Post on 22-Jul-2015
Teaching Dermatology to PA Students with a
Peer-reviewed Virtual Curriculum
P. Eugene Jones, PhD, PA-C
Patrick McCleskey, MD, FAAD
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
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.
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
Implementation
• Went live on AAD Website March 2012
– http://www.aad.org/education-and-quality-care/medical-student-core-curriculum
– Free, publically available to everyone
• Learners review at their own pace
• Each Module can be given as a lecture or small group discussion
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?
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
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
Use of website correlates with higher post-test scores
p 0.003 trend p 0.003
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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
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
Intro to MSCC on AAD website
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
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.
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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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
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
Course Feedback: Effort Required
0%
10%
20%
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40%
50%
60%
70%
great deal more
somewhat more
about the same somewhat less a lot less
Course Feedback: Module Number
0%
10%
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30%
40%
50%
60%
much too many somewhat too many
right amount somewhat too few
Much too few
Course Feedback: Satisfaction
very satisfied somewhat satisfied
neutral somewhat dissatisfied
very dissatisfied
0%
5%
10%
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30%
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40%
45%
50%
Course Feedback: Intellectual Challenge
0%
10%
20%
30%
40%
50%
60%
very easy easy average difficult very difficult
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
Course Feedback: Online Effectiveness
0%
10%
20%
30%
40%
50%
60%
extremely effective
somewhat effective
neutral somewhat ineffective
extremely ineffective
Course Feedback: Knowledge Increase
0%
10%
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50%
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90%
strongly agree agree neutral disagree strongly disagree
Course Feedback: Would Recommendto Other PA Students
0%
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definitely recommend
probably recommend
uncertain probably not recommend
definitely not recommend
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
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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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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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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Take-Home Points
• Instead of teaching in clinic, direct the students what to learn on their own
• Visit the AAD website:
– http://www.aad.org/education-and-quality-care/medical-student-core-curriculum
• Use the website to do the teaching for you, to save time in clinic
• Follow-up to close the learning loop
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Incorporating the Core Curriculum into PA instruction
Discussion about how you might use this curriculum in your program or office
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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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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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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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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
Open Discussion and Questions
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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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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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