Effective Collaboration on Skin Disease Starts With Medical Education

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As medical trainees, we are concerned about the paucity of training that nondermatologists receive in cutaneous pathology and morphology. Management of skin disease often requires coordination among multiple medical specialties. Familiarity with describing skin lesions and fundamental understanding of dermatology is necessary for appropriate referral and constructive communication between care providers. Studies have demonstrated that errors in identifying skin diseases and failures to call appropriate dermatology consultations have resulted in diagnostic delays and poor clinical outcomes.1 The current, and likely continued, shortage of academic dermatologists further cements the need for basic competency in initial examinations, appropriate triaging, and management of chronic cutaneous conditions by nondermatologic practitioners.2
Unfortunately, medical students often receive little to no dedicated exposure to dermatology throughout their training. As a result, our current medical graduates have little practice in describing skin lesions, insight into cutaneous disease, or ability to communicate effectively with dermatologists.
We advocate for increased exposure to dermatology throughout medical school. While dedicated teaching time with dermatologists provides optimal opportunities for reinforcement of skills, such opportunities are not feasible in all training environments. Alternatives include uses of standardized patient encounters and day-to-day reinforcement of basic skills in other areas of clinical practice. To illustrate, a trainee seeing a rash in the emergency room should work to accurately describe it using well-defined morphologic terminology. His or her supervising attending must also become well versed in these descriptors in order to provide constructive feedback.
The purpose of increased training in dermatology is not necessarily to create more dermatologists. Rather, we advocate for a system that will render all physicians more confident in approaching the dermatologic patient and more capable of coordinating care with dermatologists. As research on skin cancer outcomes has demonstrated, our patients ultimately benefit when we are able to effectively collaborate across specialties.

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