key: cord-0857540-2954ie1c authors: Ashrafzadeh, Sepideh; Imadojemu, Sotonye E.; Vleugels, Ruth Ann; Buzney, Elizabeth A. title: Strategies for Effective Medical Student Education in Dermatology During the COVID-19 Pandemic date: 2020-08-20 journal: J Am Acad Dermatol DOI: 10.1016/j.jaad.2020.08.068 sha: 7b2219d5abb1b2e126a031224d26d7b945de7eac doc_id: 857540 cord_uid: 2954ie1c nan To the Editor: Recent publications have discussed that teledermatology can serve as a tool in medical student education, enabling students to form differential diagnoses, document clinical notes, and discuss morphologies. 1, 2 Expanding on this topic, we share the structure of a completely virtual dermatology elective piloted at our institution during the COVID-19 pandemic, with positive feedback from students, faculty, and patients. The innovative clinical rotation utilized asynchronous and synchronous telehealth and fulfilled 12 of the 13 Association of American Medical Colleges Core Entrustable Professional Activities, which are skills students should develop before entering residency (Table 1) . 3 In the four-week elective, we assigned each student to work closely with three faculty members. Limiting the number of faculty was ideal because students learned the expectations, pertinent interview questions, clinical note formats, and subspecialty-specific diseases associated with each faculty's practice. Spending substantial time with the same faculty enabled students to establish strong relationships with faculty and patients, allowing for enriched patient follow-up and enhanced learning throughout the rotation. An important step for the virtual rotation included having faculty assign specific patients for students to evaluate. Subsequently, students called patients the day before clinic, obtained patients' verbal consent for student participation in their care using a prespecified script, collected a thorough history, and helped patients electronically submit photographs of their skin findings. This process enabled students to prepare oral presentations describing morphologies and differential diagnoses and facilitated clinical encounters to efficiently address J o u r n a l P r e -p r o o f all patients' concerns. Furthermore, faculty had more time to provide patient and student education during visits since components of the visits were completed beforehand. A brief virtual meeting between faculty and students prior to clinic was helpful in discussing the clinic flow for that day. This meeting also provided dedicated time to discuss faculty's expectations, students' goals, and feedback on students' notes from the prior clinic. Immediate feedback on student presentations was provided during the clinic session. In the pilot, students participated in synchronous visits from home only; faculty first There were some limitations to medical student education with the virtual structure. For example, students were unable to observe or assist with procedures such as biopsies or cryotherapy. Also, students did not conduct full-body skin exams. As social distancing guidelines for the COVID-19 pandemic may limit the presence of student trainees in dermatology clinics, 2,4 we anticipate that teledermatology will serve a critical role in medical student education. The virtual dermatology elective that we piloted and J o u r n a l P r e -p r o o f Methods to address this skill in the virtual dermatology elective Collect a history and perform a physical exam Students call patients to collect a history and describe morphologies based on photographs that patients submit. If students are unable to contact patients before the visit, they ask questions and describe lesions that they see during the televisit. Formulate and prioritize a differential diagnosis Students formulate and prioritize a differential diagnosis both in their oral presentation and in their clinical note. Recommend diagnostic and screening tests Students recommend diagnostic and screening tests (e.g. biopsy, thyroid hormone levels, etc.). Students enter electronic orders for laboratory tests and prescription medications as well as write clear patient instructions on how to take prescribed medications on a section of the electronic medical record that is accessible to patients. Document a clinical encounter in the patient record Students write clinical notes for the patients they evaluate. Give an oral presentation of a clinical encounter Students give oral presentations for each patient they are able to call prior to the clinical encounter. Formulate questions and retrieve evidence to advance patient care Students conduct literature reviews to investigate treatment options for patients with uncommon conditions or patients who have failed multiple therapies. Give or receive a patient handover Students give patient handovers to different specialists when a patient is referred to another specialist and students email patient summaries to primary care providers or other providers. Collaborate as a member of an interdisciplinary team Students 1) verify medications and dosages with other clinicians when patients take medications other than prescribed, 2) coordinate imaging and laboratory tests with other teams, and 3) coordinate SARS-CoV-2 testing for patients with COVID-19 symptoms who need to come in for in-person visits. Recognize urgent or emergent situations Students recommend patients come in for in-person dermatology visits that require biopsy and when needed, recommend that patients present to the emergency room. Obtain informed consent of tests or procedures Students obtain informed consent from patients for laboratory tests (e.g. HIV, syphilis), imaging, and biopsies (for patients coming in for in-person dermatology visits). This EPA cannot be performed or assessed virtually. However, students can practice suturing and performing biopsies independently using kits and instructional videos. Identify system failures and promote a culture of safety Students identify patients who have not been followed up by the appropriate providers or who have not obtained important laboratory or imaging tests. Asynchronous teledermatology in medical education: Lessons from the COVID-19 pandemic COVID-19 and its effect on medical student education in dermatology Toolkits for the 13 Core Entrustable Professional Activities for Entering Residency. Association of American Medical Colleges Optimizing teledermatology visits for dermatology resident education during the COVID-19 pandemic described may serve as a helpful model as other institutions restructure medical student electives in the upcoming months.