Dermatology: Practical and Conceptual Research Letter | Dermatol Pract Concept. 2024;14(2):e2024122 1 Innovations in Dermoscopy Training: A Comparative Analysis of Dermoscopy Training Educational Delivery Models for Resident Physicians T. Austin Black1, Emelie E. Nelson1, Anthony J. Teixeria2, Travis Anthony3, Julie Simon4, Kelly C. Nelson5 1 McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA 2 Davidson College, Davidson, NC, USA 3 Department of Cancer Prevention & Control Platform, The University of Texas MD Anderson Cancer Center, Houston, TX, USA 4 Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA 5 Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA Key words: dermoscopy, dermoscopy education, educational theory, educational methods, early detection Citation: Black TA, Nelson EE, Teixeria AJ, Anthony T, Simon J, Nelson KC. Innovations in Dermoscopy Training: A Comparative Analysis of Dermoscopy Training Educational Delivery Models for Resident Physicians. Dermatol Pract Concept. 2024;14(2):e2024122. DOI: https://doi.org/10.5826/dpc.1402a122 Accepted: December 13, 2023; Published: April 2024 Copyright: ©2024 Black et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: Julie Simon and Dr. Kelly C. Nelson were supported by philanthropic contributions of the Lyda Hill Foundation to the MD Anderson Melanoma MoonShots Program. Competing Interests: None. Authorship: All authors have contributed significantly to this publication. T. Austin Black and Emelie E. Nelson have contributed equally to this work and share first authorship. Corresponding Author: Kelly C. Nelson, MD FAAD, MD Anderson Cancer Center, 1400 Pressler St, Unit 1452, Houston, TX 77030. Email: kcnelson1@mdanderson.org Introduction DERMatology: Early Melanoma Detection (DERM:EMD) is a scalable, metric-driven educational intervention designed to improve dermatology resident physicians’ confidence and accuracy in evaluating skin growths via dermoscopic examination. The program launched in 2017 and runs on an academic year calendar. While the program employed live synchronous delivery via Zoom from 2017-2020, the program transitioned to asynchronous web-based delivery with the 2020/21 academic year [1]. The web-based deliv- ery utilized Canvas as the main educational platform with two additional educational software programs: Knowbly (enabled interactive data fields where residents click on spe- cific dermoscopic features and receive feedback) and Pan- opto (enabled search for spoken or written word content and supported progress bars to assist with intuitive navigation through the lectures) [2-4]. We hypothesized the web-based delivery would be non-inferior to live delivery in support- ing knowledge and confidence gains among dermatology residents. Case Presentation DERM:EMD employs two assessments: the Cutaneous Neoplasm Diagnostic Self-Efficacy Instrument (CNDSEI) 2 Research Letter | Dermatol Pract Concept. 2024;14(2):e2024122 to measure confidence in diagnosing skin tumors via clin- ical or dermoscopic examination, and the Long Dermos- copy Assessment (LDA) to measure diagnostic accuracy [5]. Assessments are collected before and immediately after the educational exposure and at the end of the academic year to assess knowledge retention. While collection of the pre- exposure and year-end data has been consistent, completion rates for the immediate post-exposure data have varied sig- nificantly. As participants are encouraged to take the course multiple times throughout residency, only data derived from the first instance in which a resident completed both the pre- and year-end assessments within the same academic year were analyzed. Scores collected at the course start and year-end were consolidated, and the percent mean improvement between live (2018/19, 2019/20) and web-based (2020/21, 2021/22) delivery years were compared. No difference was found in confidence gains when comparing the live and web-based delivery years (CNDSEI 10.04 vs 11.38, P=0.348, 95% CI: -21.54–7.61, Figure 1a). However, residents completing the web-based delivery demonstrated greater gains in diag- nostic accuracy compared to the live-delivery residents (LDA 10.49 vs 7.8, P=0.049, 95% CI: -1.54– -0.002, Figure 1b). Transitioning to a web-based asynchronous delivery model correlated with an expanded reach of DERM:EMD. In 2018/19, 10 dermatology residency programs participated in DERM:EMD; in 2022/23, 31 programs participated. This increase directly translates to the potential number of pa- tients impacted by the course. At year-end, residents esti- mated the average weekly number of skin cancer patients they had cared for over the preceding month. This estimate was then multiplied by 47 to account for elective and va- cation weeks, providing a conservative yearly approxima- tion of patient reach (Figure 2). With the implementation of the web-based delivery method, the estimated patient reach more than doubled compared to live-delivery (237,797 vs. 706,575). Conclusion The web-based delivery supported greater outcomes over the live-delivery in two ways: first, the ability to revisit course material over time and accommodate diverse learning styles supported greater knowledge gains; second, the improved scheduling flexibility supported expanded programmatic, and therefore patient, reach. Similar delivery methods could be considered for other specialty dermatology residency education topics. Figure 1. (A) Percent mean improvement from pre- to year-end in CNDSEI scores (self-efficacy). (B) Percent mean improvement from pre- to year-end in LDA scores (diagnostic accuracy). Figure 2. Potential number of patients impacted per academic year. Research Letter | Dermatol Pract Concept. 2024;14(2):e2024122 3 References 1. Zoom. Version 5.15.12. San Jose, CA: Zoom Video Communi- cations; 2023. 2. Canvas LMS. Version 2023-09-16.9. Salt Lake City, UT: Instruc- ture, Inc; 2023 3. Knowbly. Version 1.48.0.2. Reston, VA: Echo360 Inc; 2023. 4. Panopto. Version 14.3.0. Seattle, WA: K1 Investment Manage- ment, LLC; 2023. 5. Nelson KC, Brown AE, Herrmann A, et al. Validation of a Novel Cutaneous Neoplasm Diagnostic Self-Efficacy Instru- ment (CNDSEI) for Evaluating User-Perceived Confidence With Dermoscopy. Dermatol Pract Concept. 2020;10(4):e2020088. DOI:10.5826/dpc.1004a88. PMID: 33150029