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E-IJD® - SHORT COMMUNICATION
Year : 2022  |  Volume : 67  |  Issue : 3  |  Page : 313
An analysis of interns' feedback after dermatology posting


1 Department of Dermatology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
2 Department of Skin and VD, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India

Date of Web Publication22-Sep-2022

Correspondence Address:
Satyaki Ganguly
Department of Dermatology, All India Institute of Medical Sciences, Raipur - 492 099, Chhattisgarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.ijd_259_22

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   Abstract 


Background: Dermatology knowledge among fresh medical graduates is poor in India as undergraduate medical curriculum and Internship training lack adequate focus on this subject. This contributes to the inappropriate management of Dermatology patients by the medical graduates. Objective: To analyse the expectations, motivations and experience of interns during their dermatology posting. Materials and Methods: This was a retrospective record review of questionnaire-based anonymous validated feedback forms submitted by interns posted in a dermatology department of a tertiary care institute. The feedback form contained nine multiple choice questions some of which allowed multiple responses. Results: A total of 63 completed forms were analysed. The common expectations before the posting were, to learn the management of basic dermatological problems (98.4%), to take an informed decision regarding post-graduation in dermatology (53.9%) and hope that the posting will be useful for the postgraduate entrance test (50.7%). After the posting, 69.87% of them felt that their expectations were fulfilled. After the posting, 84.1% of the interns felt that they would have liked to study dermatology as a separate undergraduate subject with a summative assessment at the end. Limitations: The sample size was less and the feedback form contained limited questions. Conclusion: The majority of the interns were satisfied after dermatology posting. Increased exposure of interns to dermatology inpatients and side laboratory procedures will further enrich their clinical experience. The inclusion of dermatology as a separate subject with examination in the undergraduate curriculum was a felt need.


Keywords: CRRI, dermatology, internship


How to cite this article:
Ganguly S, Jaykar KC, Chhabra N, Prabha N. An analysis of interns' feedback after dermatology posting. Indian J Dermatol 2022;67:313

How to cite this URL:
Ganguly S, Jaykar KC, Chhabra N, Prabha N. An analysis of interns' feedback after dermatology posting. Indian J Dermatol [serial online] 2022 [cited 2022 Sep 30];67:313. Available from: https://www.e-ijd.org/text.asp?2022/67/3/313/356731





   Introduction Top


At present the undergraduate medical students get very little exposure to dermatology in their curriculum. There are limited theory lecture classes and a short duration of clinical postings for dermatology in the undergraduate medical course without any summative assessment at the end. After clearing their final examination, they are offered an optional 15 day posting in dermatology during their Compulsory Rotating Residential Internship (CRRI). Therefore, they remain ill-equipped to treat even basic dermatological problems which form a significant proportion of patients at the primary care level. As a result, dermatological problems are not managed adequately at the primary care level and tend to become complicated by the time the patients present to a dermatologist. In this present scenario, the most effective intervention could be the conversion of Dermatology posting during the internship from optional to compulsory as well as improvement in the quality of training during the internship. This however is further complicated by the usually crowded dermatology out-patient, shortage of faculties and the focus on the training of postgraduates in institutes with post graduate training programmes. To help with finding a solution in order to improve the quality of training of interns in the present scenario and facilities, we should have some basic information about the motivation and expectation of the trainees (interns) and their experience of the training during Dermatology posting at present and the perceived shortcomings. The department of dermatology, as a departmental policy collects anonymous voluntary feedback from the interns, after completion of their posting to assess their feedback regarding the quality of training. The questions are focused on the motivation and expectations of the interns and their experience of the dermatology posting. A systematic assessment of the feedback could help in identifying potential areas for intervention to improve the Internship training programme. Therefore, we aimed to analyse the expectations, motivations and experiences of interns during their dermatology posting.


   Materials and Methods Top


A draft questionnaire-based feedback form was designed and sent for peer review to four dermatology faculties in different medical colleges in India. They assessed the content validity of the draft questionnaire and the questionnaire was modified depending on their feedback. Further, 10 interns posted during October, November and December 2017 were given this feedback form for testing inter-rater reliability and their responses were analysed to further rephrase the questions. The questionnaire included questions based on domains of attitude, perception and experience. Questions 1, 3 and 4 allowed multiple responses while the rest allowed only one response. Question number 10 was deliberately kept as an open ended comments section to analyse the comments and further modify the questionnaire. The anonymous voluntary feedback forms were handed over to the interns after signing their logbook certifying the completion of their dermatology posting and they were requested to fill it up and submit it to the departmental office in a drop box at a later date. This was a retrospective record review of questionnaire based feedback forms (Annexure 1) conducted over a period of 2 months after obtaining clearance from the institute ethics committee. We included all available completed anonymous feedback forms submitted by interns posted in the department of dermatology from January 2018 to December 2019 and excluded incomplete feedback forms. Data in the form of responses to each question was entered in an excel sheet. Statistical analysis was done using SPSS (statistical program for social science version 21), and the frequency was expressed in percentages. Some of the questions in the feedback form were interlinked (example - questions no 1 and 2, Annexure 1). Chi square test was performed to determine the significance of responses to those questions.


   Results Top


Out of 157 interns posted in the department of dermatology in this time period, 78 submitted the anonymous voluntary feedback forms. A total of 63 (Response rate of 40.1%) completed feedback forms were analysed. The common expectations among the interns before they started their dermatology rotation were to learn the management of basic dermatological problems (98.4%), to take an informed decision on whether they would like to do post-graduation in dermatology (53.9%) and the hope that the posting will be useful for post graduate entrance test (50.7%). Analysing further, 26.98% of the interns had a single expectation [Figure 1]; learning management of basic dermatological problems whereas 20.63% had all 3 mentioned expectations and 19% wanted to learn about management of basic dermatological problems and wanted to decide on postgraduation in dermatology. USMLE and cosmetology were among the expectations for only three and four interns, respectively. After the posting, 69.84% felt that their expectations were fulfilled whereas the expectations were only partially fulfilled for 28.57% of them. All (100%) of them felt that they learned the management of basic dermatological problems, while 77.7% felt that they learned to explain the correct use of medicines to the patients. 76.1% opined that they saw some rare cases and 71.4% performed some side laboratory procedures like KOH preparation. On analysing the pattern of responses, 26.98% of them felt that they learned management of basic dermatological problems, saw some rare cases/syndromes, performed some side lab procedures like KOH mount and instructed the patients about the correct use of prescribed medicines [Figure 2]. About 71.4% felt that lack of space in the OPD was the main difficulty during the posting, whereas 33.3% of them felt it was less number of inpatients in the wards, while 20.6% felt the excessive paper work was a difficulty. Lack of space was the only difficulty among 49.2% of interns whereas 9.5% felt only less number of dermatology inpatients was a problem and 15.8% felt both of these factors were important. However, 12.6% of interns felt that there was no difficulty. As many as 98.4% agreed that explaining the correct use of medicines to the patients was a learning experience for them. About 60.3% thought that the duration of the posting was adequate, while 31.7% felt that the duration was too short. About 96.8% of them felt that the dermatology posting will turn out to be useful in their future professional carrier. After the posting, 84.1% of the interns felt that they would have liked to study dermatology as a separate undergraduate subject with a summative assessment at the end. 49.2% of the interns felt that they would like to do post-graduation in dermatology after finishing the posting, while 28.5% were not sure about it. On analysing the co-relation between Q7 and Q9, we found that out of the interns who thought that the posting will turn out to be useful for their future professional carrier only 49.1% wished to join post-graduation in dermatology in the future [Table 1]. Similarly, analysing the co- relation between Q8 and Q9, we found that out of the interns who thought that they would have liked to study dermatology as an undergraduate examination subject only 52.8% wished to join post-graduation in dermatology in the future [Table 2].
Figure 1: Expectations from internship (responses of Q1 of annexure 1). (a. Will be helpful for licencing exams to go abroad e.g., USMLE. b. Will be useful for post graduate entrance test. c. To learn the management of basic dermatological problems. d. To decide whether you would to like to join dermatology for post-graduation. e. To get some idea about cosmetology)

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Figure 2: What did you learn from dermatology posting (responses of Q3 of annexure1) (a. Management of basic dermatological problems like Tinea, Scabies etc. b. Saw some rare cases/syndromes. c. Performed some side lab procedures like KOH mount. d. Just routine work like filling up forms/entering investigation results. e. Instructing the patients about correct use of prescribed medicines)

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Table 1: Co-relation between Q7 and Q9

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Table 2: Co-relation between Q8 and Q9

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Discussion: Very few studies focused on training of undergraduate students and interns in dermatology are available in the English literature, to the best of our knowledge. A study in 1977 compared the improvement of the performance of undergraduate students after a 4-week elective training in dermatology with pre and post tests with a control group.[1] A similar study conducted in 1990 also found significant benefits of a 4-week dermatology training for both internal medicine residents and fourth-year medical students. However, these studies primarily assessed the knowledge gained from the training, rather than the felt needs of the trainees. Moreover, The results of studies conducted in the United States cannot be extrapolated to the Indian scenario because of vast differences in the undergraduate medical training programme and health care systems.[1],[2] We found only one study from India, which used a pre and post-test method to assess the effectiveness of the dermatology posting during the internship in imparting cognitive skills related to common skin problems.[3] However, that study concentrated on the assessment of dermatology knowledge alone and not attitude or affective skills.

The common expectations among the interns before starting the internship in dermatology mirrored their aspirations and concerns during the internship as expected; post-graduate entrance test and choice of subject for post-graduation. However, the most common expectation was learning management of basic dermatological problems, indicating the majority of them were still in-sync with the basic reason for internship. Contrary to popular belief, USMLE and cosmetology were the priority for very few. The majority of them were fully or partially satisfied after the posting, indicating that broadly the training is as per their expectation. Apart from the management of basic dermatological problems, the majority of the interns gained some experience in the complexity of dermatology therapeutics and also dermatology side lab procedures. Lack of space in dermatology OPD is a common occurrence because of the relatively higher number of patients and often the low priority accorded to Dermatology while designing and space allocation in a hospital. Excessive paper work is a common difficulty in all departments during the internship. The relatively less number of inpatients in dermatology reflects the reality that only seriously incapacitated dermatology patients agree to undergo inpatient care. Almost all of them felt that the experience they have gained from dermatology posting will be useful in the future. This validates the perception that the internship in dermatology should be compulsory, instead of being elective. A very high percentage of interns would have liked to study dermatology as a separate undergraduate subject with an examination at the end, indicating the present undergraduate dermatology training is inadequate. We found that even among interns who do not plan to do post-graduation in dermatology, a significant number felt that this dermatology posting will be useful for their future professional carrier and dermatology should be as an undergraduate subject with an examination at the end. This is indeed true because a majority of systemic disorders have common dermatological manifestations and identification of those manifestations provides an opportunity for early diagnosis and better outcomes for those systemic disorders.

However, ours was a single centre study with small sample size and low response rate, so the generalizability of the conclusions is limited and multicentric studies with larger sample size will be ideal. The use of electronic reminders could have enhanced the response rate.


   Conclusion Top


Inclusion of Dermatology as a separate undergraduate examination subject will be commensurate with the dermatological disease burden and it's importance in a clinical setting. Internship in dermatology should be made compulsory rather than elective because the undergraduate training in dermatology is inadequate. Dermatology training is a felt need among interns and those who underwent the training, clearly benefited from it.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.


   Annexure 1 Top


Dept. of Dermatology

Internship feedback form (Multiple answers are allowed)

  1. What was your expectation from the internship period in the dermatology department, when you joined?


    1. Will be helpful for licencing exams to go abroad e.g., USMLE
    2. Will be useful for post graduate entrance test
    3. To learn the management of basic dermatological problems
    4. To decide whether you would to like to join dermatology for post-graduation
    5. To get some idea about cosmetology
    6. No expectations at all/Didn't really think about it


  2. Was your expectation fulfilled?


  3. a. Yes b. No c. Partially

  4. What did you learn in the dermatology posting?


    1. Management of basic dermatological problems like Tinea, Scabies etc.
    2. Saw some rare cases/syndromes
    3. Performed some side lab procedures like KOH mount
    4. Just routine work like filling up forms/entering investigation results
    5. Instructing the patients about correct use of prescribed medicines


  5. What was the main difficulty during the posting?


    1. Lack of space in the OPD
    2. Too many patients
    3. OPD goes on for too long
    4. Less no of inpatients
    5. Too much clerical work
    6. Consultants/residents too preoccupied to clear your doubts


  6. Instructing the patients about correct use of prescribed medicines was useful for you?


  7. a. Strongly agree b. Agree c. Not sure d. Disagree e. Strongly disagree

  8. What is your opinion about the duration of dermatology posting (15 days)?


  9. a. Adequate b. Too short c. Too long d. Not sure

  10. Do you think this posting will turn out to be useful for your future professional carrier?


  11. a. Yes b. No c. Not sure

  12. Do you feel (after the posting) that you would have liked to study dermatology as an undergraduate examination subject?


  13. a. Yes b. No c. Not sure

  14. Would you like to join post-graduation in dermatology (your opinion after the posting)?


  15. a. Yes b. No c. Not sure

  16. Any other comments/suggestions




 
   References Top

1.
Simon PE, Bergstresser PR. Eaclstein WH. Medical education and the dermatology elective. Int J Dermatol 1977;16:760-3.  Back to cited text no. 1
    
2.
Sherertz EF. Learning dermatology on a dermatology elective. Int J Dermatol 1990;29:345-8.  Back to cited text no. 2
    
3.
Shyam Prasad AL, Reddy PKS. Assessment of cognitive skills in dermatology during internship. Int J Res Dermatol 2017;3:10-12.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

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    Materials and Me...
   Results
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