Abstract
Reflectance confocal microscopy (RCM) images skin lesions noninvasively at quasi-histological resolution. RCM has improved the diagnosis of skin neoplasms, and recently acquired billing codes in the USA.1 However, reading RCM images requires training, imposing a major barrier to its widespread adoption.2 To date, RCM learning has not been standardized and is primarily based on ‘mentorship’ and ‘on-site’ learning. There is a paucity of CME-accredited RCM courses in the USA and across the globe, as well as a lack of reports on CME’s clinical impact. This study aimed to evaluate the impact of a short-duration RCM course on learning and clinical integration.
Dear Editor, Reflectance confocal microscopy (RCM) enables imaging of skin lesions noninvasively at quasi-histological resolution. RCM has improved the diagnosis of skin neoplasms, and recently acquired billing codes in the USA.1 However, reading RCM images requires training, imposing a major barrier to its widespread adoption.2 To date, RCM learning has not been standardized and is primarily based on ‘mentorship’ and ‘on-site’ learning. There is a paucity of Continuing Medical Education (CME)-accredited RCM courses in the USA and across the globe, as well as a lack of reports on CME’s clinical impact. The objective of this study was to evaluate the impact of a short-duration RCM course on learning and clinical integration.
This was a single-centre, retrospective study conducted at Memorial Sloan Kettering Cancer Center. We present data on the first 4 years of courses (2018–2022). The 2018–2019 courses were 1 day in duration and conducted in person, while the 2021–2022 courses lasted 2 days and were held virtually, due to the COVID-19 pandemic. The course faculty members had more than 5 years of experience. The courses comprised the following RCM modules: (i) didactic lectures on basic principles, terminology and features of cutaneous neoplasms; (ii) clinical integration of technology; (iii) hands-on training (prerecorded demonstrations) on image acquisition; and (iv) interactive quizzes. Attendees’ demographics and post-course evaluation surveys were collected from these four modules (Table 1). The survey included satisfaction ratings for each module as ‘excellent’, ‘good’ or ‘poor’, and questions related to the technology’s impact and integration in clinics.
Table 1.
Demographics and main survey responses from attendees of Continuing Medical Education reflectance confocal microscopy (RCM) courses
| Modality | 2018 | 2019 | 2020 | 2021 | Overall |
|---|---|---|---|---|---|
| In-person | In-person | Virtual | Virtual | ||
| Demographics, n | 67 | 62 | 102 | 83 | 314 |
| Academic qualification | |||||
| MD | 55 (82) | 40 (74) | 66 (73.3) | 50 (60) | 211 |
| PA | 0 | 2 (4) | 0 | 0 | 2 |
| DO | 1 (2) | 0 | 2 (2.2) | 0 | 3 |
| PhD | 4 (6) | 3 (6) | 11 (12.2) | 13 (16) | 31 |
| Other (e.g. BS, NP) | 7 (10) | 17 (27) | 23 (22.5) | 20 (24) | 67 |
| Area of work | |||||
| Dermatology | 55 (82) | 41 (54) | 71 (69.6) | 60 (72) | 227 |
| Pathology | 9 (13) | 11 (18) | 25 (24.5) | 20 (24) | 65 |
| Other | 3 (5) | 10 (16) | 6 (5.8) | 3 (4) | 22 |
| Years of clinical practicea | |||||
| ≥ 10 years | 29 (66) | 8 (33) | 12 (34.3) | 12 (38) | 61 (45.2) |
| 5–10 years | 8 (18) | 5 (21) | 8 (22.9) | 6 (19) | 27 (20) |
| 3–4 years | 4 (9) | 0 (0) | 3 (8.5) | 2 (6) | 9 (6.7) |
| 1–2 years | 2 (5) | 3 (13) | 5 (14.2) | 5 (16) | 15 (11.1) |
| < 1 year | 1 (2) | 1 (4) | 0 | 0 | 1 (0.7) |
| Post-course survey responses, n | 44 | 24 | 35 | 32 | 135 |
| Understanding basic principles, excellent | 42 (95) | 22 (92) | 32 (91) | 30 (94) | 126 (93.3) |
| Learning of terminology, excellent | 41 (93) | 22 (92) | 31 (89) | 29 (91) | 123 (94.2) |
| Ability to integrate into clinical practice | 27 (61) | 21 (88) | 24 (69) | 28 (88) | 100 (74.1) |
| Ability to interpret at the bedside | 27 (61) | 21 (88) | 22 (63) | 26 (81) | 96 (71.1) |
| Found course relevant to daily practice | N/E | 24 (100) | 34 (97) | 26 (81) | 84 (92.3)b |
| Would recommend to a colleague (≥ 8)c | 42 (95) | 23 (96) | 34 (97) | 31 (97) | 130 (99.2) |
| Learning format, excellent | 44 (100) | 24 (100) | 35 (100) | 32 (100) | 135 (100) |
All data are n (%) unless otherwise indicated. BS, Bachelor of Science; DO, Doctor of Osteopathic Medicine; MD, Doctor of Medicine; N/E, not evaluated; NP, nurse practitioner; PA, physician assistant; PhD, doctorate; RCM, reflectance confocal microscopy. aPercentages do not total 100. bBased on n = 91 participants. cEvaluated with a visual analogue scale.
During the 4 years of courses, a total of 314 attendees registered, of whom 135 completed the survey (43%). Most attendees were medical doctors specializing in dermatology; however, over the 4 years we noticed an increase in registration of pathologists and nurse practitioners (Table 1). In all, 126 (93.3%) reported an excellent understanding of the basic principles, 123 (94.2%) reported an excellent understanding of terminology, 100 (74.1%) reported clinical integration, 96 (71.1%) the ability to interpret at the bedside, and 84 (92.3%) found the content relevant to their clinical practice. Both the ‘in-person’ and ‘virtual’ formats were rated as ‘100% effective’.
Since the acquisition of the billing codes for RCM, there has been a 104% increase in its use, but formal RCM courses are scarce.3 The CME-accredited courses provided a structured and comprehensive teaching opportunity: More than 90% of attendees acquired the basic knowledge to interpret RCM images. More importantly, the courses enabled more than two-thirds of attendees to integrate RCM into their clinical practice. Over the duration, we saw an increase in registration of other related specialties such as pathology. Most attendees had 5–10 years and more than 10 years of practice. This is contrary to our belief that it is the younger generation who are more readily amenable to embracing novel technologies. Finally, the inclusion of game-based learning opportunities has emerged as a novel learning strategy valued by participants.4
Limitations of the study include the relatively small numbers of participants and lack of information on prior RCM knowledge. The latter would be included in surveys in subsequent courses. Reporting quantifiable gains in knowledge and educational theory-based approaches in the future would add relevant data. In conclusion, short-duration, structured RCM courses have the potential to train novices rapidly and enable integration of this technique in clinics, leading to wider adoption.
Contributor Information
Cristian Navarrete-Dechent, Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Milind Rajadhyaksha, Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Ashfaq A Marghoob, Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Kishwer S Nehal, Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Allan C Halpern, Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Anthony M Rossi, Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Manu Jain, Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Funding sources
This research is funded in part by a grant from the National Cancer Institute/National Institutes of Health (P30-CA008748) made to the Memorial Sloan Kettering Cancer Center.
Data availability
The data underlying this article will be shared on reasonable request to the corresponding author.
Ethics statement
As an educational quality initiative project using de-identified data, it was determined that our project did not constitute human subjects research and thus did not require IRB oversight. Informed consent: not applicable.
References
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data underlying this article will be shared on reasonable request to the corresponding author.