key: cord-0891306-rwiu60nf
authors: Patel, Payal M.; Tsui, Cindy L.; Varma, Aakaash; Levitt, Jacob
title: Remote Learning for Medical Student-Level Dermatology During the COVID-19 Pandemic
date: 2020-08-14
journal: Journal of the American Academy of Dermatology
DOI: 10.1016/j.jaad.2020.08.033
sha: 064d3417c5540d0f6090d32cee2fe480119bd61f
doc_id: 891306
cord_uid: rwiu60nf

nan

Traditionally, online resources available to medical students for learning dermatology have been designed as adjuncts to in-person clerkships. The COVID-19 pandemic has created an unmet and unprecedented need for remote structured learning for medical students interested in dermatology. Medical student clinical exposure has been limited to ensure their safety and to conserve personal protective equipment. 1 In light of the deconstruction of the traditional handson clerkship environment, 2-4 medical schools struggle to educate their budding dermatologists.

Proposed solutions include implementation of teledermatology and integration of supplemental online resources into the medical student-level dermatology curriculum. 5 We envision the mission of a MS3-MS4 dermatology elective curriculum to render a medical student competent in the art of history taking, physical examination, documentation, and therapeutic management of common dermatoses ( Table 1) . While social distancing and minimum room occupancy guidelines are in place, familiarizing medical students with routine dermatologic patient encounters is challenging.

Historically, clinical rotations reinforce recognition of common diagnoses based on random disease state encounters, making the set of clinical entities learned variable from student to student depending on their relative clinical environment, subspecialty area of the attending, season, and patient population. We propose a solution to both the haphazard exposure in normal times and limited exposure in COVID times with a comprehensive, standardized, and actionable curriculum to learn dermatology remotely.

A comprehensive dermatology curriculum begins with training students on history taking and performing a dermatologically directed physical examination. The next step entails describing morphology and understanding the pathophysiology of common diagnoses.

We achieve these two steps with Zoom and PowerPoint lectures, which can be recorded J o u r n a l P r e -p r o o f for future review, while using pre-and post-assessments on SurveyMonkey and other platforms to highlight important points, thereby inducing the learner to have a focused guide with which to approach the lectures. At this point, repetitive exposure to clinical photographs will enable students to recognize dermatologic pathology in diverse patient groups. A deliberate effort should be made to incorporate photos representative of all skin tones. In our experience, asking students to pick one disease out of a side-by-side comparative dyad enhances the efficiency of learning by forcing in-depth analysis of the correct answer while doubling the volume of photographic exposure. Next, students can progress to case-based clinicopathologic correlation focused on clinical presentation, histology, and management of common dermatoses. We have found starting with a photo followed by a second-order multiple choice question is effective. Finally, all of the above can be done in parallel to learning dermatologic procedures. We encourage a flipped classroom approach, with video learning by the student prior to one-on-one instruction with skin substitutes and supplemental visual learning with a textbook on dermatologic procedural safety. When the opportunity finally arises to see the patient with the random presentation of dermatologic disease, the student can draw upon their structured morphologic drilling and case-based reinforcement to create a differential diagnosis, provide workup, and therapeutic management. 

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