Direct to Patient Synchronous Teledermatology During COVID-19 Pandemic.

Background: During the COVID-19 pandemic, teledermatology became a popular mode of health care delivery. Thus, deciphering which diagnoses are best suited for synchronous video visits is important to guide providers on appropriate patient care. Methods: We conducted a retrospective study of 1,647 submitted synchronous video visits from September 1, 2020 to March 31, 2021 at a single, large academic institution. Results: Video visits' follow-up rate was significantly associated with diagnosis subtype (p < 0.001). Compared with patients with skin lesions and nonskin dermatologic conditions, patients with a rash had higher odds of being recommended to have their follow-up visit as a video visit (odds ratio [OR] = 0.222, p < 0.001; OR = 0.296, p < 0.001). Patients with a rash had lower odds of being recommended to have their follow-up visit as an in-person office visit when compared with skin lesions (OR = 9.679, p < 0.001), nonskin dermatologic conditions (OR = 4.055, p < 0.001), and other skin dermatologic conditions (OR = 2.23, p < 0.01). Demographically, employed, middle-aged patients with private insurance made up the majority of video visit usage. African American patients were less likely to utilize a video visit compared with Asian patients (OR = 2.06, p < 0.038). Conclusions: Certain dermatologic diagnoses, most notably rashes, are more conducive to video visit management. Rashes made up 86% of new patient video visits, were more likely to have video visit follow-up if needed and were more likely to not require further follow-up indicating that the management of rashes from initial diagnosis to completion in care is suitable for video visit management.

Efficacy of an Introductory Nail Disorder Learning Module to Supplement the Medical School Curriculum: Experience from One United States Medical School.

Introduction: Dermatologic and systemic conditions affecting nails are common, but nail pathology education in medical school curricula is limited. We created and evaluated the efficacy of a case-based module on nail pathologies in a medical student cohort from one well-respected US medical school. Methods: We developed a module consisting of five cases: melanonychia, onychomycosis, nail psoriasis, Beau's lines/onychomadesis, and apparent leukonychia. Participants completed a pre-module questionnaire prior to completing the module and another questionnaire directly following completion. Results: Sixty-two clinical medical students completed the pre-module questionnaire, the module, and the post-module questionnaire. 59.68% of participants reported they had evaluated 1-5 patients with nail findings. However, 43.55% of study participants denied receiving any lectures on nail pathologies in their medical education. On average, the module took 13.73 min to complete. Student-reported confidence in both identifying and treating common nail disorders significantly increased from to pre- to post-module responses for both identification (p < 0.001) and treatment (p < 0.001) of common nail pathologies. Discussion/Conclusion: Nail findings are prevalent in all medical specialties, and improved medical student education on nail pathologies is necessary. Our introductory, case-based module on pathologies is an effective way to improve student confidence in identifying and treating nail disorders.

A Framework and Recommendations to Recruit and Engage Faculty Facilitators for Large-Scale IPE Events.

AIMS: As integration of interprofessional education (IPE) events gains traction in health sciences, there is an increased need to recruit and train faculty to facilitate student groups from multiple health care disciplines. This report describes a framework used to effectively recruit and prepare faculty as facilitators for a large-scale, one-time IPE event. We detail recruitment strategies, training tools, facilitators' perceptions about the training, and recommendations for future training. PROCEDURES: Faculty were recruited via email to facilitate an IPE student group of 8-10 learners for an in-person, one-time event. Before the event, faculty facilitators received a Welcome Video and Guidebook providing a description of their role, best practices of facilitation, and scripts. On the event day, facilitators engaged in a face-to-face session to familiarize themselves with the Guidebook and best practices. After the event, facilitators received an email to thank them and invite their participation in a survey regarding perceptions of the training. Data were collected on 2018 and 2019 facilitators. Descriptive statistics were calculated for Likert scales or agreement survey items, and thematic analysis was completed for open-ended questions. RESULTS: Over two offerings of the event, 235 faculty facilitators across 10 academic units participated in 2018 and 2019. Most facilitators felt prepared (92.5% average across 2018 and 2019), the Guidebook was helpful (91%), and an increased interest in IPE (78.5%). Written responses indicated engaging diverse students as the main challenge. Fifty-three percent of facilitators in 2019 were newly recruited. CONCLUSIONS: This work demonstrates an effective training program with a hybrid self-directed and in-person approach that adequately prepares faculty to facilitate IPE discussions. Inclusion of academic unit leaders for recruiting and acknowledging faculty facilitation may add value to the IPE event.

Non-infectious environmental antigens as a trigger for the initiation of an autoimmune skin disease.

Pemphigus represents a group of organ specific autoimmune blistering disorders of the skin mediated by pathogenic autoantibodies with well-defined antigenic targets. While most of these diseases are sporadic, endemic forms of disease do exist. The endemic form of pemphigus foliaceus (also known as fogo selvagem, FS) exhibits epidemiological features that suggest exposure to hematophagous insect bites are a possible precipitating factor of this autoimmune disease, and provides a unique opportunity to study how environmental factors contribute to autoimmune disease development. FS patients and healthy individuals from endemic regions show an autoreactive IgM response that starts in early childhood and becomes restricted to IgG4 autoantibodies in FS patients. In searching for triggering environmental antigens, we have found that IgG4 and IgE autoantibodies from FS patients cross-react with a salivary antigen from sand flies. The presence of these cross-reactive antibodies and antibody genetic analysis confirming that these antibodies evolve from the same naïve B cells provides compelling evidence that this non-infectious environmental antigen could be the initial target of the autoantibody response in FS. Consequently, FS serves as an ideal model to study the impact of environmental antigens in the development of autoimmune disease.