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Following the clinical experience, a debrief session discussing sociocultural and dermatological factors of neglected tropical diseases occurred. Results: The feedback obtained regarding the simulation was exceptionally positive. The participants indicated that the simulation improved their medical knowledge of neglected tropical diseases, diagnostic abilities, and interprofessional communication skills. Discussion: This simulation can easily be adapted for use in conferences, health professional education, and patient advocacy, making it relevant for training in a wide variety of settings.
Through the application of this simulation, greater progress can be made in the education of medical professionals on neglected tropical diseases and dermatology. Not only will the application of realistic workshops increase medical competency regarding these rarely encountered diseases, it will also provide opportunities to engage with these diseases, which can cultivate interest in the future pursuit of global health.
Keywords Educational Objectives By the end of this session, participants will be able to: Describe the public health impact in the developing world of neglected tropical diseases and the reasons why clinicians in the United States should be able to recognize and correctly diagnose these conditions. Use the information gathered from the medical history and physical examination of a standardized patient to correctly identify four common neglected tropical diseases.
Briefly summarize the epidemiology, symptoms, dermatologic findings, diagnostic workup, and treatment of eight common neglected tropical diseases.
There is a significant need to increase public and medical involvement in the eradication of NTDs. However, little has been done on the integration of simulations and workshops in graduate education as a means to address this educational need. Due to the wide variation of participant background knowledge, no prerequisite training or knowledge was required for the simulation.
Our target audience included interprofessional graduate and undergraduate health students and staff from the fields of medicine, pharmacy, and nursing. Although there are ample studies on the importance of dermatologic education, few resources are available for integrating NTDs. Previous team-based learning TBL exercises have taught common dermatologic characteristics with significant success.
The Yale School of Medicine has implemented a Skin Signs of Systemic Disease TBL in its curriculum in order for learners to gain knowledge from written material and apply it to a clinical picture in real time at a clinical practice simulation. This class combines topics with practical skills such as monitoring of active labor and basic tooth extraction. This specific simulation focused on the dermatologic clinical presentation of these neglected diseases. By educating medical professionals on the dermatologic presentations, the importance of successful containment of NTDs can be brought before the public.
Public awareness and media coverage may increase funding and community engagement to help foster pharmaceutical research and intervention strategies and increase the global effort necessary to eradicate NTDs. Methods The target audience for this resource is interprofessional graduate and undergraduate health students and staff from the fields of medicine, pharmacy, and nursing.
Required personnel include four standardized patients, four makeup artists, one board-certified dermatologist, and three simulation directors. Preparation The three simulation directors designed the simulation to represent patients presenting with dermatologic manifestations of NTDs. We created four cases with patients demonstrating clinical presentations of dengue fever, cutaneous leishmaniasis, lepromatous leprosy, and yaws. The goal of the simulation was to have participants assess, diagnose, and improve medical knowledge regarding NTDs with dermatologic manifestations while working in an interdisciplinary team.
After designing the simulation, the first task was to prepare the four standardized patient actors for their roles. The standardized patient roles were played by four medical students.
Two weeks prior to the simulation date, the patient scripts were finalized. They were emailed out to the standardized patient actors, ensuring adequate time for them to memorize and assimilate their roles. The scripts were meant to be a guideline, and the patients were allowed to improvise if desired.
We recruited three medical students and one faculty member with varying backgrounds in moulage skills, ranging from little skill to an undergraduate degree in theater, to artistically portray the cutaneous lesions of dengue fever, cutaneous leishmaniasis, yaws, and lepromatous leprosy on the standardized patient actors. One week before the simulation, we hosted a practice session for our moulage artists. We found instructions on how to use the moulage kit to represent yaws, cutaneous leishmaniasis, and dengue through various sources on the internet.
Based on the practice session, we determined that 2 hours would be necessary for setup on the day of the simulation. See Appendix H to view photographs of the moulage disease replications.
Moreover, for future replications of this simulation, it would be highly beneficial to have another blinded dermatologist view the moulaged patients and confirm that the dermatological presentations are accurate. This allowed the participants to have access to clinic resources such as ophthalmoscopes, reflex hammers, and blood pressure monitors as needed to perform a physical exam on the standardized patients.
However, these clinic resources are not essential for the simulation and can be easily adapted for future replications. The simulation lasted a total of 50 minutes and was broken down into the following time line.
Each group consisted of a maximum of four students, and each group visited a total of four rooms representing four different diseases: Three minutes: introduction by conference host to explain the simulation and divide the participants into groups. Twenty-four minutes: 6 minutes per room times four rooms. Three minutes: walk to student group learning room, located in a different area of the building.
Five minutes: debrief portion to allow the students to diagnose the four diseases. Fifteen minutes: debrief with a PowerPoint by the dermatologist. Postsimulation survey received by email Appendix I.
These time limits were determined with the aim of allowing maximum time for interviewing patients and discussion within the allotted total 50 minutes.
The simulation templates for each disease portrayed by the standardized patient actors can be found in Appendices A-D. Upon arriving at the patient room, participants found a sheet with vital signs and physical exam findings Appendix E posted on the door.
This allowed the participants to receive expedited pieces of information, necessary because of the limited window of time available to assess each of the standardized patients. Each participant received a clipboard with blank sheets of paper to take notes. The participants interviewed, examined, and assessed the standardized patients. After evaluation of each patient, participants were handed a fact sheet on either epidemiology, photographs of dermatologic presentation, treatment, common symptoms, or diagnostic workup Appendix G.
After groups had assessed all of the standardized patient actors and received all five fact sheets, there was a 5-minute session to work together to discuss differential diagnoses for each case. The participants used the fact sheets to synthesize information received from the standardized patients and come up with a diagnosis. Afterwards, these results were checked and discussed with a board-certified dermatologist regarding the correct disease association, with an emphasis on the dermatologic presentation.
Assessment and Debriefing After the minute simulation came a minute postsession debrief, which we believe was beneficial in encouraging solidification of the material. The first 5 minutes of this debrief were dedicated to allowing the students to work together with their notes and fact sheets to diagnose the four dermatological diseases they had witnessed.
Then, a minute small-group discussion with a PowerPoint debrief was led by the dermatologist.