Alam, Murad

Alvarez, Gabriella

Antonovich, Diana

Bar, Anna

Bolotin, Diana

Boucher, Alison

Cahn, Brian

Chow, Maggie L

Council, M Laurin

Dave, Loma

Deng, Min

Elsanadi, Rachel

Eshaq, Milad

Farah, Ronda S

Ghareeb, Erica

Greywal, Tanya

Hisham, Farhana Ikmal

Hooper, Deirdre

Hoss, Elika

Hu, Jenny C

Joo, Jayne

Kang, Bianca Y

Kelly, Kristen M

Kibbi, Nour

Kole, Lauren CS

Kourosh, A Shadi

Kuhn, Helena

Labadie, Jessica G

Lawrence, Naomi

Levin, Yakir S

Luke, Janiene

members of the AACD Regulatory, Education

Minkis, Kira

Nadir, Umer

Nawas, Zeena Y

Orringer, Jeffrey S

Ortiz, Arisa

Pearlstein, Michelle V

Petronic-Rosic, Vesna

Roberts, Jared E

Robinson, Carolyn A

Saikaly, Sami K

Schenck, Olivia L

Schlick, Cynthia A

Shah, Kalee

Shahabi, Ladan

Shi, Victoria J

Stratman, Erik J

Suggs, Amanda K

Suozzi, Kathleen C

Tolaymat, Leila

Vashi, Neelam A

Ward, Kimberley HM

Wyles, Saranya P

Yi, Michael D

Yoo, Simon S

eScholarship - University of California

UC IrvineUC Irvine Previously Published WorksTitleCosmetic Directors on ACGME Program Requirements: A Cross-Sectional SurveyPermalinkhttps://escholarship.org/uc/item/5fm4g6pvAuthorsMinkis, KiraStratman, Erik JShi, Victoria Jet al.Publication Date2024-03-01DOI10.1016/j.jaad.2024.01.085 Peer reviewedeScholarship.org Powered by the California Digital LibraryUniversity of CaliforniaJournal Pre-proofCosmetic Directors on ACGME Program Requirements: A Cross-Sectional SurveyKira Minkis, MD, PhD, Erik J. Stratman, MD, Victoria J. Shi, BA, Tanya Greywal, MD,Jenny C. Hu, MD, MPH, Kathleen C. Suozzi, MD, Sami K. Saikaly, MD, Arisa Ortiz,MD, Bianca Y. Kang, MD, Murad Alam, MD, MBA, MSCI, members of the AACDRegulatory, Resident Education, and Advocacy Working GroupPII: S0190-9622(24)00444-4DOI: https://doi.org/10.1016/j.jaad.2024.01.085Reference: YMJD 18442To appear in: Journal of the American Academy of DermatologyReceived Date: 28 June 2023Revised Date: 15 January 2024Accepted Date: 28 January 2024Please cite this article as: Minkis K, Stratman EJ, Shi VJ, Greywal T, Hu JC, Suozzi KC, SaikalySK, Ortiz A, Kang BY, Alam M, members of the AACD Regulatory, Resident Education, andAdvocacy Working Group, Cosmetic Directors on ACGME Program Requirements: A Cross-SectionalSurvey, Journal of the American Academy of Dermatology (2024), doi: https://doi.org/10.1016/j.jaad.2024.01.085.This is a PDF file of an article that has undergone enhancements after acceptance, such as the additionof a cover page and metadata, and formatting for readability, but it is not yet the definitive version ofrecord. This version will undergo additional copyediting, typesetting and review before it is publishedin its final form, but we are providing this version to give early visibility of the article. Please note that,during the production process, errors may be discovered which could affect the content, and all legaldisclaimers that apply to the journal pertain.© 2024 Published by Elsevier Inc. on behalf of the American Academy of Dermatology, Inc.1   Title: Cosmetic Directors on ACGME Program Requirements: A Cross-Sectional Survey 1 Article type: Research Letter 2 Authors: Kira Minkis MD, PhD1, Erik J. Stratman MD2, Victoria J. Shi BA3, Tanya Greywal MD4,  3 Jenny C. Hu MD, MPH5, Kathleen C. Suozzi MD6, Sami K. Saikaly MD7, Arisa Ortiz MD8, Bianca Y. 4 Kang MD3, Murad Alam MD, MBA, MSCI3,9, 10, 11, and members of the AACD Regulatory, Resident 5 Education, and Advocacy Working Group*.  6  7  8  9  10  11  12  13  14  15  16  17  18  19 Affiliations:  20 1Department of Dermatology, Weill Cornell/New York Presbyterian, New York, NY 21 2Department of Dermatology, Marshfield Clinic Health System, Marshfield, MI 22 3Department of Dermatology, Northwestern Feinberg School of Medicine, Chicago, IL 23 4Division of Dermatology, University of Washington, Seattle, WA 24 5Department of Dermatology, Keck School of Medicine of University of Southern California, Los Angeles, CA 25 6Department of Dermatology, Yale School of Medicine, New Haven, CT 26 7Department of Dermatology, University of Florida, Gainesville, FL 27 8Department of Dermatology, University of California San Diego, San Diego, CA 28 9Department of Surgery, Northwestern Feinberg School of Medicine, Chicago, IL 29 10Department of Otolaryngology, Northwestern Feinberg School of Medicine, Chicago, IL 30 11Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, Chicago, IL 31  32 Corresponding Author: 33 Murad Alam, MD 34 676 N Saint Clair 35 Suite 1600 36 Chicago Illinois 60611 37 m-alam@northwestern.edu 38  39 Funding sources: None. 40  41 Conflicts of Interest: None 42  43 IRB approval status: As this study only included interactions involving survey procedures and because 44 any disclosure of Human Subjects’ responses would not reasonably place the subjects at risk of criminal 45 AACD Regulatory, Resident Education, and Advocacy Working Group*:  A. Shadi Kourosh MD, MPH, Alison Boucher MD, Amanda K. Suggs MD, Anna Bar MD, Brian Cahn MD, Carolyn A. Robinson DO, Cynthia A. Schlick MD, Deirdre Hooper MD, Diana Antonovich MD, Diana Bolotin MD, PhD, Elika Hoss MD, Erica Ghareeb MD, Farhana Ikmal Hisham BS, Gabriella Alvarez MD, Helena Kuhn MD, Janiene Luke MD, Jared E. Roberts MD, Jayne Joo MD, Jeffrey S. Orringer MD, Jessica G. Labadie MD, Kalee Shah MD, Kimberley H.M. Ward MD, Kristen M. Kelly MD, Ladan Shahabi MD, Lauren C.S. Kole MD, Leila Tolaymat MD, Loma Dave BS, M. Laurin Council MD, Maggie L. Chow MD, PhD, Michael D. Yi BS, Michelle V. Pearlstein MD, Milad Eshaq MD, Min Deng MD, Naomi Lawrence MD, Neelam A. Vashi MD, Nour Kibbi MD, Olivia L. Schenck MD, Rachel Elsanadi BS, Ronda S. Farah MD, Saranya P. Wyles MD, PhD, Simon S. Yoo MD, Umer Nadir BS, Vesna Petronic-Rosic MD, MSc, MBA, Yakir S. Levin MD, PhD, and Zeena Y. Nawas MD. Journal Pre-proof2   or civil liability or be damaging to the subjects’ financial standing, employability, educational 46 advancement, or reputation, this study did not meet the criteria for human participant research and did not 47 require institutional review board approval or informed consent, in accordance with 45 CFR §46. 48  49 Reprint requests: Murad Alam 50  51 Manuscript word count:   500 52 References:     5 53 Figures:     1 54 Supplementary figures:    2; doi: 10.17632/6y3m8s8scc.3 55 Tables:     1 56 Supplementary tables:    2; doi: 10.17632/6y3m8s8scc.3 57  58 Attachments: CROSS checklist; survey instrument 59  60 Keywords: Cosmetic; Director; Accreditation; Council; Graduate; Medical; Education; ACGME; Program; 61 Requirement; Cross; Sectional; Survey; Association; Academic; Cosmetic; Dermatology; Residency; Training; 62 Neurotoxin; Filler; Laser  63 Journal Pre-prof3   To the editor: 64 The Accreditation Council for Graduate Medical Education (ACGME) defines specialty-specific Program 65 Requirements (PRs) for residencies and fellowships.1 PRs for cosmetic and laser procedures in 66 dermatology are in Supplemental Table 1.2 Unlike excisions and repairs, which residents must perform 67 50 times, cosmetic/laser procedure minimums can be met through observation alone.   68  69 Studies demonstrate that although over 90% of residents believe hands-on training in cosmetic procedures 70 should be required, 3,4 27% of program directors do not recommend such requirements.5 Since no studies 71 report the opinions of cosmetic directors, this study aims to describe these opinions.  72  73 This was a cross-sectional survey study of cosmetic and laser directors at ACGME-accredited US 74 dermatology residencies who were members of the Association of Academic Cosmetic Dermatology 75 (AACD). An electronic survey was developed and reviewed for accuracy by the AACD Regulatory, 76 Resident Education, and Advocacy Committees, which included experts in qualitative research and survey 77 design, as well as past members of the ACGME Dermatology Review Committee and the American 78 Board of Dermatology. Participants reported the degree of ease or difficulty for residents at their program 79 to observe versus perform each of the minimum totals pertaining to cosmetic dermatology (15 laser, 5 80 filler, and 10 botulinum toxin procedures) on a 5-point scale (1=“extremely difficult”, 5=“extremely 81 easy”). Participants were also asked to rate their agreement with a list of modified requirements (Table 1).   82  83 The primary outcome was the degree of difficulty for residents to meet minimum totals. Secondary 84 outcomes were differences in such difficulty across procedures (Kruskal-Wallis test (=0.05) with Dunn’s 85 tests for pairwise comparisons); and frequency of participants agreeing with potential modifications. 86 Statistical analyses used SPSS v29. 87  88 Journal Pre-prof4   Ninety-six of 113 (85%) completed the survey. Participants were cosmetic directors or co-directors at 71 89 dermatology residencies. Observing 15 laser (mean score 4.30), 5 filler (mean 4.39), and 10 botulinum 90 toxin procedures (mean 4.66), was generally extremely or somewhat easy (83%, 85%, and 93% 91 respectively). Completing hands-on training (Figure 1) in laser (mean 3.99), filler (mean 4.27), and toxin 92 procedures (mean 4.27), was also typically extremely or somewhat easy (75%, 68%, and 85% 93 respectively). A minority (<5%) reported extreme difficulty in meeting filler or laser performance 94 minimums. 95  96 There were differences (p<0.001) between ease of observation versus performance. Pairwise comparisons 97 found observing 10 toxin procedures was easier than performing these (mean score 4.66 vs. 4.27, 98 p=0.038), performing filler injections (4.66 vs. 4.27, p=0.038), or performing laser procedures (4.66 vs. 99 3.99, p=0.000; Supplemental Table 2).  100  101 Most cosmetic directors believed that the ACGME should require hands-on minimums for laser (54%), 102 filler (60%), and botulinum toxin procedures (59%; Table 1), and that observation alone was inadequate. 103 Respondents noted that hands-on training may provide residents with sufficient confidence to perform 104 these services after residency. Limitations include that this study queried only cosmetic dermatology 105 directors. 106  107 Changing dermatology residency requirements to include hands-on cosmetic training may better align 108 with the needs of residents and residency training programs in comparable specialties. ACGME 109 minimums for cosmetic procedures were established 20 years ago and may need to be updated to reflect 110 current practice.   111 Journal Pre-proof5   REFERENCES 112 1. About Us. Accreditation Council for Graduate Medical Education. Accessed February 2, 2023. 113 https://www.acgme.org/about-us/overview/ 114 2. 2021 Program Requirements for Graduate Medical Education in Dermatology. Accreditation 115 Council for Graduate Medical Education (ACGME). Editorial revision: Effective July 1, 2020. Published 116 July 1, 2020. Accessed October 22, 2021. https://www.acgme.org/Specialties/Dermatology/Program-117 Requirements-and-FAQs-and-Applications 118 3 Champlain A, Reserva J, Webb K, et al. Cosmetic Dermatology Training During Residency: 119 Outcomes of a Resident-Reported Survey. Dermatol Surg. 2018;44(9):1216-1219. 120 doi:10.1097/DSS.0000000000001557 121 4 Kirby JS, Adgerson CN, Anderson BE. A survey of dermatology resident education in cosmetic 122 procedures. J Am Acad Dermatol. 2013;68(2):e23-28. doi:10.1016/j.jaad.2011.05.010 123 5 Bauer B, Williams E, Stratman EJ. Cosmetic dermatologic surgical training in US dermatology 124 residency programs: identifying and overcoming barriers. JAMA Dermatol. 2014;150(2):125-129. 125 doi:10.1001/jamadermatol.2013.6713   126 Journal Pre-proof6   FIGURE LEGENDS 127 Figure 1. Perceived ease or difficulty of meeting current Accreditation Council for Graduate Medical 128 Education (ACGME) minimum totals in dermatology for laser (10 procedures required before 129 graduation), filler (5), and botulinum toxin (15) with observed experiences versus hands-on experiences. 130  131   132 Journal Pre-proof7   Table 1.  Opinions of cosmetic directors regarding ACGME requirements pertaining to cosmetic 133 procedures. Participants were asked to select all of the statements they felt reflected their opinion 134 regarding program requirements. 135  136 Statement Regarding ACGME Requirements Participants Agreeing with Statement (N=96) Current ACGME requirements are adequate, and I would prefer these remain the same and not change.   28 (29%)  ACGME requirements should change to be silent on total minimum totals for graduates.   4 (4%)  ACGME requirements should change to include more hands-on cosmetic procedure requirements for graduates.   49 (50%)  Current ACGME requirements are difficult to achieve, and I would prefer minimums totals for laser procedures be eliminated.   1 (1%)  Current ACGME requirements are difficult to achieve, and I would prefer minimums totals for soft tissue augmentation / skin filler procedures be eliminated.   1 (1%)  Current ACGME requirements are difficult to achieve, and I would prefer minimums totals for botulinum toxin procedures be eliminated.   2 (2%)  ACGME requirements should require hands-on minimums for laser procedures; observation alone should not be adequate.   53 (54%)  ACGME requirements should require hands-on minimums for soft tissue augmentation procedures; observation alone should not be adequate.   59 (60%)  ACGME requirements should require hands-on minimums for botulinum toxin; observation alone should not be adequate.   58 (59%)  Different programs have different cosmetic populations and procedural strengths, so programs should be able to calculate cosmetic experience totals from a group of cosmetic procedures rather than from each individual procedure type.   25 (26%)  Dermatology residency programs should be required to designate a faculty member as director of cosmetic dermatology, like they do for dermatologic surgery and dermatopathology.   34 (35%)  137 Jonal Pe-proofJournal Pre-proof

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Cosmetic Directors on ACGME Program Requirements: A Cross-Sectional Survey

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