After spending the past few weeks planning for my teaching exercise, the day had finally arrived where I would have the opportunity to lead a 30-minute session on dermatology in internal medicine to our fellow clerks. I decided on this topic because I felt that this is an area that we spend very little formalized curriculum time on (~ 1 week) and an area that people often feel uncomfortable with due to our limited experiences. The goal of my teaching exercise was to raise awareness about dermatological manifestations related to internal medicine conditions as there can be many cutaneous clues if one were to look for it on inspection.
I approached this teaching session using a mixed approach involving didactic teaching and case-based learning with interactive components.
I began the presentation with an overview of basic morphology to describe cutaneous lesions:
Then we went through a mini-quiz to describe various lesions. (However, I should have made sure to include dimensions for each lesion because it is challenging to tell on screen).
Next, I went through 2 cases involving erythema nodosum. The first case was about sarcoidosis. This gave me an opportunity to have a discussion about sarcoidosis, Lofgren syndrome, and lupus pernio. The second case was about IBD. There are a lot of extra-intestinal manifestations of IBD but the two cutaneous ones that I covered were erythema nodosum and pyoderma gangrenosum. I brought up pyoderma gangrenosum because it can be easily mistaken to be infectious in etiology but it is actually inflammatory. I then reviewed erythema nodosum, including its differential diagnoses, work-up, and management.
Reflecting on this experience, I realized that I tried to condense too much information into such a short-time period. If I were to do this again, I would have made just focused on erythema nodosum and the work-up for it, including the sensitivities and specificities for certain tests. I would have eliminated dermatological manifestations of internal malignancy all together. I would also summarized the information with a jeopardy format or have a pre- and post- mini-quiz to reflect on their learning.
-JT-
Reference(s):
1. https://dermnetnz.org/
2. https://aad.org
3. Diagnosis and management of sarcoidosis. https://www.aafp.org/afp/2016/0515/p840.html
4. Erythema nodosum. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4918049/
5. Erythema nodosum as a presentation of inflammatory bowel disease. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1174850/
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