Assessing the Level of Knowledge of Emergency Department Physicians in Recognition of Common Skin Lesions

Dermatological conditions are a frequent reason for consultation at the emergency department (ED), with a prevalence of 1% in Singapore to 3.2% across Ontario, Canada [1,2]. In a 2009 study in Singapore, among 4061 patients presenting with a skin condition of 157,527 total patients, the commonest diagnoses were herpes zoster infection (20.8%) and eczema or dermatitis (11.6%) [3]. There is significant dermatologic diagnostic performances between primary care physicians and dermatologists with 93% correct diagnoses for dermatologists as compared to 50% for nondermatologists [4]. Despite educators expecting medical students to learn to diagnose or treat common skin diseases, little time is designated for this in most medical schools [5]. The advent of Teledermatology in the Emergency Service has allowed patients to obtain specialist advice remotely while reducing hospitalisations, outpatient clinic demands and inaccurate diagnoses. We aim to assess the level of knowledge of ED physicians in recognition of common skin lesions. This can further suggest improvements in continuous medical education as well as the medical school Assessing the Level of Knowledge of Emergency Department Physicians in Recognition of Common Skin Lesions


Introduction
Dermatological conditions are a frequent reason for consultation at the emergency department (ED), with a prevalence of 1% in Singapore to 3.2% across Ontario, Canada [1,2]. In a 2009 study in Singapore, among 4061 patients presenting with a skin condition of 157,527 total patients, the commonest diagnoses were herpes zoster infection (20.8%) and eczema or dermatitis (11.6%) [3]. There is significant dermatologic diagnostic performances between primary care physicians and dermatologists with 93% correct diagnoses for dermatologists as compared to 50% for nondermatologists [4]. Despite educators expecting medical students to learn to diagnose or treat common skin diseases, little time is designated for this in most medical schools [5]. The advent of Teledermatology in the Emergency Service has allowed patients to obtain specialist advice remotely while reducing hospitalisations, outpatient clinic demands and inaccurate diagnoses. We aim to assess the level of knowledge of ED physicians in recognition of common skin lesions. This can further suggest improvements in continuous medical education as well as the medical school Abstract Background: Dermatological conditions are a frequent reason for consultation at the emergency department (ED). The advent of Teledermatology has reduced inaccurate diagnoses and unnecessary hospitalisations. We aim to assess the level of knowledge of ED physicians in recognition of common skin lesions. This can further suggest improvements in continuous medical education as well as the medical school dermatology curriculum and evaluate the educational and service value of Teledermatology.
Methods and findings: ED Physicians in a tertiary hospital in Singapore were surveyed with a 15-slides questionnaire based on identification of common dermatological and life-threatening conditions in the local population. The final summative score out of a maximum total of 15 showed average scores of medical officers, registrars and consultants to be 9.9 (66%), 7.3 (48%) and 11 (73%) respectively. Correlation analyses performed for years of practice and scores showed a value of -0.341.

Conclusions:
A negative correlation between years of medical practice and questionnaire scores prompts further opportunities for continued medical education and multidisciplinary exchange of knowledge.
Keywords: Medical education, Dermatology, Emergency department dermatology curriculum and evaluate the educational and service value of Teledermatology.

Methods
ED Physicians in a tertiary hospital in Singapore were surveyed with a 15-slides questionnaire based on identification of common dermatological and life-threatening conditions in the local population. Gender, years and level of practice as well as their scores were tabulated. Initial descriptive analysis of individual items was recorded and correlation analyses performed (Figure 1). Consent was obtained prior to administration of the questionnaire and all respondents' information was de-identified to maintain confidentiality.

Results
48 doctors from the ED were surveyed; 24 medical officers, 12 registrars and 12 consultants. There were a total of 26 females (54%) and 22 males (46%) who participated in the study. The number of picture slides correctly identified was expressed as the of practice and scores showed a value of -0.341. There was a 95% response rate for the questionnaire. Standard error comparing of years of practice with sample number was 0.64, standard error of questionnaire scores with sample number was 0.41 and that of years of practice with questionnaire scores was 4.0.

Discussion
Recognition of common dermatological conditions is essential for proper diagnosis and management. Knowledge gaps in the ED can be bridged with Teledermatology which highlights its potential educational efficacy. Although limited by sample size, a negative correlation between years of medical practice and questionnaire scores prompts further opportunities for continued medical education and multidisciplinary exchange of knowledge.  final summative score out of a maximum total of 15 (1 point for each correctly identified slide). The average scores for the medical officers, registrars and consultants were 9.9 (66%), 7.3 (48%) and 11 (73%) respectively (Table 1). Average years of practice were 3.3 years for medical officers, 9.5 years for registrars and 9.8 years for consultants. Correlation analyses performed for years Level Number (%) Average years of practice Average scores (%) Consultants 12 (25%) 10 11 (73%) Registrars 12 (25%) 9 7.3 (48%) Medical Officers 24 (50%) 3 9.9 (66%) Table 1 showing average questionnaire scores and years of practice among emergency department physicians surveyed.