Optimizing teledermatology visits for dermatology resident education during the COVID-19 pandemic

To the Editor: After an outbreak of unexplained pneumonia cases in Wuhan, China, in December 2019, the World Health Organization officially named the disease caused by the culprit virus as coronavirus disease 2019 (COVID-19).¹ Faced with a global public health emergency, dermatology practices are now using telemedicine to limit in-person appointments to reduce transmission of COVID-19 per interim guidance from the Centers for Disease Control and Prevention and the American Academy of Dermatology.² A recent Letter to the Editor likewise recommends minimizing trainee exposure to maintain a potential pool of residents to supplement the growing need for hospital staff.³

Although some dermatology residents will eventually be deployed to treat patients with COVID-19 in overloaded hospital systems, most dermatology residents are currently working in dermatology clinics impacted by this pandemic. The Accreditation Counsel for Graduate Medical Education's clinical and educational expectations are such that “significant changes in resident/fellow education of more than 4 weeks in duration must be reported to the Executive Director of the applicable Review Committee.”⁴ Training disruptions caused by the implementation of telemedicine and altered clinic workflow may affect resident board eligibility and compromise dermatology resident education. Preservation of resident education during this pandemic is essential.

Epic (Epic Systems Verona, WI), an electronic medical record software application, is used at our institution as well as many other academic centers. The Epic Haiku application can be used on smartphones to perform virtual video visits, which will allow many institutions to transition to teledermatology. Epic Haiku features a “multi-provider” video visit option whereby multiple providers can simultaneously interface with the patient from distinct and remote locations. There are several ways that residents can be incorporated into these video visits. So far, we have found the most educational and efficient way is as follows:

• 1.The resident and attending both login to Haiku.
• 2.The resident leads the history and physical assessment with the patient.
• 3.The resident briefly discusses the assessment and plan with the attending with the patient still present on the call, depending on patient comfort.
• 4.The attending then confirms the plan and makes necessary changes.

So far, we have found patients to be very accepting of this approach. Alternative models could be adapted depending on clinic schedule, patient complexity, and patient comfort.

Teledermatology is likely going to become a longstanding method of the future practice of dermatology, and the Accreditation Counsel for Graduate Medical Education now permits residents to use telemedicine under supervision to care for patients.⁵ Institutions should immediately start implementing workflows that incorporate residents to both avoid disruption in resident education and allow for trouble shooting while patient volume is low. Resident education should not be sidelined during the COVID-19 pandemic.