Identifying an Education Gap in Wound Care Training in United States Dermatology

July 2015 | Volume 14 | Issue 7 | Original Article | 716 | Copyright © July 2015


Emily Stamell Ruiz MD,a Amber Ingram BS,b Angelo Landriscina BA,b Jiaying Tian MD MPH,b Robert S. Kirsner MD PhD,c and Adam Friedman MDb,d

aDepartment of Dermatology, Brigham & Women’s Hospital, Boston, MT
bDivision of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
cDepartment of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL
dDepartment of Dermatology, George Washington School of Medicine and Health Sciences, Washington, DC

Abstract
IMPORTANCE: As restoration of the integument is paramount to wound healing, dermatologists should be central to managing wounds; yet this is often not the case. If a training gap exists during residency training, this may account for the observed discrepancy.
OBJECTIVES: To identify United States (US) dermatology residents’ impressions regarding their preparedness to care for wounds, and to assess the amount and type of training devoted to wound care during residency.
DESIGN, SETTING, AND PARTICIPANTS: An online survey among current US dermatology residents enrolled in a residency training program.
MAIN OUTCOMES AND MEASURES: The primary goal was to determine whether dermatology residents believe more wound care education is needed, evaluate preparedness to care for wounds, and identify future plans to manage wounds.
RESULTS: Responses were received from 175 of 517 (33.8%) US Dermatology residents contacted. The majority of residents did not feel prepared to manage acute (78.3%) and chronic (84.6%) wounds. Over three quarters (77.1%) felt that more education is needed. Fewer than half (49.1% and 35.4%) of residents planned to care for acute and chronic wounds, respectively, when in practice.
CONCLUSIONS AND RELEVANCE: There is a gap in wound care education in US dermatology residency training. This translates to a low percentage of dermatology residents planning to care for wounds in future practice. Dermatology residents need to receive focused wound care training in order to translate the underpinnings of wound healing biology and ultimately better serve patients.

J Drugs Dermatol. 2015;14(7):716-720.

INTRODUCTION

Acute and chronic wounds account for a large number of outpatient and hospital visits in the United States (US). More than 11 million patients are seen annually in an emergency room for acute wounds,1 and chronic wounds cost in excess of $25 billion and affect 6.5 million Americans each year.2 Wounds are more common in patients with co-morbidities, such as diabetes mellitus, vascular disease, and obesity, and in the elderly. As the incidence of these conditions is on the rise, so too will be the incidence of chronic wounds.1
Management of chronic wounds is complex and requires a multidisciplinary approach involving physicians, nursing/ancillary support, the patient/family, and/or the community.3 Despite the heavy burden of chronic wounds on patients and healthcare providers, outside of wound centers a standardized treatment protocol has not been incorporated into most medical centers or physician offices. As wound care technologies continue to expand, physicians encounter more wound care products. Appropriate choice of dressings and adjuvants requires an understanding of the principles of wound healing, the various products available, and the cost-effectiveness of the treatment course. Education and experience are paramount in success, especially as there is a dearth of evidence-based medicine to guide treatment protocols in wound care.3
As the integument is central to successful wound healing, dermatologists may participate in management. However, to our knowledge, there are no studies evaluating education of wound care during dermatology residency training. Therefore, we sought to subjectively evaluate the quality and quantity of wound care training from the dermatology residents’ perspective, with the primary goal of assessing whether or not residents feel prepared to care for wounds.

METHODS

This study received exempt status by the Albert Einstein College of Medicine’s institutional review board. The 114 dermatology residency programs in the US were contacted (either through an administrator or program director), requesting a list of the dermatology residents email addresses. Email addresses were collected from those programs that agreed to participate in the study. A web-based 15-item questionnaire comprised the survey, and a unique hyperlink was sent to the dermatology residents. The residents were given 2 months to
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