Dermoscopy Training in Family Medicine Residencies: A CERA Survey of Program Directors.

BACKGROUND AND OBJECTIVES: Diagnosing skin disorders is a core skill in family medicine residency. Accurate diagnosis of skin cancers has a significant impact on patient health. Dermoscopy improves a physician's accuracy in diagnosing skin cancers. We aimed to quantify the current state of dermoscopy use and training in family medicine residencies. METHODS: We included questions on dermoscopy training in the 2021 Council of Academic Family Medicine Educational Research Alliance (CERA) survey of family medicine residency program directors. The survey asked about access to a dermatoscope, the presence of faculty with experience using dermoscopy, the amount of dermoscopy didactic time, and the amount of hands-on dermoscopy training. RESULTS: Of 631 programs, 275 program directors (43.58% response rate) responded. Half of the responding programs (50.2%) had access to a dermatoscope, and 54.2% had a faculty member with experience using dermoscopy. However, only 6.8% of residents had 4 or more hours of didactics on dermoscopy over their entire training. Only 16.2% had 4 or more hours of hands-on dermoscopy use. Over half (58.9%) of programs planned to add more dermoscopy training. We did not find any correlations between the program's size/type/location and dermoscopy training opportunities. CONCLUSIONS: Despite reasonable access to a dermatoscope and the presence of at least one faculty member with dermoscopy experience, most family medicine residency programs provided limited dermoscopy training opportunities. Research is needed to better understand how to facilitate dermoscopy training in family medicine residencies.

Expert Consensus Statement on Proficiency Standards for Dermoscopy Education in Primary Care.

BACKGROUND: Primary care providers (PCPs) frequently address dermatologic concerns and perform skin examinations during clinical encounters. For PCPs who evaluate concerning skin lesions, dermoscopy (a noninvasive skin visualization technique) has been shown to increase the sensitivity for skin cancer diagnosis compared with unassisted clinical examinations. Because no formal consensus existed on the fundamental knowledge and skills that PCPs should have with respect to dermoscopy for skin cancer detection, the objective of this study was to develop an expert consensus statement on proficiency standards for PCPs learning or using dermoscopy. METHODS: A 2-phase modified Delphi method was used to develop 2 proficiency standards. In the study's first phase, a focus group of PCPs and dermatologists generated a list of dermoscopic diagnoses and associated features. In the second phase, a larger panel evaluated the proposed list and determined whether each diagnosis was reflective of a foundational or intermediate proficiency or neither. RESULTS: Of the 35 initial panelists, 5 PCPs were lost to follow-up or withdrew; 30 completed the fifth and last round. The final consensus-based list contained 39 dermoscopic diagnoses and associated features. CONCLUSIONS: This consensus statement will inform the development of PCP-targeted dermoscopy training initiatives designed to support early cancer detection.

Advanced Primary Care Orthopedics: Bridging the Gap in Musculoskeletal Education.

BACKGROUND AND OBJECTIVES: Musculoskeletal problems are common in primary care, yet many family physicians lack confidence and competence in this area. The Advanced Primary Care Orthopedics (APCO) course utilizes hands-on physical exam instruction, interactive cases, and intentional repetition to teach anatomy, a standardized exam, and important diagnoses. This study assesses the effectiveness of APCO in improving musculoskeletal exam knowledge and confidence. METHODS: APCO is a 1.5-day course taught annually to family medicine residents. A 1-day course has also been conducted as a preconference workshop targeting faculty physicians. Participants completed pre- and postcourse assessments to evaluate their knowledge and confidence with the musculoskeletal exam. We compared results using mean differences with paired t-test statistics. RESULTS: In the 2018 and 2019 resident courses, 23 of 30 participants (77%) completed the knowledge assessment and 25 of 30 participants (83%) completed the confidence assessment. Knowledge assessment scores improved by 9.5 points (P<.05) after completion of the course. Confidence in the musculoskeletal exam, as assessed on a 5-point Likert scale (1-not confident at all; 5-very confident), improved from 2.2 to 3.8 after the course (P<.05). In the 2018 preconference workshop, 23 of 36 participants (64%) completed the confidence assessment. Confidence increased from 2.17 to 3.61 (P<.05) after course completion. CONCLUSIONS: Participation in the APCO course increased short-term musculoskeletal knowledge and confidence. APCO has many potential applications for residency curricula, faculty development, and continuing medical education.

Lemierre syndrome following oropharyngeal infection: a case series.

Lemierre syndrome is a potentially fatal complication of oropharyngeal infections that is characterized by jugular vein thrombosis and septic emboli. Fusobacterium spp. are the causative organisms. Patients typically present with high fevers, neck pain, and pulmonary symptoms. Prompt clinical diagnosis and treatment with appropriate antibiotics are critical. Anticoagulation for this syndrome is controversial. We present 3 cases within a 12-month period of young, family practice patients seen with oropharyngeal infections who developed Lemierre syndrome. The incidence of Lemierre syndrome may be increasing and primary care physicians should be aware of this rare though serious condition.