Survey of resident physician and attending physician feedback perceptions: There is still work to be done

Feedback is essential for resident physician (RP) personal and professional growth. The goal of this study was to explore RP and attending physician (AP) perceptions of feedback. Two online surveys (one for RPs and one for APs) were distributed. One hundred twenty two responses were received, of which 67 were RPs and 55 were APs. Although the majority of RP and AP agree that feedback is essential for resident formation, there was a statistical difference between these groups, P=0.04 (RPs 91% versus APs 80%) with residents more likely to agree and strongly agree with this sentiment. Thirty one percent of APs report giving daily feedback, while only 9% of RPs report receiving daily feedback. Resident physicians are more dissatisfied with the quality of the feedback (40%) rather than the amount of feedback (34%). When providing feedback to their AP only 33% of RP versus 83% of APs provide honest and balanced feedback (P?0.001). RPs desire feedback that is specific, prompt, private, personalized and face-to-face. This knowledge and skills gap presents an important opportunity to incorporate feedback training into residencies to ensure that the dermatologists of the future are not only medically competent, but also competent in providing feedback to future generations

Red puffy hand syndrome mistaken for inflammatory arthritis

Red puffy hand syndrome is an uncommon clinical manifestation of intravenous drug abuse, which presents with bilateral, painless and non-pitting erythema and edema of the dorsal hands. The pathophysiology is believed to primarily be the result of lymphatic blockage from either direct toxicity of the injected drug, drainage of impurities, or infection complications. A woman in her 40's with remote intravenous drug use presented with over a decade of fixed, painless erythema and swelling of bilateral dorsal hands. Owing to an elevated rheumatoid factor, which would later be attributed to patient's untreated hepatitis C, these findings were mistaken for rheumatoid arthritis and unnecessarily treated with methotrexate and prednisone. Upon proper recognition of her underlying Red puffy hand syndrome, systemic medications were discontinued and appropriate care was initiated with lymphedema decongestion and occupational therapy. Red puffy hand syndrome, albeit rare, is an important manifestation of intravenous drug abuse; its recognition will spare patients from unnecessary systemic treatments

Localized anagen effluvium and cataract development following an extended fluoroscopic interventional procedure

The skin and the eyes are prone to radiation-induced injury in fluoroscopic procedures. The degree of injury is related to various exposure and patient-related factors. We report a man who presented with an alopecic patch on the left occipital scalp following an extended fluoroscopically-guided endovascular procedure. He subsequently experienced complete hair regrowth, but was later diagnosed with a cataract in his left eye. To our knowledge this is the first report of both anagen effluvium and cataract development in a patient following fluoroscopic radiation exposure. It is important for dermatologists to be aware of these mucocutaneous side effects of radiation exposure to ensure proper management

Assessment of risk and use of prophylaxis for glucocorticoidinduced-osteoporosis among dermatologists in the Pacific Northwest: a survey study

Objective: Exposure to even physiologic doses of glucocorticoids can reduce one's bone mass and increase risk for osteoporotic fracture. There currently exists a wide variation in clinician approach to the assessment and management of glucocorticoid-induced osteoporosis (GIO). Our objectives were to characterize Pacific Northwest dermatology providers' general practices, assessment of risk for GIO, and preferred GIO prophylaxis measures by way of survey. To identify whether knowledge deficits exist with respect to preventing and managing GIO in dermatology patients.Design: A self-administered, 22-question survey was sent electronically to respondent population. Surveyed population composed of 392 dermatology providers of the Washington State Dermatology Association and Oregon Dermatology Society registries. Survey responses were collected anonymously via Catalyst WebQ.Results: Respondents over-estimated fracture risk and reported they would prescribe antiresorptive medications at a less-than-adequate rate. When given clinical scenarios and asked to assess risk of major osteoporotic fracture, respondents frequently overestimated risk compared to that estimated by the FRAX tool (67%-71%). When asked directly if one would prescribe bisphosphonates as GIO prophylaxis for a high-risk patient, only 49% responded always/almost always.Conclusions: This study suggests that a knowledge deficit exists within dermatology with respect to prevention and screening of GIO. The resultant practice gap is likely contributing to morbidity and mortality for dermatology patients requiring chronic glucocorticoid use for dermatologic disorders. Provider variability in practices suggests that dermatology could benefit from additional education in assessment and treatment of GIO, as well as a clear set of guidelines for GIO management

Assessment of risk and use of prophylaxis for glucocorticoidinduced-osteoporosis among dermatologists in the Pacific Northwest: a survey study

Objective: Exposure to even physiologic doses of glucocorticoids can reduce one's bone mass and increase risk for osteoporotic fracture. There currently exists a wide variation in clinician approach to the assessment and management of glucocorticoid-induced osteoporosis (GIO). Our objectives were to characterize Pacific Northwest dermatology providers' general practices, assessment of risk for GIO, and preferred GIO prophylaxis measures by way of survey. To identify whether knowledge deficits exist with respect to preventing and managing GIO in dermatology patients.Design: A self-administered, 22-question survey was sent electronically to respondent population. Surveyed population composed of 392 dermatology providers of the Washington State Dermatology Association and Oregon Dermatology Society registries. Survey responses were collected anonymously via Catalyst WebQ.Results: Respondents over-estimated fracture risk and reported they would prescribe antiresorptive medications at a less-than-adequate rate. When given clinical scenarios and asked to assess risk of major osteoporotic fracture, respondents frequently overestimated risk compared to that estimated by the FRAX tool (67%-71%). When asked directly if one would prescribe bisphosphonates as GIO prophylaxis for a high-risk patient, only 49% responded always/almost always.Conclusions: This study suggests that a knowledge deficit exists within dermatology with respect to prevention and screening of GIO. The resultant practice gap is likely contributing to morbidity and mortality for dermatology patients requiring chronic glucocorticoid use for dermatologic disorders. Provider variability in practices suggests that dermatology could benefit from additional education in assessment and treatment of GIO, as well as a clear set of guidelines for GIO management

Survey of resident physician and attending physician feedback perceptions: There is still work to be done

Feedback is essential for resident physician (RP) personal and professional growth. The goal of this study was to explore RP and attending physician (AP) perceptions of feedback. Two online surveys (one for RPs and one for APs) were distributed. One hundred twenty two responses were received, of which 67 were RPs and 55 were APs. Although the majority of RP and AP agree that feedback is essential for resident formation, there was a statistical difference between these groups, P=0.04 (RPs 91% versus APs 80%) with residents more likely to agree and strongly agree with this sentiment. Thirty one percent of APs report giving daily feedback, while only 9% of RPs report receiving daily feedback. Resident physicians are more dissatisfied with the quality of the feedback (40%) rather than the amount of feedback (34%). When providing feedback to their AP only 33% of RP versus 83% of APs provide honest and balanced feedback (P?0.001). RPs desire feedback that is specific, prompt, private, personalized and face-to-face. This knowledge and skills gap presents an important opportunity to incorporate feedback training into residencies to ensure that the dermatologists of the future are not only medically competent, but also competent in providing feedback to future generations

Subcutaneous panniculitis-like T-cell lymphoma responsive to combination therapy with methotrexate and corticosteroids

Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare condition that falls underneath the umbrella of primary cutaneous T-cell lymphomas (CTCLs). SPTCL can be very difficult to diagnose as it may mimic other subtypes of CTCL, such as γ/δ T-cell lymphoma (TCL), or other forms of panniculitis. Confirmation of diagnosis often requires immunohistochemical analysis and is essential for proper prognosis and therapeutic management. Herein, we present a case of SPTCL that mimicked lupus panniculitis and was successfully treated with prednisone taper and methotrexate

A virtual faculty exchange program enhances dermatology resident education in the COVID-19 era: a survey study

One of the many consequences of the COVID-19 pandemic was the cancelation of the 2020 American Academy of Dermatology Annual Meeting. This conference historically features lectures from world-renowned experts in all areas of dermatology, thus providing an important educational experience for dermatology residents. We hypothesized that the cancellation of this meeting produced a substantial educational loss for dermatology residents. To mitigate this impact, we developed a virtual faculty exchange program and surveyed dermatology residents' perspectives on its implementation. All participating residents found the virtual faculty exchange useful and would recommend it to other residents/programs. Moreover, all residents wanted to participate in more faculty exchange sessions as well as incorporate them throughout the academic year. Additionally, this educational program eliminated the potential cost of >$15,000 in flights and >24 metric tons of carbon emissions. This virtual faculty exchange program is a viable tool to enhance dermatology resident education in the COVID-19 era