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Paea 2012 aad course10.17.2012
1. Teaching Dermatology to
PA Students with a
Peer-reviewed Virtual Curriculum
P. Eugene Jones, PhD, PA-C
Patrick McCleskey, MD, FAAD
2. 1. Problem Identification and General
WHY?
Needs Assessment
6. Evaluation WHO?
2. Targeted Needs
and
HOW WELL? WHAT?
Assessment
Feedback
3. Goals and
5. Implementation WHAT?
Objectives
JUST DO IT
HOW? WHEN?
4. Educational Strategies
WHERE?
2
3. Step 2: Targeted Needs Assessment
Acne
Seborrheic dermatitis
Warts
Rosacea
Atopic dermatitis
Superficial dermatophytoses
McCleskey PE, Gilson RT, Devillez R. Medical student core curriculum in
dermatology survey. J Am AcadDermatol2009;61(1):30-35. 3
4. 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
5. 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
6. 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?
7. 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
9. Use of website correlates with higher
post-test scores
p 0.003 trend p 0.003
9
10. 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
11. 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
13. 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
14. 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.
16. 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
17. Course Examination Outcomes
• Class of 2013 • Class of 2014
– N=36 students – N=38 students
– Mean exam score 92.3 – Mean exam score 91.05
– Range 81-98 – Range 80-97
18. Course Feedback: Effort Required
70%
60%
50%
40%
30%
20%
10%
0%
great deal somewhat about the same somewhat less a lot less
more more
19. Course Feedback: Module Number
60%
50%
40%
30%
20%
10%
0%
much too many somewhat too right amount somewhat too Much too few
many few
25. Course Feedback: Would Recommend
to Other PA Students
70%
60%
50%
40%
30%
20%
10%
0%
definitely probably uncertain probably not definitely not
recommend recommend recommend recommend
26. 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
27. 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
27
28. 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
28
29. 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
29
30. 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
30
31. Incorporating the Core
Curriculum into PA instruction
Discussion about how you might use this
curriculum in your program or office
31
32. 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
32
33. 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
33
34. 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
34
35. Flow of Dermatology Learning
PA SCHOOL
LECTURES* DERM ELECTIVE*
MSCC LEARNING MODULES AS TEST PREP / DERM PRIMER
PACKRAT* PANCE*
PA-C IN PRACTICE
GENERAL*: CME/PANRE DERM*: DLI
* POSSIBLE USES OF AAD CORE CURRICULUM
37. Discussion
• How can this be used as an adjunct to current
curriculum at your program?
• How might you use this to orient new PAs
coming into your practice?
• Could you now convince local dermatologists to
take on PA students?
37
38. Thank You
Members of the American Academy of
Dermatology Medical Student Core
Curriculum Workgroup
Tim Berger, Sarah Cipriano (UCSF)
PAEA leadership and membership
38
Figure 1.1 A Six Step Approach to Curriculum DevelopmentCurriculum development is a dynamic interactive processProgress was made on multiple steps simultaneouslyEach step has the potential to influence another. For example, in developing our pre- and post-test questions for our evaluation study, we continued to refine our learning objectives. EXAMPLE ON NEXT SLIDE
Clinic exposure varied from student to student; some were in clinic every day, some just a few times during the month. Number of half-days in clinic did NOT correlate with post-test scores (p 0.27). There is a trend showing that increased use of the website (i.e., completing more learning modules) is associated with higher post-test scores and greater delta from pre-test to post-test. The difference between the lowest quartile of website activity/usage and every other quartile is significant (p 0.001, 0.001, and 0.000), and the trend toward increasing scores with increasing website activity/usage is also statistically significant.-Year level of resident physicians had NO influence on post-test scores (p 0.55)-Post-test scores did NOT differ based on age, gender, or amount of time spent in dermatology clinic. (p values of 0.29, 0.09, and 0.27, respectively)This suggests that students are not only learning because they are seeing patients in clinic, but that the high use of the on-line curriculum leads to greater knowledge acquisition regardless of how much or how little clinic exposure residents had during their rotation.Note: p scores listed are for analysis of variance using the F test for multiple variables. Additional between group analysis was done for relevant groups but is not reported here.
