Asunto(s)
Cirugía de Mohs , Neoplasias Cutáneas , Humanos , Neoplasias Cutáneas/cirugía , Neoplasias Cutáneas/prevención & control , Cirugía de Mohs/educación , Cirujanos/educación , Luz Solar/efectos adversos , Conocimientos, Actitudes y Práctica en Salud , Encuestas y Cuestionarios/estadística & datos numéricos , Protectores Solares/administración & dosificación , Quemadura Solar/prevención & controlRESUMEN
BACKGROUND: Tissue preservation and tumor clearance are hallmarks of Mohs micrographic surgery, but no standardized method currently exists to guide trainees on how to balance the two. OBJECTIVE: The authors provided residents and fellows with additional histologic information to enhance their surgical decision-making without changing the standard methodology of Mohs surgery. METHODS AND MATERIALS: Trainees were provided initial biopsy slides (IS) and frozen vertical sections (VS) of the first Mohs layer. All Mohs layers were excised in standard fashion, and vertically oriented sections were taken from the layer without disturbing the surgical margins to obtain VS. Surveys were used to assess trainees' confidence in performing Mohs surgery with and without these tools. RESULTS: Trainees reported increased confidence in performing Mohs surgery when they reviewed IS before surgery and viewed VS of the first layer. CONCLUSION: Reviewing IS and VS improved trainees' confidence in performing Mohs surgery. This additional histological information was obtained while maintaining the usual steps of Mohs surgery. Objective information obtained from IS and VS may explain why trainees' confidence increased using this technique. Both IS and VS can be valuable teaching tools that may enhance trainees' ability to perform Mohs surgery.
Asunto(s)
Competencia Clínica , Internado y Residencia , Cirugía de Mohs , Neoplasias Cutáneas , Cirugía de Mohs/educación , Humanos , Biopsia , Neoplasias Cutáneas/cirugía , Neoplasias Cutáneas/patología , Secciones por CongelaciónRESUMEN
BACKGROUND: According to the curriculum guidelines of the Accreditation Council of Graduate Medical Education and the American Board of Dermatology, Mohs micrographic surgery & dermatologic oncology (MSDO) fellows must demonstrate competency in the use of oral skin cancer chemoprophylaxis. The current level of education in this area is unknown. OBJECTIVE: To characterize oral skin cancer chemoprophylaxis education for acitretin and nicotinamide among current MSDO fellows and to compare the clinical indications felt most appropriate for prescribing to a previously published expert consensus. METHODS: An electronic survey was distributed to all active MSDO fellows by the American College of Mohs Surgery. RESULTS: Responses were received from 63 (69.2%) MSDO fellows. Twenty (31.7%) and 37 (58.7%) fellows reported receiving fellowship training on acitretin and nicotinamide, respectively. Fifty-seven (90.5%) intend to prescribe chemoprophylaxis after training. Sixteen (28.1%) and 43 (75.4%) report feeling very comfortable prescribing acitretin and nicotinamide, respectively. Fellow concordance with a previously published expert consensus opinion on appropriate prescribing indications is variable. Forty-one (65.1%) indicated that additional education would increase the likelihood to prescribe after training. CONCLUSION: Although most MSDO fellows intend to prescribe oral skin cancer chemoprophylaxis, a standardized curriculum may promote increased use and concordance with expert consensus recommendations.
Asunto(s)
Neoplasias de la Boca , Neoplasias Cutáneas , Humanos , Estados Unidos , Cirugía de Mohs/educación , Estudios Transversales , Acitretina/uso terapéutico , Neoplasias Cutáneas/prevención & control , Neoplasias Cutáneas/cirugía , Curriculum , Escolaridad , Educación de Postgrado en Medicina , Niacinamida , Becas , Encuestas y CuestionariosRESUMEN
The characteristics and medical conditions of patients being managed by Mohs micrographic surgeons (MMS) have not been extensively established. In this cross-sectional review of 2017 Medicare Public Use data, we compared patient demographics and medical comorbidities among dermatologists billing for MMS based on surgeon fellowship training and practice settings. Overall patient complexity, as measured through Medicare's Hierarchical Condition Category (HCC) score, did not significantly differ by fellowship training status. However, among fellowship-trained surgeons, those in academic centers managed a higher proportion of dual Medicare-Medicaid beneficiaries (9.4% versus 5.4%, P<0.0001) with higher mean HCC scores (1.33 versus 1.13, P<0.0001). Depression and chronic kidney disease were notably more common among academic beneficiaries. These findings help to establish the patient complexity distribution among dermatologic surgeons, which may have important implications for perioperative management and monitoring given the growing prevalence of skin cancer and other medical comorbidities.
Asunto(s)
Dermatología/educación , Becas , Cirugía de Mohs/educación , Neoplasias Cutáneas/cirugía , Cirujanos/educación , Centros Médicos Académicos , Anciano , Comorbilidad , Estudios Transversales , Educación de Postgrado en Medicina , Femenino , Humanos , Masculino , Medicare , Neoplasias Cutáneas/complicaciones , Estados UnidosRESUMEN
BACKGROUND: Traditional letters of recommendation used for postgraduate medical training applications have multiple limitations, including a lack of clarity, inflated and overly flattering assessments, and low reliability between interpreting faculty. A micrographic surgery and dermatologic oncology (MSDO) standardized letter of recommendation (SLOR) was created to improve the efficiency, validity, and stratification of applicants to dermatology fellowship training programs. OBJECTIVE: To analyze the MSDO SLOR for trends in grading based on letter-writer and applicant characteristics and to evaluate its ability to demonstrate differences between applicants. METHODS: Standardized letter of recommendations received by 4 fellowship programs from the 2019 San Francisco Match application cycle were reviewed retrospectively. RESULTS: Two hundred forty-nine SLORs were analyzed from 140 applicants. Grade inflation and limited variability in scores were evident. Higher scores correlated with the length of the relationships between letter-writers and applicants and with female letter-writer gender. There was no applicant gender or ethnicity bias detected. CONCLUSION: Despite score inflation, the MSDO SLOR allows for differentiation between fellowship applicants. Future studies are needed to further evaluate the reliability of the SLOR and find ways to improve its content.
Asunto(s)
Correspondencia como Asunto , Dermatología/educación , Oncología Médica/educación , Cirugía de Mohs/educación , Selección de Personal/normas , Competencia Clínica , Becas , Femenino , Humanos , Internado y Residencia , Masculino , Estudios RetrospectivosAsunto(s)
Melanoma/cirugía , Cirugía de Mohs/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Neoplasias Cutáneas/cirugía , Adulto , Estudios Transversales , Becas/estadística & datos numéricos , Femenino , Secciones por Congelación , Humanos , Inmunohistoquímica , Masculino , Melanoma/patología , Persona de Mediana Edad , Cirugía de Mohs/educación , Neoplasias Cutáneas/patología , Coloración y Etiquetado , Encuestas y Cuestionarios , Estados UnidosAsunto(s)
Dermatólogos/estadística & datos numéricos , Melanoma/cirugía , Cirugía de Mohs/estadística & datos numéricos , Neoplasias Cutáneas/cirugía , Cirujanos/estadística & datos numéricos , Dermatólogos/educación , Humanos , Internado y Residencia , Melanoma/diagnóstico , Melanoma/patología , Cirugía de Mohs/educación , Estadificación de Neoplasias , Pautas de la Práctica en Medicina/estadística & datos numéricos , Piel/patología , Neoplasias Cutáneas/diagnóstico , Cirujanos/educaciónAsunto(s)
Cirugía de Mohs/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Grabación en Video/estadística & datos numéricos , Congresos como Asunto , Femenino , Humanos , Práctica Institucional/estadística & datos numéricos , Masculino , Cirugía de Mohs/educación , Práctica Privada/estadística & datos numéricos , Procedimientos de Cirugía Plástica , Factores Sexuales , Colgajos Quirúrgicos , Encuestas y Cuestionarios , Enseñanza , Factores de Tiempo , Estados Unidos , Técnicas de Cierre de HeridasAsunto(s)
Lateralidad Funcional , Internado y Residencia/estadística & datos numéricos , Cirugía de Mohs/métodos , Cirujanos/estadística & datos numéricos , Humanos , Cirugía de Mohs/educación , Cirugía de Mohs/estadística & datos numéricos , Cirujanos/educación , Encuestas y Cuestionarios/estadística & datos numéricos , Estados UnidosAsunto(s)
Biografías como Asunto , Becas/estadística & datos numéricos , Internado y Residencia/estadística & datos numéricos , Cirugía de Mohs/estadística & datos numéricos , Rol del Médico , Humanos , Cirugía de Mohs/educación , Folletos , Grupo de Atención al Paciente , Educación del Paciente como Asunto , Relaciones Médico-PacienteAsunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Cirugía de Mohs/estadística & datos numéricos , Neoplasias Cutáneas/cirugía , United States Department of Veterans Affairs/estadística & datos numéricos , Veteranos/estadística & datos numéricos , California , Estudios Transversales , Accesibilidad a los Servicios de Salud/organización & administración , Humanos , Cirugía de Mohs/educación , Calidad de la Atención de Salud , Piel/patología , Neoplasias Cutáneas/patología , Estados Unidos , United States Department of Veterans Affairs/organización & administraciónAsunto(s)
Recursos Audiovisuales , Dermatología/educación , Internado y Residencia/métodos , Cirugía de Mohs/educación , Grabación en Video , Competencia Clínica/estadística & datos numéricos , Estudios de Cohortes , Dermatólogos/educación , Dermatólogos/psicología , Dermatólogos/estadística & datos numéricos , Dermatología/estadística & datos numéricos , Humanos , Internado y Residencia/estadística & datos numéricos , Cirugía de Mohs/estadística & datos numéricos , Autoimagen , Encuestas y Cuestionarios/estadística & datos numéricosRESUMEN
BACKGROUND: The American Society for Dermatologic Surgery (ASDS) International Traveling Mentorship Program (ITMP) has initiated an International Mohs Fellowship Recognition Program, with 3 centers accredited to date. OBJECTIVE: To describe and compare the outcomes of Mohs micrographic surgery (MMS) at the three units. METHODS: From patient files, we extracted demographic information, as well as tumor type, location of tumor, tumor histology, stages of MMS, and outcomes. RESULTS: At the 3 units, 3,899 patients were treated with MMS over a 5-year period in the South African unit, and 1,141 cases in the Romanian unit. Over a 3-year period, 849 cases were treated in the Netherlands unit. Basal cell carcinomas (BCCs) constituted 78.9% (South African unit), 79% (Romanian unit), and 97.2% (Netherlands unit), and squamous cell carcinomas (SCCs) 17.7% (South African unit), 19% (Romanian unit), and 0.7% (Netherlands unit) of the tumors treated. The recurrence rate following MMS was low, at 0.1% (South African Unit) and 0.17% (Romanian Unit) of cases at the end of the study period, with a median follow-up time of 2 years. CONCLUSION: Mohs micrographic surgery is an effective treatment modality for removing BCC and SCC at ASDS ITMP-recognized International Mohs Fellowship units.