objectives, and assess achievement of those objectives. Programs should also be documenting ways they are improving the evaluation process. They must be in full compliance with implementation, measurement, and assessment of the six core competencies for accreditation. The next phase required by the ACGME involves developing curriculum based on competencies as well as using resident, fellow, or graduate competency performance to assess success in preparing trainees for the practice of medicine. This manuscript discusses measurable objectives to address the core competencies for dermatopathology fellowship training as well as dermatopathology rotations in dermatology and pathology residency training.

Cosmetic Dermatologic Surgical Training in US Dermatology Residency Programs: Identifying and Overcoming Barriers

IMPORTANCE The public and other medical specialties expect dermatologists who offer cosmetic dermatology services to provide competent care. There are numerous barriers to achieving cosmetic dermatology competency during residency. Many dermatology residents enter the workforce planning to provide cosmetic services. If a training gap exists, this may adversely affect patient safety. OBJECTIVES To identify resources available for hands-on cosmetic dermatology training in US dermatology residency training programs and to assess program director (PD) attitudes toward cosmetic dermatology training during residency and strategies, including discounted pricing, used by training programs to overcome barriers related to resident-performed cosmetic dermatology procedures. DESIGN, SETTING, AND PARTICIPANTS An online survey in academic dermatology practices among PDs of US dermatology residency programs. MAIN OUTCOMES AND MEASURES Frequency of cosmetic dermatology devices and injectables used for dermatology resident hands-on cosmetic dermatology training, categorizing PD attitudes toward cosmetic dermatology training during residency and describing residency-related discounted pricing models. RESULTS Responses from PDs were received from 53 of 114 (46%) US dermatology residency programs. All but 3 programs (94%) offered hands-on cosmetic dermatology training using botulinum toxin, and 47 of 53 (89%) provided training with hyaluronic acid fillers. Pulsed dye lasers represented the most common laser use experienced by residents (41 of 52 [79%]), followed by Q-switched Nd:YAG (30 of 52 [58%]). Discounted procedures were offered by 32 of 53 (60%) programs, with botulinum toxin (30 of 32 [94%]) and fillers (27 of 32 [84%]) most prevalent and with vascular lasers (17 of 32 [53%]) and hair removal lasers (12 of 32 [38%]) less common. Various discounting methods were used. Only 20 of 53 (38%) PDs believed that cosmetic dermatology should be a necessary aspect of residency training; 14 of 52 (27%) PDs thought that residents should not be required to perform any cosmetic dermatology procedures. CONCLUSIONS AND RELEVANCE Although almost every program provides hands-on cosmetic dermatology training, there are barriers to training, including patient preferences, costs of procedures and products, and PD attitudes toward cosmetic dermatology training. To promote patient safety, procedural competency is imperative.

The utility of a touch preparation in the diagnosis of fluctuant subcutaneous fat necrosis of the newborn.

Abstract:  Subcutaneous fat necrosis of the newborn (SFNN) is an uncommon self‐limiting panniculitis. Lesions may be fluctuant and spontaneously drain. Here we report a technique to rapidly confirm the diagnosis of SFNN when fluctuance exists via a touch preparation that demonstrates the characteristic histologic features of this condition. The material can be collected by fine needle aspirate, from draining fluctuant lesions, or if biopsy if performed.

Drug-Induced Bullous Sweet Syndrome with Multiple Autoimmune Features

Sweet syndrome (SS) (Acute Febrile Neutrophilic Dermatosis) has been reported in association with autoimmune phenomena including relapsing polychondritis, drug-induced lupus, and the development of antineutrophil cytoplasmic antibodies (ANCAs). However, a combination of these autoimmune features has not been reported. Herein, we report a case of drug-induced bullous SS with ocular and mucosal involvement, glomerulonephritis, and multiple autoimmune features including clinical polychondritis with antitype II collagen antibodies, ANCAs, antinuclear (HEp-2), and antihistone antibodies in a patient on hydralazine and carbamazepine.