Keeping up

By Ruth Carol, contributing writer, August 1, 2021

With an estimated 33,000 peer-reviewed, English-language, scientific journals and more than 3 million articles published each year, it’s no wonder that staying current with the medical literature is a daunting task. 

“Keeping up with medical education is crucial for physicians, and it’s harder than ever to do because we are living in an age of information overload and time compression,” noted Warren Heymann, MD, FAAD, physician editor of DermWorld Insights and Inquiries. “However, it’s important to carve out time to make sure that you’re on top of your game.”

Damon Marquis, MA, MS, AAD’s vice president of continuing professional education, agreed. “Dermatology is a competitive field, so staying current is essential,” he said. “It’s not just about obtaining continuing medical education (CME) credit to maintain board certification and licensure. It’s about engaging in lifelong learning and providing quality patient care.” 

There are ways to stay on top of the latest clinical research that make it more manageable and even enjoyable. Experts explain.

Be alert

Subscribing to scientific and medical peer-reviewed journals is a great starting point. High-quality general medical journals, such as the New England Journal of Medicine (NEJM) and Journal of the American Medical Association (JAMA), serve as a solid foundation, Dr. Heymann said. Excellent specialty-specific journals include the Journal of the American Academy of Dermatology (JAAD), JAMA Dermatology, International Journal of Dermatology, and British Journal of Dermatology. Marquis stressed not to discount international journals as research develops differently abroad and can raise questions about what is happening in this country. “It’s a great way to assess your skillset and knowledge,” he added. 

Instead of reading these journals cover to cover, Dr. Heymann suggests skimming the titles. “Reading the titles in different journals can help you refer back to the article at a later point,” he said. In fact, Dr. Heymann had to change his approach to keeping up with the medical literature due to the proliferation of journals in recent years. Nowadays, he reads through the table of contents of several journals instead of reading a couple of them cover to cover. Then he chooses one or two articles that are specific to his practice to read. 

“I recommend that people read selectively to get all the key articles that relate to their areas of practice plus the hot topics that catch their eye.”

Dirk M. Elston, MD, FAAD, the editor of JAAD, selectively reads articles about general medicine that are of interest in JAMA. He reads JAAD, JAMA Dermatology, and the dermatopathology journals cover to cover, and enjoys other dermatology journals, especially JAAD Case Reports, JAAD International, and Cutis. “There is so much good material there, it’s like getting to travel to everyone’s grand rounds without having to leave home,” he said. Dr. Elston also reads Dermatitis, as contact dermatitis remains a key area of his practice. “I recommend that people read selectively to get all the key articles that relate to their areas of practice plus the hot topics that catch their eye. That is completely appropriate,” he said, adding, “We each need to find what works best for our practices.”

David Harker, MD, FAAD, scans the alerts from JAAD, JAMA Dermatology, and NEJM for dermatology-related articles. He also gleans the table of contents of JAAD and JAMA Dermatology focusing on new treatments, trials of new therapies, and outcomes of different therapies. Dr. Heymann likes Dermatology Daily, which takes a few seconds to read through on his smartphone. Dr. Elston likes the short blurbs that keep him up to date. 

Let tech do the work

Technology has created numerous digital education opportunities from apps and online CME platforms, to podcasts that can help dermatologists stay current.

When it comes to apps, Twitter wins. Roxana Daneshjou, MD, PhD, FAAD, uses Twitter to follow dermatology journals and other science journals of interest. “I also follow scientists and clinicians whose work I am interested in,” she said. Dr. Harker uses Twitter and Instagram to follow journals. 

Dr. Harker likes the Academy’s Question of the Week and Case Challenge that offer opportunities to test one’s knowledge. “The cases are interesting and I always learn something.”

Dr. Heymann highly recommends Question of the Week. He also encourages every board-certified dermatologist to join CertLink®, the American Board of Dermatology’s (ABD’s) alternative to its 10-year Maintenance of Certification (MOC) exam. CertLink is an article-based assessment that enables dermatologists to keep up with general dermatology, but also concentrate on their subspecialty and it can be tailored to their practice. “It’s a phenomenal way to keep learning and growing over time,” said Dr. Heymann who serves as a director on the ABD. 

Regarding podcasts, Dialogues in Dermatology is the only podcast that Dr. Daneshjou listens to. “I find it to be a really useful way to learn the latest in dermatology,” she said. 

In addition to being informative, these digital education opportunities are convenient. If a patient cancels and the dermatologist finds that they have 15 minutes to spare, the dermatologist can fit in a digital education session, Marquis said. 

Use social media

Social media platforms, such as Twitter and Facebook, are fast replacing the in-person journal club. Twitter journal clubs are especially beneficial for small specialties, such as dermatology, because they allow dermatologists to share knowledge across institutions, Dr. Daneshjou said. Plus, they help promote the specialty to a wider, cross-specialty audience highlighting the dermatologist’s role in patient care. Another advantage of Twitter is that the conversations are recorded, allowing people to comment after the fact, which is especially helpful for participants from different time zones, she added. 

Dr. Harker participates in the #DermTwitter journal club because he can interact directly with authors. Sometimes they tweet about their published articles and may include threads that almost serve as an expanded article abstract. He has reached out many times to authors to discuss their papers. More and more dermatologists are getting on Twitter, Dr. Harker noted. 

Using his handle @HarkerDavid, he posts educational cases on Twitter as well. When Dr. Harker comes across an interesting case or valuable educational information, he first gets signed consent from the patient and then posts a picture and asks, “What is your ddx?” Later in the week, Dr. Harker presents a recap and summary of the diagnosis. “Twitter is a unique space that has allowed me to contribute to medical discussions for other providers and lay persons,” he said. 

“Twitter is a unique space that has allowed me to contribute to medical discussions for other providers and lay persons.”

“I’ve learned different perspectives and conversed with dermatologists who I probably wouldn’t have connected with as they are outside of my training sphere,” Dr. Harker added. In dermatology, many clinical trials are small and established standards of care to treat rare skin diseases are lacking, he said. Sometimes, small case series and anecdotal reports are all there is. Especially in those cases, it helps to obtain different perspectives from experienced clinicians. 

Dr. Daneshjou also believes that #DermTwitter is a great place to find teaching, pearls, and the latest research. In addition, Global Dermatology Talks has been holding twice-monthly virtual talks throughout the COVID-19 pandemic, providing a way for dermatologists to connect and learn for free, she said. The series features diverse speakers from around the world sharing the latest in clinical and scientific advances. 

In 2018, Dr. Daneshjou started @DermatologyJC journal club to create a space to focus on the latest research. To date, it has more than 3,900 followers. Since COVID-19, topics have included transitioning to virtual visits and continuing residency training. More recently, the registry-based study of cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination was discussed. Esther Freeman, MD, PhD, FAAD, the principal investigator of the COVID-19 Dermatology Registry, and several other authors were available to answer questions during the chat. “Having the authors of the study available for discussion enhances the opportunity to learn more,” said Dr. Daneshjou. Joint meetings with other specialties tend to draw the largest number of participants like the one with nephrology to discuss the dermatologist’s role in managing immunosuppressed kidney transplant patients at higher risk of skin cancer. 

Prioritize in-person and digital education

Despite the return of in-person meetings, such as the AAD Summer Meeting Aug. 5-8, in Tampa, Florida, there will still likely be virtual meetings and other digital learning opportunities. “The future will likely be a hybrid of in-person and virtual meetings,” Dr. Elston said. “People will want to tune in even when they can’t travel.”

Dr. Elston finds the interactions in live sessions more engaging, and he tends to retain the material better compared with virtual sessions. “For many of us, this is how we maintain ties with friends from our past,” he said. “I would never want to give up that aspect of an in-person meeting.”  

Dr. Heymann attended many valuable lectures at AAD VMX 2021 but is looking forward to going to in-person meetings once again. “When you go to a meeting, you get immersed in it,” he said. “You leave everything behind.” A full day of lectures is broken up with exhibits and networking. In contrast, sitting in front of a computer for four-plus hours while juggling work and home responsibilities can be daunting, Dr. Heymann said. 

Dr. Harker hopes that a virtual option will be offered for all conferences moving forward. “You can pay to come to the conference in person or pay less to stream it,” he said. Dermatologists in the same practice will benefit from a virtual option because they can rotate attending in-person meetings with virtual ones, Marquis said.

Like virtual meetings, digital education lacks a personal connection, but it is incredibly valuable and convenient, Marquis added. The AAD offers various educational courses, many of which are online, to help dermatologists stay on the cutting edge. He encourages members to regularly check the Academy’s website for new educational offerings. The AAD will be upgrading to a more user-friendly learning management system that will allow for even more on-demand educational activities. The new system is expected to go live in 2022. 

Make time

Staying current takes grit and persistence, Dr. Heymann said. “It has to be made a priority by carving out time in your schedule to divorce yourself from the daily grind of responsibility,” he said. It could be 30 minutes a day or two hours a week, depending on the individual. “Whatever schedule you set for yourself make sure it is high-impact time,” Dr. Heymann added. He sets aside about six hours a week to work on DermWorld Insights and Inquiries. “Writing these columns forces me to delve into and enjoy real learning,” he said. 

Knowing one’s peak hours for learning can help, Dr. Elston noted. For some, it’s early morning. For others, it’s evening when everyone else goes to bed and they have quiet time. Still, others need to get away from work and home to devote their full attention to a topic. “I am an early morning guy and much of my reading takes place on the elliptical machine,” he said. “When I’m reading something interesting, I don’t even feel the burn in my legs. But it’s different for everyone; find what works for you.” 

Knowing one’s learning style is also beneficial, Dr. Heymann said. “For some, it’s listening to a lecture or reading an article. For others, it’s going to conferences. Everyone learns differently. It’s important to develop a plan that works best for you.” 

“Exercising is a priority for my overall physical health. Staying current should be a priority for every dermatologist’s overall professional health.”

Dr. Harker’s goal is to read three to four journal articles per week either during lunch or if he has down time during clinic. “It doesn’t take long to cruise through an article,” Dr. Harker noted. “I try to do as much as I can at work as I like to be present when I’m home.” 

Dr. Daneshjou likes to read several research papers a week whenever she can fit them in. “I’m always checking to see what the dermatology journals have featured on their social media accounts,” Dr. Daneshjou said.

Another option is to create “your own educational opportunity,” Dr. Heymann suggested. As an example, focus on questions a particular patient asked and conduct a literature search to answer those questions. “This is a very valuable exercise and is easy to make part of your routine,” he said. Another take on this is to identify a difficult case each week, using that patient as a springboard to seek out additional education, Marquis said.

Dr. Harker recently did this with a patient who had persistent pernio following COVID infection. He contacted Dr. Freeman, who presented at the @DermatologyJC journal club on the topic, and she sent him a recent article she wrote about prolonged skin disease after COVID infection that was very helpful. 

Dr. Heymann views keeping current the same as exercising every day. “You won’t notice a difference after a week, but after a year, you will,” he said. “Exercising is a priority for my overall physical health. Staying current should be a priority for every dermatologist’s overall professional health.”

Additional DermWorld Resources