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Photodermatol Photoimmunol Photomed 1999: 15: 39–40 Copyright C Munksgaard 1999 Printed in Denmark ¡ All rights reserved ISSN 0905-4383 Review Are we teaching phototherapy? Results of an informal survey of phototherapy education Green LJ. Are we teaching phototherapy? Results of an informal survey L. J. Green of phototherapy education. Photodermatol Photoimmunol Photomed Department of Dermatology, George Washington 1999: 15: 39–40. C Munksgaard, 1999. University School of Medicine, Washington, D.C., USA Key words: phototherapy; phototherapy education; dermatology teaching programs Lawrence J. Green, M.D., Department of Dermatology, George Washington University School of Medicine, 2150 Pennsylvania Avenue, Washington, D.C., 20037, USA Accepted for publication September 18, 1998 Among physicians, dermatologists are uniquely qualified to utilize phototherapy. Adequate train- ing in phototherapeutic modalities during resi- dency would seem to be a prerequisite for using phototherapy in clinical practice. However, there is at present no formal core curriculum for photo- therapy education in dermatology teaching pro- grams in the United States. Phototherapy edu- cation thus depends on the individual residency program. An informal survey was therefore under- taken to determine whether phototherapy edu- cation in dermatology teaching programs is stan- dardized and preparatory for private practice. Material and methods In early 1994, the American Academy of Derma- tology mailed surveys addressed to chief residents and chairmen of dermatology teaching programs in North America (105 programs in the United States and Canada). A total of 66 chief residents and 48 chairmen responded to this anonymous eleven-question survey. Responding chairmen did not necessarily correspond with chief residents in the same programs. Chief residents were also asked to respond to the twelfth question regarding com- fort level using phototherapeutic modalities. Re- sponses to this twelfth question were also used to 39 determine whether a chairman or a chief resident had responded to the survey. Results Seventy-seven percent of chief residents and chair- men said they had formal core phototherapy lec- tures at their institutions. More than 50% of chair- man and chief resident respondents indicated that these lectures were less than 3 hours per year. Ex- planations from residents who did not have a phototherapy core lecture series were that photo- therapy education is gained from American Acad- emy of Dermatology meetings and that senior resi- dents train first-year residents. A total of 77% of chairmen and 55% of chief residents reported that they had a ‘‘hands on’’ tu- torial by faculty on the use of phototherapy equip- ment. More than 80% of respondents noted their clinics to have ultraviolet B (UVB), psoralen plus ultraviolet A (PUVA), and hand/foot PUVA units. A total of 34% of chairmen and 48% of chief resi- dents stated that their teaching programs have no phototherapy units on inpatient hospital wards. Respondents indicated that phototherapy is used at their institutions for psoriasis, atopic dermatitis, vitiligo, pruritus, pityriasis lichenoides, eosin- ophilic folliculitis, alopecia totalis, polymorphous

Are we teaching phototherapy? Results of an informal survey of phototherapy education

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Page 1: Are we teaching phototherapy? Results of an informal survey of phototherapy education

Photodermatol Photoimmunol Photomed 1999: 15: 39–40 Copyright C Munksgaard 1999Printed in Denmark ¡ All rights reserved

ISSN 0905-4383

Review

Are we teaching phototherapy? Results of aninformal survey of phototherapy education

Green LJ. Are we teaching phototherapy? Results of an informal survey L. J. Greenof phototherapy education. Photodermatol Photoimmunol Photomed Department of Dermatology, George Washington1999: 15: 39–40. C Munksgaard, 1999. University School of Medicine, Washington,

D.C., USA

Key words: phototherapy; phototherapyeducation; dermatology teaching programs

Lawrence J. Green, M.D., Department ofDermatology, George Washington UniversitySchool of Medicine, 2150 Pennsylvania Avenue,Washington, D.C., 20037, USA

Accepted for publication September 18, 1998

Among physicians, dermatologists are uniquelyqualified to utilize phototherapy. Adequate train-ing in phototherapeutic modalities during resi-dency would seem to be a prerequisite for usingphototherapy in clinical practice. However, there isat present no formal core curriculum for photo-therapy education in dermatology teaching pro-grams in the United States. Phototherapy edu-cation thus depends on the individual residencyprogram. An informal survey was therefore under-taken to determine whether phototherapy edu-cation in dermatology teaching programs is stan-dardized and preparatory for private practice.

Material and methods

In early 1994, the American Academy of Derma-tology mailed surveys addressed to chief residentsand chairmen of dermatology teaching programsin North America (105 programs in the UnitedStates and Canada). A total of 66 chief residentsand 48 chairmen responded to this anonymouseleven-question survey. Responding chairmen didnot necessarily correspond with chief residents inthe same programs. Chief residents were also askedto respond to the twelfth question regarding com-fort level using phototherapeutic modalities. Re-sponses to this twelfth question were also used to

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determine whether a chairman or a chief residenthad responded to the survey.

Results

Seventy-seven percent of chief residents and chair-men said they had formal core phototherapy lec-tures at their institutions. More than 50% of chair-man and chief resident respondents indicated thatthese lectures were less than 3 hours per year. Ex-planations from residents who did not have aphototherapy core lecture series were that photo-therapy education is gained from American Acad-emy of Dermatology meetings and that senior resi-dents train first-year residents.

A total of 77% of chairmen and 55% of chiefresidents reported that they had a ‘‘hands on’’ tu-torial by faculty on the use of phototherapy equip-ment. More than 80% of respondents noted theirclinics to have ultraviolet B (UVB), psoralen plusultraviolet A (PUVA), and hand/foot PUVA units.A total of 34% of chairmen and 48% of chief resi-dents stated that their teaching programs have nophototherapy units on inpatient hospital wards.Respondents indicated that phototherapy is usedat their institutions for psoriasis, atopic dermatitis,vitiligo, pruritus, pityriasis lichenoides, eosin-ophilic folliculitis, alopecia totalis, polymorphous

Page 2: Are we teaching phototherapy? Results of an informal survey of phototherapy education

Green

Table 1. Resident responses to question ‘‘Do you feel confortable using anyof the following modalities in your practice after you have finished training?’’Right hand column (%) represents residents responding favorably to eachtherapy

Therapy Residents ‘‘comfortable’’ with

Ultraviolet B 95%PUVA 90%Hand/foot PUVA 72%Topically applied PUVA 58%Photodynamic therapy 2%None 5%

light eruption, and pityriasis rosea. One respon-dent indicated that phototherapy is routinely usedfor acne, and another respondent stated photo-therapy is routinely used for keloids.

A twelfth question requesting a response onlyfrom chief residents was worded: ‘‘Do you feel con-fortable using any of the following modalities inyour practice after you have finished training?’’Five percent chief residents indicated that they donot feel ‘‘comfortable’’ using any phototherapeuticmodalities after residency, while 10% and 28% ofresidents responded that they did not feel‘‘comfortable’’ using PUVA, or hand/foot PUVA,respectively (Table 1).

Discussion

Although this survey was informal, and no statisti-cal conclusions can be drawn, several interestingfindings are noted. First, almost one-fourth of re-sponding programs had no formal phototherapy

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lecture series. Although most teaching programsemploy UVB, PUVA, and hand/foot PUVA intheir clinics, formal resident training with thisequipment sems variable. For example, almost 25%of chairmen and 50% of residents responded thatresidents do not receive formal faculty instructionat phototherapy units. Disregarding that this widerange separating chairmen from resident responsescan be reconciled because the chairmen and resi-dents were from different programs, another possi-bility is that a ‘‘hands on’’ tutorial given by facultyis not a memorable experience for many residents.Interestingly, many programs do not have photo-therapy units on patient wards, further indicatingthat hospitalization for phototherapy has becomeuncommon even at teaching centers. The finalquestion regarding ‘‘comfort’’ level with photo-therapeutic modalities was written intentionally toencourage positive resident responses. If the ques-tion had been worded differently, e.g., ‘‘Whichphototherapeutic modalities are you prepared toutilize in your practice after training?’’, the percen-tage of residents responding favorably to usingeach phototherapeutic modality may have beenlower.

Other questions raised from this survey include:1) Should recommendations be made for a moredefined, structured core curriculum devoted to theprinciples and practice of phototherapy? 2) Shouldsuch a curriculum mandate a faculty-taught ‘‘handon’’ tutorial (one that hopefully would be remem-bered by residents)? 3) Should goals of every train-ing program include having graduating residentsfeel confortable performing UVB, PUVA, andhand/foot PUVA?