The Eye with Ears – A Symbol-Based Aid in Medical Teaching

Visual clinical examination forms the diagnostic basis in skin-related conditions and is an essential element in medical teaching. The author describes a symbol-based aid to explain the dichotomy of factual observed findings with the information based on medical history: The Eye with Ears. It represents the two most relevant aspects in clinical examination of skinrelated conditions and helps to clarify the contrast between the actual observation with information based on the context or past medical history. With the described aid, the author believes to have improved the quality of the teaching clinical examination and that it has functioned as a practical help for medical students’ and residents’ professional development.Peer reviewe

Critical evaluation of the undergraduate curriculum - are we asking the right questions?

The curricular content in medical education needs continuous development and therefore must regularly undergo a critical evaluation. Here, the author describes an implemented shift in the teaching substance of an undergraduate dermatology course aimed to focus on relevance and practicability for general practitioners. The changes were based on a comprehensive nationwide database analysis of the spectrum of skin‐related conditions seen in primary care.Peer reviewe

The Microbiome - New Insights Into the Skin's Own Ecosystem

Peer reviewe

Perceptual learning modules in undergraduate dermatology teaching

Background Dermatological diagnosis depends highly on visual skills, and implicit nonanalytical proficiency plays a key role. To correctly diagnose skin diseases, the clinician needs visual skills, and intuitive recognition plays a key role. Aim To investigate the effectiveness of digital perceptual learning modules (PLMs) in undergraduate teaching, and how these affect medical students' learning about skin diseases. Methods This was a study performed in Finland, which enrolled 39 students of an undergraduate dermatology course. Online PLMs designed for dermatology, using different pictures of skin diseases were performed three times: before, during and at the end of the course. The modules provided four outcome measures: diagnostic accuracy (percentage of correct responses), a rating of confidence about the decision, fluency (response/decision time) and a list of features on which the decision was based. Results As the number of PLMs and the course duration increased, there were also improvements in the four measures, with a significant increase in diagnostic accuracy [from 66% to 94%; P < 0.001; partial eta(2) (eta(2)(p)) = 0.92], fluency (as measured by a decrease in response time (from 10 to 6 s; P < 0 0.001; eta(2)(p) = 0.69) and self-perceived confidence (2.5 to 4.3; P < 0 0.001, eta(2)(p) = 0.86) with subsequent PLMs and course duration. There was a diversification of recognized features, an increase in pattern recognition, and better attention to localization and contextual association. Based on student feedback, the PLMs functioned well online, and enhanced motivation and learning. Conclusion PLMs increased diagnostic accuracy, had a positive effect on learning outcomes and were easily integrated alongside clinical teaching. Considering the current era of digital technologies, we believe that there is potential for wider use of PLMs to improve visual skills and strengthen implicit learning in dermatology.Peer reviewe

Angioedeema

Ajankohtaista lääkärin käsikirjasta. Artikkelin täydellinen versio on luettavissa Lääkärin tieto¬kannoista. Terveysportista: www.terveysportti.f

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English summar

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https://www.lukusali.fi/index.html?p=66cc6bf8-04ff-11e5-b3ce-00155d64030

Keratosis pilaris and filaggrin loss-of-function mutations in patients with atopic dermatitis - Results of a Finnish cross-sectional study

Keratosis pilaris (KP) associates with epidermal barrier defects in atopic dermatitis (AD) but its role in disease severity and concomitant atopic diseases seems to vary between populations. We performed a cross-sectional observational study with 502 randomly selected AD patients of a Finnish tertiary health care center. At a single clinical examination, disease severity (Rajka Langeland severity score and EASI), clinical signs and patient history were evaluated and total IgE levels and frequent filaggrin (FLG) loss-of-function mutations were investigated. There was no link with disease severity (p = 0.649, 95% CI 0.569-0.654), asthma (p = 0.230, 95% CI 0.206-0.281) or atopic sensitization (p = 0.351, 95% CI 0.309-0.392). Keratosis pilaris was significantly associated with palmar hyperlinearity (p < 0.000, 95% CI 0.000-0.006, OR 4.664, 95% CI 2.072-10.496) and the filaggrin loss-of-function mutation 2282del4 (p < 0.000, 95% CI 0.000-0.009, OR 4.917, 95%CI 1.961-12.330). The prevalence of KP in the cohort was generally low and KP seems to be infrequent in Finnish AD patients. This may be explained by the fact that the tested FLG loss-of-function mutations are rarer in the Finnish population compared for example, with central Europe or Asia. Mutations in other locations of the FLG gene or other genes of the epidermal barrier may play a more important role.Peer reviewe

The spectrum of skin‐related conditions in primary care during 2015–2019–A Finnish nationwide database study

Background: Skin‐related conditions are the frequent cause of doctors’ consultations in primary care. Methods: Based on nationwide data bank information of the Finnish Institute for Health and Welfare, we analysed the 20 most frequent main diagnoses for each ICD‐10 category of all general practitioners’ visits in the public health care in Finland over the years 2015–2019. Results: The total amount of doctor’s visits was 19 204 613 of which 1 489 228 consultations (7.80%) had a skin‐related condition as the main diagnosis. The most frequent skin‐related conditions were eczematous eruptions, bacterial skin infections and benign skin neoplasms accounting for 749 351 consultations (50.32%). The spectrum of skin‐related conditions was diverse, with a large quantity of rarer diagnoses. Some diagnoses showed significant proportional changes. Conclusions: The results demonstrate that a limited amount of conditions comprises most of the skin‐related consultations in primary care in Finland. Undergraduate education in dermatology should concentrate on the most frequent conditions seen by general practitioners, but also address the wide range of skin problems.Peer reviewe