DT04: Teledermatology reporting experiential teaching model for dermatology registrars: a qualitative study

Ashima Lowe, Vani Agarwal, Kate Lawlor and Richard Motley

University Hospital of Wales, Cardiff, UK

Teledermatology was introduced into the UK dermatology training curriculum in August 2021. National surveys of dermatology trainees in the UK undertaken in 2019 and 2020 demonstrated a vital learning gap in teledermatology (Lowe A, Pararajasingam A, Goodwin R. A UK-wide survey looking at teaching and trainee confidence in teledermatology: a vital gap in a COVID-19-induced era of rapid digital transformation? Clin Exp Dermatol 2020; 45: 876–9). Feedback received elucidated that registrars were desirous of observing dermatology consultants during teledermatology reporting, particularly undertaking this themselves under direct supervision. To bridge the gap, we set up a regional virtual teledermatology reporting teaching programme for registrars in our deanery, applying Kolb’s experiential learning model and using our local asynchronous teledermatology service. Our aim was for trainees to participate directly in teledermatology reporting for skin lesions under consultant supervision, developing confidence in triaging patients, providing appropriate advice to general practitioners (GPs), and for discharging benign lesions. Teaching was delivered through eight interactive sessions with a focus on skin lesions, over a 12-month period from August 2020 to August 2021, by a senior consultant dermatologist with an interest in teledermatology and skin cancer. Eight dermatology registrars from four different hospital trusts participated, using MS Teams® as the virtual platform. Registrars logged in and selected a new referral awaiting review. Screen sharing enabled registrars and the supervising consultant to view the accompanying clinical history and images and engage in a brief discussion. Trainees decided to either accept or reject, directing accepted referrals into urgent suspected cancer, urgent or routine. Where appropriate, advice regarding treatment that GPs could prescribe in the community was given. Qualitative feedback was collected pre- and postprogramme, using e-mailed questionnaires. A 5-point Likert scale was used to assess confidence levels in the following domains: assessing and diagnosing; triaging; discharging skin lesions; giving advice regarding benign skin lesions; and overall confidence in teledermatology. Responses ranged from 1 (strongly agree) to 5 (strongly disagree). The response rate was 100% (n = 8). Trainee confidence was compared using a nonparametric Mann–Whitney U-test. A significant improvement post-teaching was demonstrated in all domains. Most (87%) rated the programme as being extremely relevant to their training. Our study is limited by a relatively small sample size of residents. Nevertheless, results demonstrate that this model is effective in increasing trainee confidence in using teledermatology for the reporting of skin lesion referrals in actual practice, thus equipping registrars with the skills needed to keep pace with changing service demands in an increasingly digital ecosystem.