Introduction
Continuing medical education (CME) involves educational and professional opportunities for healthcare providers (HCPs) to develop, maintain, and broaden their knowledge and skills. Historically, post-medical school and residency training, physicians have had somewhat limited opportunities to keep up with new information. In more recent times, there are both increased requirements for HCPs to adhere to continuing education, as well as novel methods for the delivery of professional educational material. While conventional CME methodologies are more accessible and well-known, newer approaches to CME are increasingly important for HCPs. For example, with respect to education focused on integrative approaches to medicine, new developments may not be as readily published or acknowledged by conventional journals and scientific research platforms and thus may be better represented in other formats.
Through evolving technology and the onset of the digital era, awareness should be brought to an expanded toolbox of delivering continuing education to HCPs. While our focus will be on dermatology, these concepts are by no means limited to any specialty. The time-honored “three P’s” historically consisted of Posters, Podium (ie, scholarly lectures), and Publications. We propose that there are at least four additional novel “P’s” by which HCPs may continue maintaining their medical competencies and improving patient care. The “seven P’s” that include both conventional and novel ones are as follows: Posters, Podium, Publications, Podcasts, Play, Peer-to-peer, and Patient interactions.
The Three Conventional P’s: Posters, Podium, & Publications
Among the numerous ways to earn CME credits, many physicians attend scientific meetings where medical literature is presented in the form of a poster or through formal presentations. Traditional dermatology meetings such as those held by the AAD (American Academy of Dermatology) typically feature case presentations, posters of novel advances in the field, discussions by researchers and practitioners, and a wide variety of evidence-based lectures on various topics. The AAD also allows physicians to claim CME through reading journal publications and completing multiple-choice questions that meet requirements.
Scientific meetings in which posters and presentations were the predominant form of continuing education quickly halted at the start of the COVID-19 pandemic. While in-person meetings and travel were prohibited, the medical field witnessed rapid advancements in bringing technology to the forefront of education.1 These various means of technology and learning have proved to be favorable in delivering professional opportunities for growth. A few of the novel modalities that are making considerable traction in this arena include but are not limited to, podcasts, play, peer-to-peer, and patient interactions.
The Four Novel P’s: Podcasts, Play, Peer-to-Peer, and Patient Interactions
Podcasts
Medical podcasts have gained popularity over the last several years as a medium of disseminating education for students and healthcare professionals.2 Although originally developed as a form of entertainment, podcasts are now available from several medical journals such as the New England Journal of Medicine.3 Podcasts allow for a quick way to deliver up-to-date information, evidenced-based data, as well as various perspectives from practicing clinicians. Compared with traditional methods of delivering new information, podcasts allow for more flexible learning, reduce the burden of time-consuming CME activities during already busy HCP schedules, and are generally more accessible and cost-efficient.2 Through their investigation of medical podcasts, Newman et al suggest that despite the challenges of developing high-quality podcasts, continued professional development delivered via podcasting should be more routinely considered by pharmaceutical companies and can ultimately improve patient care.2 Although industry use of podcasts to communicate novel therapies and such may be beneficial, care must be taken by listeners as such podcasts may be incentivized to positively portray products.4 Overall, however, medical podcasts appear to be an efficient and effective method of communicating new information with HCPs and engaging the medical community.
In a recent publication reviewing podcasts in dermatology, 35 dermatology-related podcasts were found, including six associated with peer-reviewed journals and five that offer continuing medical education credit.4 Content encompassed clinical dermatology, alternative medicine, aesthetics, patient perspectives, applying to dermatology residency, and business of medicine, among other topics. When investigating the quality of these podcasts, multiple podcast hosts were not dermatology clinicians, particularly in alternative medicine topics.5 Given the nature of integrative medicine as an evolving field gaining acceptance in the medical community, podcasts created by board-certified dermatology experts in alternative medicine may allow for more accurate information to be distributed. On the other hand, this may also allow for fresh perspectives on topics previously unavailable to conventionally trained dermatologists. Through increased regulation and peer-reviewing processes for medical podcasts, achieving higher quality podcasts could be beneficial to create a more reliable way to disseminate updates and educational material to HCPs.
Play – Gaming & Simulation Technology
A “serious game” is defined as a digital application created for the purpose of providing professional health education.5 Serious games relate to the concept of “gamification” which ultimately defines the application of these games to the real world.5 Gaming has the potential to provide HCPs with unique and active learning opportunities that can help develop analytical and psychomotor skills such as critical thinking, multitasking, and tactical skills.5,6 In a large Cochrane systematic review by Gentry et al, serious gaming/gamification showed an increase in knowledge, skills and satisfaction when compared to traditional education and other modalities of digital education.5 Although they are still yet to be integrated into medical curricula and formal learning, serious games may be effective as a medium of professional development to ultimately improve health outcomes.7,8
A more recent platform that has gained popularity in the realm of medical games is the use of a smartphone application. Smartphone applications created by physicians allow for a reliable source of digital health education. A recent dermatology game created with the input of multiple board-certified dermatologists provides HCPs the opportunity to engage in a broad spectrum of dermatology scenarios.9 With the inclusivity of different skin tones and the ability to render even the rarest conditions, image and question-based games offer CME opportunities that are applicable to a diverse array of patient scenarios. Additionally, more complex and longitudinal scenarios can be modeled in a game setting in ways that conventional education cannot. Medical game smartphone applications are a unique venue for continued professional development that create cost-efficient, easily accessible, and time saving opportunities, which are all qualities of CME that are desirable by many HCPs.9
In addition to medical video games, simulation is another method of supplementing training that creates real-life scenarios, in a controlled setting with reproducible conditions, to measure skillsets. The goal of simulation technology is to engage learners to experience a simulated scenario followed by effective feedback and debriefing.10 In a study by Hazan et al evaluating the impact of cadaveric simulation on the training of dermatology residents, residents had significantly higher confidence in their knowledge of surgical anatomy and surgical skills.11 Skin simulation for dermatologic surgery is important for continued training in various cutaneous surgical techniques. Simulation technology is an effective way to provide such opportunities for not only dermatology residents but for the maintenance and development of novel surgical techniques for board-certified dermatologists.
Peer-to-peer
Peer-to-peer learning involves collaborative learning where colleagues and health professionals can share knowledge and support each other to achieve greater health outcome goals. Peer-to-peer medical education can involve conversations among HCPs, online interactive sessions among various experts, and the use of social media as a platform for distributing knowledge. Over the past several years, social media has gained popularity as a convenient means of reaching large audiences for educational purposes. Since the COVID-19 pandemic, the use of social media has rapidly grown and become a healthcare tool for patient education and professional communication.12
Dermatology in particular, has witnessed an increase in the use of social media platforms such as Twitter, Facebook, Instagram, TikTok, and YouTube to share content. For example, dermatology journals such as Journal of the American Academy of Dermatology (JAAD) and Journal of the American Medical Association (JAMA) Dermatology post updates on the latest publications using both Twitter and Facebook.13 In 2018, there were 22 dermatology journals active on Facebook, and 21 journals active on Twitter; both numbers which are likely to have increased since the start of COVID-19. Additionally, organizations with a substantial following, such as “dermRounds Dermatology Network” keep dermatologists up to date with new research and guidelines.13
Peer-to-peer is another methodology by which experts in integrative medicine can share knowledge with other HCPs seeking to provide patients with alternative treatments to conventional medicine. Inter-professional education (IPE) where two or more professions learn from one another to foster collaboration, is another way in which dermatologists and experts in integrative medicine can engage and discuss individual successes and failures with various approaches.14 Since continuing interprofessional education (CIPE) is its own entity in the United States, more formal approaches to CIPE as a means of CME requirements for health professionals may be beneficial to allow for integrative learning to be more accessible.15
Patient Interactions
Simulating patient interactions is another opportunity for HCPs to further their skills and enable improvement in many areas of patient care. In a pilot study of a simulation-based workshop, dermatologists identified that practicing and improving communication skills through feedback from patients in different scenarios was beneficial to both patient and physician experiences.16 This study identified that the lowest-scoring skills were allowing patients to share their “narrative thread,” providing a summary of the patient’s history, and assessing patient understanding.16 By participating in patient interaction workshops such as this one, HCPs can better tailor their communication skills to the areas identified by patients as necessitating improvement. The incorporation of opportunities to practice and improve communication skills as a part of continuing medical education can contribute to increased patient and physician satisfaction.
In addition to simulated patient interactions, patient-centered feedback from real-life medical encounters is another opportunity for HCPs to improve upon existing interpersonal skills and develop treatment plans that incorporate patients’ perspectives in their health outcomes. An example of such a patient-centered process developed to improve adherence, prevent complications, and improve quality of life (QoL), is therapeutic patient education (TPE). TPE involves a multidisciplinary team of healthcare professionals who facilitate the process of understanding patients’ knowledge and hopes, setting objectives, and subsequently helping patients acquire necessary skills.17 According to worldwide surveys of experts in the field, TPE has been shown to positively affect patients with atopic dermatitis by preventing disease complications, improving autonomy, and increasing patient QoL.18,19 By incorporating patient feedback platforms and patient interactions into continued medical education, HCPs can create processes such as TPE which have proven to impact chronic conditions with previously suboptimal therapeutic outcomes.19
An additional consideration for patient-driven learning and interaction is the concept of HCPs utilizing technology and resources that the general public can access for health education. Incorporating these means of gaining knowledge can advance healthcare literacy of the public and improve patient and provider communication. By utilizing many of the platforms discussed, including podcasts, social media, videos, and gaming applications, HCPs can communicate with patients in novel ways, perhaps leading to more effective communication in some cases. With an increase in access to technology with advanced video language translation, subtitles or other accessible features for example, HCPs can reach a larger audience with ease and leverage these same features to further their own education. For instance, video conferencing, a widely utilized tool that has increased in utility after the COVID-19 pandemic, is one of many examples by which both HCPs and patients can learn from. Whether it is a video-based informational session on a novel therapy or an integrative approach to managing a condition, both patients and providers can utilize the technology to further their knowledge. Users of video conferencing applications can broadcast lectures to viewers from anywhere in the world, allowing guest speakers and learners flexibility to attend from various locations.20 Further, these applications allow multiple users to interact, comment, share documents, broadcast presentations, or record meetings.20 The ease and convenience of such technologies allows for both the general public and HCPs to learn from platforms that will ultimately allow better patient communication.
Discussion & Conclusion
As medical education evolves with the onset of new technology, digital health, and environmental factors, it is important to consider different approaches of delivering new information to HCPs. While posters, presentations, and publications remain the conventional methods to disseminate information and maintain competencies within the medical field, more novel venues of professional development such as podcasts, gaming, social media, and patient interactions are growing. While studies have shown inconclusive results in the efficacy of digital education in dermatology, these results may be attributable to low-quality evidence and the lack of effective research on newer methods of continuing medical education.21 With the increase in educational podcasts, serious games, and social media presence among other modalities of disseminating information, high-quality research is needed to further support digital health education as a means of continuing professional development for HCPs.
Furthermore, as we examine the methods by which providers can gain access to updates in integrative medicine topics, they are few and far between. The more novel methods of communicating medical education represent new opportunities for all clinicians, but especially for those interested in integrative dermatology that may not have as much representation in other formats. Not only are these methods an opportunity for clinicians to update other HCPs, but likewise for HCPs to gain new perspectives and evidence-based data to better care for patients. Equally important, professional medical organizations and societies must evolve to acknowledge and support these newer venues as means of meeting continuing medical education requirements.
Funding
No sources of funding were used to prepare for this review.
Conflicts of Interest
Dr. Lio reports research grants/funding from AOBiome, Regeneron/Sanofi Genzyme, and AbbVie; is on the speaker’s bureau for Regeneron/Sanofi Genzyme, Pfizer, Incyte, Eli Lilly, LEO, Galderma, and L’Oreal; reports consulting/advisory boards for Almirall, ASLAN Pharmaceuticals, Bristol-Meyers, Concerto Biosciences (stock options), UCB, Dermavant, Regeneron/Sanofi Genzyme, Merck, Pfizer, LEO Pharmaceuticals, AbbVie, Eli Lilly, Micreos, L’Oreal, Pierre-Fabre, Johnson & Johnson, Level Ex, KPAway (Stock) Unilever, Menlo Therapeutics, Theraplex, IntraDerm, Exeltis, AOBiome, Realm Therapeutics, Altus Labs, Galderma, Verrica, Arbonne, Amyris, Bodewell, Burt’s Bees, My-Or Diagnostics, Sibel Health, and Kimberly-Clark. In addition, Dr. Lio has a patent pending for a Theraplex product with royalties paid and is a Board member and Scientific Advisory Committee Member of the National Eczema Association and an investor at LearnSkin.