P6504Are dermatology residents adequately prepared for the business ofmedicine?

Rajiv I. Nijhawan, MD, St. Luke’s-Roosevelt Hospital Centers and Beth IsraelMedical Centers, New York, NY, United States; Kavita Mariwalla, MD, St. Luke’s-Roosevelt Hospital Centers and Beth Israel Medical Center, New York, NY, UnitedStates; Lauren A. Smith, MD, New York University School of Medicine, New York,NY, United States; Thomas E. Rohrer, MD, SkinCare Physicians, Chestnut Hill,MA, United States

New physicians of all specialties spend valuable time at the beginning of theircareers learning the basics of practice management. To assess current dermatologyresidents’ knowledge, education, exposure, and comfort level as it relates to billingand coding, a 16-question survey was administered to all attendees of the PracticeManagement Symposium for Residents held at the 70th Annual Meeting of theAmerican Academy of Dermatology. The majority of respondents (85/182; 46.7%)reported being only somewhat comfortable with coding for office visits and basicdermatologic procedures. Forty-nine out of 174 (28.2%) respondents reported nothaving any didactic sessions on how to code for dermatologic visits. Yet, themajority(117/179; 65.4%) reported completing their own billing 75% to 100% of the time.The majority of residents (113/178; 64.5%) reported receiving feedback from theirattendings\25% of the time or never. Most residents (174/181; 96.1%) reported thatlearning billing and coding during residency as being somewhat or extremelyimportant. Our study results suggest that a more standardized curriculum as itrelates to the business of medicine is desired by current dermatology residents toguarantee well-prepared graduates as they enter the practice of medicine.

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cial support: None identified.

Commer

P6041Dermatologic needs of an underserved patient population

Danielle Tartar, PhD, University of Missouri-Columbia, Columbia, MO, UnitedStates; LeAnna Lane, MD, University of Missouri-Columbia, Columbia, MO, UnitedStates; Whitney Hovenic, MD, University of Missouri-Columbia, Columbia, MO,United States

Background: In 2011, 16.3% of the US population lacked health insurance (USCensus Bureau). Free health care clinics frequently are the sole means by whichpatients can access specialty care such as dermatology. The risk of dermatologicdisease in the indigent population is high given greater sun exposure and loweremphasis on preventative care. MedZou Clinic offers free dermatology services touninsured patients. This monthly clinic is staffed by medical students from theUniversity of Missouri and is overseen by volunteer resident and attendingphysicians. Services available include diagnosis and management, free or low-costprescriptions, laboratory testing and minor procedures.

Methods:We performed a retrospective chart review of previously seen patients anda prospective study of new and return patient demographics including age,employment status, housing status, educational level achieved, and drug andalcohol use. Our goal was to describe the most common dermatologic conditionsfor which this population seeks care and to identify demographic factors to betterserve patient needs.

Results: Average patient age was 38.9 (range, 14-64 years) and 62% were female.Over a third (38.4%) of respondents chose housing status ‘‘homeless’’ versus ‘‘own’’or ‘‘rent.’’ The most frequent diagnosis made was benign pigmented nevus (16%),second was eczema (13%) followed closely by acne (12%). The most commoncomorbidities in our patient population were psychiatric, with 23% of our patientshaving a diagnosed psychiatric condition including depression and bipolar disorder.

Discussion: The diagnoses seen in our population were surprisingly similar to thoseof insured patients seen in dermatology clinics. Thiswas despite the high proportionof homeless patients, who have previously been described to have more acuteconditions, such as cutaneous infections. As dermatologists are available onlymonthly at MedZou clinic, it is likely that acute complaints are managed elsewhere.The most common diagnosis of benign pigmented nevus perhaps indicates thatuninsured patients may wait to seek out dermatologic care until they are concernedabout cancer such as melanoma. Our data indicate common needs between insuredand uninsured patients. However, access to specialty dermatology care for theuninsured is woefully inadequate. There is clearly room for growth in our specialtyto reach out to this population.

cial support: None identified.

Commer

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P6563Dermpedia.org: An online project created to advance the field of derma-tology by organizing the knowledge and experience acquired by cliniciansworldwide

Neal Kumar, Tufts University School of Medicine, Boston, MA, United States;Catherine Buzney, Tufts University School of Medicine, Boston, MA, UnitedStates

Dermpedia.org (Dermpedia) is a web site devoted to collecting and disseminatingthe ever-expanding knowledge, science, and experience of dermatology across theglobe. In creating a wiki-style, interactive, user-driven online community,Dermpedia uses the concept of ‘‘crowd sourcing’’ enabled by modern webtechnology to leverage mass collaboration. Cases posted online are organized bydifferent criteria such as diagnosis and linked to various collections, researchprojects, and digital textbooks. Because these cases capture a wide range of clinicalscenarios and diagnostic dilemmas, Dermpedia provides a platform for dermatolo-gists, residents, and medical students to share as well as discuss experiences in thefield, thus achieving the web site’s education goals. In contrast to printed textbookswhich present dated, established knowledge, Dermpedia contains a wiki-style user-editable textbook which enables limitless case examples uploaded by clinicians anda previously unachievable depth of illustration for each disease entity. Furthermore,Dermpedia serves as an online community for clinicians, encouraging theseindividuals to create their own collections, present information about themselvesor their institutions, publish teaching cases, and promote discussion around theseexamples. Dermpedia’s web technologies also enable users to host grand rounds,courses, seminars, self-assessment modules, and collaborative research projects.Dermpedia’s website technology, built with custom functionality on the Drupalplatform, is managed by a medical student with support from an internationalphysician advisory board. Within just 3 years following web site development,membership has rapidly grown to 2500 individuals. Dermpedia membership is freeof charge to all users as the website is now entirely funded by revenue from anannual stationary Dermpedia Continuing Medical Education (CME) course. The website also sees over 13,000 unique visitors each month, with 108,990 unique visitorsin 2011. Its content currently includes 1296 cases and 9850 images; the top 5 searchkeywords of visitors are ‘‘lichen planus,’’ ‘‘granuloma annulare,’’ ‘‘pemphigusvulgaris,’’ ‘‘pityriasis rosea,’’ and ‘‘seborrheic dermatitis.’’ In creating a free, online,sustainable medical society, Dermpedia aims to harness the collective knowledge ofclinicians worldwide in efforts to strengthen education and thus optimize patientcare within the field of dermatology.

cial support: None identified.

Commer

P6571Efficacy of a multimodality curriculum in a pigmented lesion clinic toteach dermatoscopy to dermatology residents

Amy Cao, The Ottawa Hospital, Ottawa, Canada; Jennifer Beecker, MD, TheOttawa Hospital, Ottawa, Canada

Background: Dermatoscopy is a useful tool in assessing worrisome pigmentedlesions, and its use has increased rapidly in recent years. It is particularly useful forassessing early melanoma, and determining the need for biopsy. As such, it hasbecome a fundamental skill for dermatologists to acquire. Despite this, many sourcesnote that dermatology residents often lack formal training in dermatoscopy.

Objectives: This study aims to evaluate the efficacy of a novel multi-modality pilotlearning program inwhich residents are trained in the use of dermatoscopy and totalbody imaging as a tool in the diagnosis of melanoma.

Methods: A learning programwill be designed to include the following components:a short educational computer based module, followed by a few sessions with anexpert dermatologist in a Pigmented Lesion Clinic. Volunteer dermatology residentswill be asked to fill out a questionnaire before and after this multimodalitycurriculum to assess for any changes in their skills, knowledge base, and confidencelevels. The primary outcome will be to determine if there are any changes in theresidents’ pre- and posttraining knowledge score. Secondary outcome will be todetermine their satisfaction with the educational program, and any perceivedchanges in competency and confidence levels.

Results: Study currently in progress. Results are expected to be gathered by mid-summer, with conclusions to be determined at that time. It is hoped that the use ofmultiple learning methods, including a visual computer-based curriculum followedby direct one-on-one hands-on teaching with patients will address the differentlearning styles that adult learners may require for optimal knowledge and skillacquisition. If this pilot program is effective, it could be replicated by otherresidency programs to aid in teaching the essential skill of dermatoscopy todermatology residents. This information could have a broader educational signifi-cance and perhaps improve the way future dermatologists examine the skin.

cial support: None identified.

Commer

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