Dermatology residents as educators: a qualitative study of identity formation.

BACKGROUND: One of the many identities a physician comes to form during their career is their identity as an educator. Exploring formation of this identity may enrich our understanding of how physicians make decisions related to their roles as educators, their behaviors, and how this ultimately influences the educational environment. It is the aim of this study to investigate educator identity formation of dermatology residents while early in their careers. METHODS: Drawing on a social constructionist paradigm, we conducted a qualitative study, utilizing an interpretative approach. We examined longitudinal data over a 12-month period using dermatology residents' written reflections from their professional portfolios and semi-structured interviews. We collected this data as we progressed through and beyond a 4-month professional development program designed to encourage residents' growth as educators. Sixty residents in their second, third, or final year of residency programs located in Riyadh, Saudi Arabia were invited to take part in this study. Twenty residents participated with sixty written reflections and 20 semi-structured interviews. Qualitative data were analyzed using a thematic analysis approach. RESULTS: Sixty written reflections and 20 semi-structured interviews were analyzed. Data was categorized according to themes corresponding to the original research questions. For the first research question regarding identity formation, themes included definitions of education, the process of education, and identity development. For the second research question, 1 theme entitled professional development program included, the following sub-themes: individual act, interpersonal activity, and an organizational undertaking, with many believing that residency programs should prepare residents for their educator roles. Participants also described newfound leadership ambitions of creating new dermatology fellowship programs as a result of taking part in the Resident-as-Educator program. CONCLUSIONS: Our study provides insights on the dynamic formation of educator identities amongst dermatology residents. Investment in developing residents as educators through professional development programs may instigate transformational change on the individual physician level and profession's level.

Importance of the reflective logbook in improving the residents' perception of reflective learning in the dermatology residency program in Saudi Arabia: findings from a cross-sectional study.

BACKGROUND: Reflection is an essential feature of the learning process in all medical education and training fields. While writing the logbooks has been considered to improve learners' reflection in several disciplines, it is unknown whether writing reflective logbooks improves the learning perception of dermatology residents. Therefore, this study was carried out to assess the role of the reflective logbook in improving the residents' perception of reflective learning in the dermatology residency program. METHODS: This cross-sectional study was conducted on 32 dermatology residents from year two (R2) to year four (R4) enrolled in different hospitals in Riyadh, Saudi Arabia. A baseline electronic survey was emailed to all residents before and after implementing the reflective logbook for six months. The survey included 28 close-ended questions assessing their point of view on a Likert scale, and responses varied from agreeing to disagreeing strongly. Frequencies and proportions were generated for the categorical variables such as sex and level of residency. The graphs were generated to assess the proportion of residents correctly responding to the knowledge questions. The data were analyzed using SPSS version 23. RESULTS: Almost 80% of dermatology residents considered reflection as an important element of their learning, and 47% of the residents agreed that a reflective log book increases understanding in medical education. About 44% of the residents agreed that the reflective logbook assisted in their learning, and about 19% strongly agreed on the same. However, only 37.5% agreed that logbooks helped them acquire theoretical knowledge, and 9.4% and 18.8% agreed that they helped them acquire practical and research skills, respectively. Almost 68% of the residents had support in writing the logbook, and 34.4% agreed that logbooks helped them address their patient's needs and enhance their diagnostic skills. CONCLUSION: The study findings revealed that dermatology residents perceived reflection and writing a reflective logbook as important and potentially beneficial. However, knowing the importance of reflection and what reflection means was not optimal. Not all dermatology residents were aware of the reflection and reflective logbooks as tools for reflective learning. Thereby warranting regular workshops or fostering continuous medical education on the importance of reflection.

Incidence, Risk Factors, and Prognosis of Hidradenitis Suppurativa Across the Globe: Insights from the Literature.

Hidradenitis suppurativa, a chronic inflammatory disease of the skin, affects a patient's quality of life to a greater extent. While the disease burden, including its incidence and prevalence, has been extensively studied in the western population, there is a paucity of data from developing countries on the epidemiology of Hidradenitis suppurativa. Therefore, a general literature review was conducted to shed light on the epidemiology of Hidradenitis suppurativa across the globe. We reviewed the most recently available information on epidemiology, including incidence, prevalence, risk factors, prognosis and quality of life, complications, and associated comorbid among patients with Hidradenitis suppurativa. The estimated global prevalence of Hidradenitis suppurativa is found to be 0.00033-4.1%, with a relatively higher prevalence of 0.7-1.2% in European and US populations. Both genetic and environmental factors are associated with Hidradenitis suppurativa. Patients with Hidradenitis suppurativa have associated comorbid such as cardiovascular disease, type II diabetes mellitus, mental health issues, and sleep and sexual dysfunctions. These patients spend poor quality of life and tend to be less productive. Future studies are needed to assess the burden of Hidradenitis suppurativa in developing countries. Since the disease tends to be underdiagnosed, future studies should rely on clinical diagnosis rather than self-reporting to avoid the potential of recall bias. Attention needs to be diverted to developing countries with less amount of data on Hidradenitis suppurativa.

Jacquet erosive diaper dermatitis in a child with COVID-19.

Since the start of the COVID-19 pandemic, several reports around the world indicated that the novel coronavirus could be associated with specific dermatologic manifestations. Among earlier articles, encountered features included erythematous maculopapular exanthems, chilblains-like acral skin lesions, vesicular, and urticarial rashes. We describe the first case of Jacquet erosive diaper dermatitis in a 17-month-old girl with a confirmed COVID-19 infection. This article may serve to expand the knowledge of the diverse clinical features of COVID-19 infection, particularly among the pediatric population.

Metastatic Crohn's Disease in External Genitalia With Good Outcome on Adalimumab: A Rare Case of a Saudi Female and a Short Review.

Crohn's disease (CD), an inflammatory bowel disease that involves the gastrointestinal tract, is observed in daily hospital practice. On the other hand, metastatic Crohn's disease (MCD) is a rare entity in which cutaneous lesions are found in regions apart from the digestive system. This article describes a rare case of cutaneous CD in a Saudi female, which manifested initially as vulvar and perianal skin lesions. The diagnosis was proven by skin biopsy, and adalimumab offered effective treatment. Although cutaneous MCD is rare, it is an important cutaneous manifestation, as early detection creates the possibility of accessing effective management.

Topical Corticosteroid-Induced Adrenal Insufficiency: A Case Report.

Topical Corticosteroids (TCS) are the most commonly prescribed medications in Dermatology practice. They are considered safe and effective if used at the appropriate location and for the appropriate duration. Local side effects due to TCS are not uncommon. However, systemic side effects are rare. Herein, we present a patient who developed adrenal insufficiency secondary to the use of TCS.

Conversion Rate of Tuberculosis Screening Tests among Dermatology Patients Treated with Tumor Necrosis Factor Inhibitors.

Background: The use of tumor necrosis factor-α inhibitors (TNFi) has been associated with an increased risk latent tuberculosis (TB) reactivation. The role of TB screening assays in monitoring patients during TNFi therapy remains uncertain. Spontaneous conversions and reversions have been described. Aims: This study aims to determine the conversion and reversion rate of TB screening tests among dermatology patients receiving TNFi in a country with moderate TB incidence. Subjects and Methods: A retrospective single-center study conducted on all patients in whom treatment with TNFi was initiated in our dermatology clinic in a tertiary university hospital, Riyadh, Saudi Arabia, until September 2018. Data were collected from the hospital electronic patient information system. Results: One hundred and eighteen patients were included. Majority (79.9%) of patients used adalimumab. Psoriasis was the most common indication (90%). Among patients with negative baseline TB screening who had been retested during TNFi therapy (n = 65; 55%), conversion to positive was observed in nine patients (13.8%) with a mean duration of exposure of 39.7 months, whereas among patients with positive TB testing result (n = 18), 10 (55.5%) reverted to negative. Conclusions: This study emphasizes the need for prospective large-scale multispecialty studies assessing the significance of TB retesting, which should be considered when designing rescreening protocols.

Quality of life assessment among patients suffering from different dermatological diseases.

OBJECTIVES: To assess the quality of life (QoL) of patients with different dermatological diseases. Multiple international studies have evaluated the QoL among patients with different dermatological diseases; however, few studies of this kind have been conducted in Saudi Arabia. METHODS: This quantitative, observational, cross-sectional study was carried out in the dermatology outpatient clinics of King Saud University Medical City, Riyadh, Saudi Arabia, from September 2019 until February 2020. Data was collected using the validated Arabic version of the Dermatology of Life Quality Index (DLQI). RESULTS: A total of 391 patients ≥18 years participated in the study. The mean age of participants was 33 years (18-75 years). Most participants in this study reported that their dermatological disease had a small or no effect on their QoL (62.5%). The majority of patients who had acne vulgaris (79.7%), vitiligo (79.3%), hair disorders (76.9%), or rosacea (71.5%) reported a small to no effects on their QoL. However, diseases that reflected the largest percentages of a large to extremely large effect on QoL were urticaria (37.1%), eczema (26.6%), and psoriasis (24%). A total of 42.9% of the participants suffered from lichen planus and 66.7% of participants suffered from cutaneous neoplasms reported a moderate effect on their QoL. CONCLUSION: Understanding the impact of different dermatological diseases on QoL can help dermatologists to improve thier patients' QoL. Therefore, we recommend that further studies on this topic be conducted in multiple health centers.

Publications pattern of dermatology research in Saudi Arabia.

OBJECTIVES: To analyze the quantity and characteristics of Saudi Arabia's (SA's) dermatology research publications throughout the years. Methods: A literature search was conducted between October 2018 and July 2019 in the Dermatology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia. PubMed was used as a search engine, to retrieve dermatology-related publications in SA - from the date of the first article publication in 1982 to December 31, 2018. Results: Five hundred publications were included. Two-thirds of them were written between 2010 and 2018. Approximately 50% were from the central region and only 3% were multiregional studies. Funding support was described in 13% of these publications. The top 5 most-researched fields were infectious disorders (12%), genodermatosis (10%), hypopigmentation disorders (9.4%), neoplastic disorders (9%), and hair disorders (7%). Two-thirds of the publications were observational studies, and mostly case reports (44%). Conclusion: Dermatology research in SA has increased over the past decade. However, the quality of research remains inadequate. Saudi Arabia's dermatology research output is affected b   y the availability of funding and national research projects, which could improve the studies' quality. We recommend the establishment of data registry units that can aid researchers in producing high-quality studies, while encouraging the collaboration of different centers in various SA regions (and abroad) to conduct research with generalizable results.

An unusual association of recurrent pyogenic granuloma on nevus flammeus in a patient with Von Recklinghausen's disease.

Pyogenic granuloma is a common benign vascular lesion of the skin and mucosa. There are a few reports on the rare association between it and port wine stain, but there is no clear description of an association with neurofibromatosis type 1 in the literature. This report presents a 29-year-old Saudi male with Von Recklinghausen's disease with recurrent pyogenic granuloma on the nevus flammeus over his neck. He was treated with shave excision and electrocautery with clearance and no recurrence of pyogenic granuloma for the last 5 years follow-up.