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Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, Texas, USADepartment of Dermatology, UTHealth McGovern Medical School, Houston, Texas, USA
Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, Texas, USADepartment of Dermatology, UTHealth McGovern Medical School, Houston, Texas, USA
Many dermatology residency programs adapted to the COVID-19 pandemic by transitioning to online teaching methods. This may impact the quality of education and the satisfaction of residents. Dermatology faculty and residents nationwide were surveyed regarding their experiences with the novel online curricula. A total of 65 individuals representing at least 20 ACGME-accredited dermatology programs responded. Many programs implemented a predominantly online curriculum (78%). Most participants reported that both clinical dermatology and dermatopathology were online during the pandemic's peak (90%). Among those who had experienced a live curriculum prior to the pandemic, 49% reported that a virtual curriculum had similar effectiveness, whereas 36% deemed it less effective. Open-ended questions suggested that disadvantages of a virtual curricula included too many distractions, lack of human features, and less spontaneous feedback. They also suggested advantages to an online curriculum included flexibility and more opportunities to hear from guest speakers. Dissatisfaction before the curriculum change was the same as after (7%), suggesting that the educational experience was not worsened. Failing to adjust the curriculum to residents’ needs can contribute to lower satisfaction and inadequate education. The variation of responses signifies the importance of seeking sufficient feedback from residents to meet their educational needs.
The COVID-19 pandemic has created an unprecedented time in medical education. Many residency programs transitioned from in-person lectures and skills sessions to online didactics, virtual simulations, and some teledermatology.
Inpatient teledermatology: diagnostic and therapeutic concordance among a hospitalist, dermatologist, and teledermatologist using store-and-forward teledermatology.
Immediate consequences and solutions used to maintain medical education during the COVID-19 pandemic for residents and medical students: a restricted review.
Given the variety of online learning methods, understanding factors associated with adequate education and resident satisfaction is important as programs adapt to novel learning environments.
An electronic Qualtrics survey was distributed from January to April 2021 addressing experiences with online dermatology curricula to the Association of Professors of Dermatology listserv and program coordinators for the 2020-2021 academic year. Study participation was voluntary, and informed consent was obtained. Institutional review board approval was obtained through the institutional review board of the University of Texas Health Science Center Houston. Survey results were analyzed using Microsoft Excel.
Results
Sixty-five individuals responded, including 21 faculty members and 44 residents from at least 20 ACGME-accredited dermatology residency programs (some respondents kept their program anonymous). Most of the represented programs implemented virtual, online curricula in March of 2020 (Table 1). Fifty-one (78%) respondents reported that 75% to 100% of their curriculum was virtual by January of 2021. Zoom was the most common platform used by 43 respondents (65%). Ninety percent of participants reported both clinical dermatology and dermatopathology were online during the initial peak of the pandemic.
Table 1Characteristics of online dermatology curriculum
Number of respondents
Percentage of respondents
Role in program or year in training
PGY2
20
31%
PGY3
11
17%
PGY4
12
18%
PGY5
1
2%
Program director, associate program director, or other faculty associate
21
32%
Number of residents in program
1-6
7
11%
7-9
9
14%
10-12
16
25%
13+
33
51%
Percentage of curriculum that was virtual by January 2021
1%-24% is virtual
5
8%
25%-49% is virtual
1
2%
50%-74% is virtual
6
9%
75%-100% is virtual
51
78%
We previously had virtual curriculum, but have transitioned back to 100% in-person didactics
2
3%
Components of curriculum that were virtual during peak of pandemic
Both clinical dermatology and dermatopathology
55
90%
Clinical dermatology only
3
5%
None
3
5%
Modality primarily used for lectures
Microsoft 365
7
11%
Other
2
3%
Webex
13
20%
Microsoft Teams
1
2%
Zoom
43
65%
Frequency of personal video feed on during virtual learning
Never
6
10%
Rarely
20
33%
Sometimes
11
18%
Often
12
20%
Always
12
20%
Of the in-person didactics, what percentage is led by the residents versus faculty or outside attendings?
0% resident-led
4
7%
100% resident-led
1
2%
1%-24% resident-led
11
19%
25%-49% resident-led
8
14%
50%-74% resident-led
25
43%
75%-99% resident-led
9
16%
Of the virtual didactics, what percentage is led by the residents versus faculty or outside attendings?
0% resident-led
1
2%
1%-25% resident-led
14
23%
25%-49% resident-led
11
18%
50%-74% resident-led
26
43%
75%-99% resident-led
8
13%
Strategies during virtual learning
Call on individuals to answer questions
49
75%
Poll everywhere or other form of question/answer collector
27
42%
Other
14
22%
Timing or format of the majority of the lectures?
All online lectures are live
44
73%
The majority of lectures are live, with recordings available for asynchronous viewing
15
25%
The majority of lectures are live, with some that are pre-recorded from previous years
1
2%
For faculty and/or PGY3 residents and above, how does the curriculum during COVID-19 compare to the prior curriculum?
Twelve (20%) participants reported they always had their personal video feed on during virtual learning, whereas 20 (33%) reported they rarely did. Thirty-five (67%) respondents said that their education in nonprocedural dermatology was not limited or only slightly limited by the COVID-19 pandemic (Figure 1). Seven (16%) participants said online education was more effective. Thirty-eight (74%) respondents said that their education in dermoscopy and 25 (50%) respondents believed that their education in dermatopathology was not limited or only slightly limited by the COVID-19 pandemic (Fig. 2, Fig. 3). Open-ended responses on advantages to the online learning included flexibility with driving to distant clinical sites and opportunities to hear from speakers outside of their local program. Twenty-two (49%) of faculty members and PGY3+ residents who had experienced live curriculum before the pandemic reported that the virtual curriculum had a similar level of effectiveness, whereas 16 (36%) reported it to be less effective (Supplemental Table 1). Open-ended responses as to why the pandemic curriculum was less effective included themes of “too many distractions,” “lack of human feature,” and “less spontaneous feedback.” Twenty-four of 29 (83%) PGY-3 residents and above were either satisfied or very satisfied with the curriculum prior to the pandemic, whereas 31 of 41 (76%) were satisfied or very satisfied with curriculum after pandemic-related changes. Seven of 41 (17%) were neutral about the virtual curriculum, and three (7%) were dissatisfied. Thirty-two (49%) residents reported difficulty staying engaged as the greatest educational challenges attributed to the pandemic. When asked what pandemic-related educational changes participants would like to sustain, responses ranged from making virtual attendance optional, continuing online learning only, offering a combination of virtual and in-person didactics, and increasing guest lectures.
Fig. 1Survey results from respondents concerning the extent to which education in nonprocedural dermatology has been limited by the COVID-19 pandemic.
One limitation to this study is the sample convenience survey design, making the results less generalizable. A strength of this survey is the open-ended feedback from participants. Interestingly, the level of dissatisfaction before the curriculum change was consistent with the level after (7%), suggesting that the educational experience was not worsened. Regarding why 76% of responders thought the virtual didactics were satisfactory or very satisfactory when 49% reported difficulty staying engaged, we hypothesize that despite people having difficult staying engaged, other benefits (flexibility, ability to record lectures, less commuting, etc) of virtual education outweighed the cons. Outside of didactic training, decreased procedures were a large challenge secondary to the pandemic for 26 (40%) of respondents (Supplemental Figure 1).
Conlusions
Overall, there is wide variation in responses to experiences with online dermatology curriculum. Programs may benefit from seeking detailed feedback from their residents to meet the unique individual learner needs and preferences.
Inpatient teledermatology: diagnostic and therapeutic concordance among a hospitalist, dermatologist, and teledermatologist using store-and-forward teledermatology.
Immediate consequences and solutions used to maintain medical education during the COVID-19 pandemic for residents and medical students: a restricted review.
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