Preordering Periodic Acid-Schiff Staining: A Quality Improvement Study.

ABSTRACT: Periodic acid-Schiff (PAS) stain is a commonly used ancillary test for inflammatory and infectious dermatoses, yet infrequently changes the diagnosis. Previous studies have shown that clinical suspicion and histopathologic features are poor predictors of PAS positivity. Current appropriate use criteria from the American Society of Dermatopathology supports PAS staining when histopathologic features could be consistent with a dermatophyte infection. At the authors' institution, PAS stains are preordered on biopsies of inflammatory and infectious diagnoses to aid in a timelier sign out. Our aim was to reduce the percentage of PAS stains preordered on all dermatology specimens over a 6-month period without reducing the percentage of fungal infections identified. Review of a 12-month preintervention period found that our laboratory received 6104 biopsies for which PAS stain was preordered on 616 (10.1%). Based on a review of the preintervention period, preordering PAS on cases with clinical suspicion for cutaneous T-cell lymphoma was stopped unless there was clinical suspicion for eczematous dermatitis, vesiculobullous disorders, or fungal infection. The proposed intervention resulted in a 3.7% reduction in the number of PAS stains ordered while PAS-positivity rate remained unchanged. The described quality improvement process may be used as a model for other laboratories.

Structured Case-Based Ethics Discussion for Trainees and Faculty on Dermatopathology.

Introduction: Ethical and professional dilemmas are part of the day-to-day practice of medicine, including within dermatopathology (e.g., ethical implications of self-referring skin biopsies for pathology interpretation). There is a need for teaching aids that dermatology educators can easily access to help provide ethics education. Methods: We held an hour-long, faculty-facilitated, interactive, virtual discussion about ethical issues in dermatopathology. The session followed a structured, case-based format. We administered anonymous online feedback surveys after the session and used the Wilcoxon signed rank test to compare participants' before and after responses. Results: Seventy-two individuals from two academic institutions participated in the session. We collected 35 total responses (49%) from dermatology residents (n = 15), dermatology faculty (n = 14), medical students (n = 2), and other providers and learners (n = 4). Feedback was largely positive, with 21 attendees (60%) indicating they learned a few things and 11 (31%) indicating they learned a great deal. Additionally, 32 participants (91%) indicated they would recommend the session to a colleague. Our analysis showed that attendees had a greater self-perceived level of achievement for each of our three objectives after the session. Discussion: This dermatoethics session is structured so as to be easily shared, deployed, and built on by other institutions. We hope that other institutions will use our materials and results to improve upon the foundation presented here and that this framework will be used by other medical specialties seeking to foster ethics education in their training programs.

Teledermatology in medical student, postgraduate trainee, and global dermatology education: A systematic review.

Background: In the aftermath of the COVID-19 pandemic, medical students and residents in the U.S. and globally have gained more exposure to teledermatology, both for the purposes of clinical practice and education. Objective: We conducted a systematic review to assess outcomes from teledermatology interventions for dermatology trainees in the U.S. and globally in accordance with Preferred Reporting Items for Systematic Reviews (PRISMA). Methods: We searched MEDLINE, EMBASE, Web of Science, and Cochrane CENTRAL for articles written in English and published database inception to November 20, 2022. Results: In total, 15 studies met the inclusion criteria. Outcomes reported ranged broadly from resident-provider concordance rates, diagnostic accuracy in comparison to control groups, number of patients seen, and self-reported satisfaction and improvement. Generally, studies indicated high satisfaction rates and improvement in educational outcomes among medical students, residents, and other trainees in the global health setting. Limitations: Because of the heterogeneity of study design and outcomes reported, meta-analysis could not be performed. Conclusion: Teledermatology can be successfully deployed for clinical care and education domestically and in the global health setting.