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Rash Decisions: Innovation in undergraduate dermatology education using mobile technology

Lead Dermatologist: Dr. Gayle Fischer, Dr. Saxon D Smith & Dr. Philippa Dickinson x
Project team members: Dr. Suhas Bhattacharya, Dr. Saxon D. Smith & Dr. Philippa
Affiliation: Department of Dermatology, Royal North Shore Hospital, Australia

 

Rash Decisions

 

The aim of this project is to utilize innovative technology to create a convenient mobile application, Rash Decisions, that facilitates dermatology education for Australian undergraduates, leading to increased understanding and improved patient management.

Executive summary

Dermatology is poorly taught to Australian undergraduate medical students despite the fact it represents 20% of presentations to GPs. Australian medical students receive an average of 3 lectures during their undergraduate course. This has meant that junior doctors approach skin conditions with a lack of confidence and familiarity, which in turn leads to delayed diagnosis, mismanagement and poor patient outcomes. The aim of the project is to utilise innovative technology to create a mobile application that facilitates dermatology education. The visual nature of dermatology coupled with the convenience of mobile learning will lead to increased understanding and improved patient management.

The challenge

Mastery of dermatology is important for Australian medical practitioners. Up to 20% of presentations in the primary care setting are dermatological in nature. Eczema is a more common presentation to paediatricians than asthma. Additionally, the prevalence of melanoma and non­melanoma skin cancer is a significant burden on the Australian health care system. Despite this, dermatology is poorly represented in medical undergraduate curricula across Australia. A recent study found that only 4 (24%) medical schools include dermatology as a compulsory clinical attachment. There is no other formal dermatology teaching provided to medical students before they become junior doctors or General Practice (GP) registrars. Unfamiliarity with simple dermatology presentations leads to inappropriate management, treatment delays and overloading of tertiary referral clinics.

This shortfall of education is on a background of an exponential increase in the capabilities and potential of multimedia through computer and mobile applications. It has been clearly proven that current university students are very accepting of digital education as it offers self­paced, customised courses that are up­to­date and easily accessible.

It is our aim to create an interactive, engaging mobile application which utilises innovative educational methods to successfully teach dermatology to undergraduate students. Dermatology is a highly visual specialty with a strong emphasis on pattern recognition and is therefore well suited to be paired with the convenience and capabilities of digital media. The creation of such a resource will develop students’ clinical assessment and management of common dermatological conditions and ultimately improve patient care.

Project overview

The project team is currently creating a mobile application which utilises innovative educational techniques and technology to teach dermatology. The player will have their own simple avatar and a score card reflecting how frequently they play and the number of correct answers in 10 to 15 minute bursts. The first level will teach the terminology required for dermatology. Subsequent levels will present dermatological scenarios with patient photos (used with consent). As the student progresses through the levels, the cases will become more complex and the students will become more “responsible” for the patients through more diagnostic and management decisions. All scenarios presented in the application are based on the learning objectives for undergraduate medical students written by Prof Fischer on behalf of the ACD.

At this early stage, the application is directed towards undergraduate medical students in their final years, who can access it through iTunes or Android. The application will be advertised with assistance from the administration at different clinical schools. It will be used to supplement the dermatology education they receive in tutorials or in outpatient clinics. The project team intend to eventually make the application available to junior doctors and GP registrars.

The project team has been working with educationalists from the University of Sydney and a videogame professor from Macquarie University. These groups contribute to the pedagogical theory, question design and platform presentation of the application to maximise the learning potential. Additionally, we have received funding from the University of Sydney to create the initial version of the application. The application is being coded by a small independent company. The project development is a research project and the responsibility of the department of dermatology at Royal North Shore Hospital (RNSH) who are performing background research, liaising directly with the game developers, taking patient photos and writing the scenarios.

Any issues with the feasibility of the project in the short term are expected to be minimal considering the grant already received, the experience of the project team, and relationship with the university and game developers. Long term feasibility will be dependent on further funding and demonstrated effectiveness. The application architecture is being created to facilitate continuous updating of cases without requiring coding to minimise the cost and time of maintenance. The application will remain the responsibility of RNSH. The long term effects for medical students and junior doctors will be continuously analysed by MD students and research fellows within the dermatological department at RNSH.

Timeline:

  • Baseline knowledge of students through online MCQ (April 2017)
  • Prototype of video game/online resources (May 2017)
  • Presentation of game prototype at the ASM for the ACD of Dermatologists (May 2017)
  • Completion of video game/online resource (August 2017)
  • Initial distribution to small group – play testing and bug fixing (May – June 2017)
  • Concurrent critique
  • Distribution to final year medical students (November – December 2017)
  • Initial evaluation and assessment (April ­ June 2018)
  • Focus groups with students
  • MCQ to assess knowledge retention
  • Analysis of satisfaction surveys

Success criteria and evaluation

The successful application will effectively facilitate the learning of common and simple dermatological conditions through engaging and innovative methods. The validity of this resource will be achieved through content adherence to the undergraduate curriculum, continuous play­testing by experts and students, and assessment of increased education using MCQs. MCQs, which are the most reliable way of testing knowledge, will be distributed to students before access to the application, immediately after completion of the application, and 3­6 months after completion of the application. These scores will be compared to students who do not use the application. Engagement and motivation with the application will be assessed using instruments already utilised and validated for tertiary students, such as the Motivation and Engagement Scale, and a satisfaction survey at completion of the application. Focus groups will also be organised with local students who have accessed the application to critique it, identify areas of improvement and assess its impact on their practise as junior doctors.

The long term effects of the application, especially if it is rolled out to junior doctors and GPs, will be assessed through MCQs and satisfaction surveys. These surveys will include questions regarding confidence in managing dermatological conditions and the threshold before making a referral. This information will be supplemented with an analysis of the frequency and quality of referrals received from junior doctors to the outpatient clinic.