COVID-19: challenges and solutions for the future of UK dermatology undergraduate curriculum delivery.

The COVID‐19 pandemic has left dermatology practice in disarray globally. Patient‐facing services have been compromised for patients and clinicians alike. The implications of such disruption for dermatology undergraduate education are unknown. Numerous undergraduate programmes have faced disruption, with teaching postponed or featuring reformatted, ad hoc delivery. Following the pandemic, it is anticipated that UK medical education will face a ‘new normal’, with a much greater emphasis on technology‐enhanced learning. This presents a challenge to dermatology educators as we reflect upon our undergraduate curriculum delivery in an uncertain climate.

The most recent curriculum review occurred in 2015, and reported that, pre‐pandemic, most dermatology education was delivered via a secondary care rotation in the fourth year of study, with a strong predilection for clinic‐based observation and teaching. The report also called for greater use of online resources and collaboration between medical schools (Table 1).

Table 1

Methods of undergraduate dermatology education delivery, from 2015 BAD curriculum review.

Learning and teaching method	Medical schools
	n	%
Outpatient clinics	30	100
Tutorials	28	93
Observation of surgery	28	93
Observation of specialist nurses	26	87
Problem‐based learning	25	83
Lectures	25	83
Log book	24	80
Electronic learning	20	67
Clinical slides/images	20	67
Clinical skills laboratory	18	60
Ward based	16	53
Teaching clinic	16	53
BAD expert lectures	14	47
Other e‐lectures	14	47
Histology demonstrations	7	23
Critical appraisal	7	23
Expert patient workshops	5	17

To continue to provide patient care during the pandemic and beyond, outpatient clinics have been augmented by teledermatology, with dermatologists offering telephone or video consultations. However, this clearly presents challenges for student clinics. In such a scenario, observing clinics immediately becomes more complex, presenting practical issues that range from technical threats to patient consent and time pressures. Access to cohort‐wide lectures may be restricted, further compromising the ‘traditional’ delivery of undergraduate education.

There are numerous examples of web‐based materials in dermatology education, although the uptake of such resources is unknown, and their efficacy is poorly evidenced. However, innovations such as gamified learning have been well received by medical students and found to consolidate lecture‐based teaching. Such resources could be adapted for virtual delivery in the context of social distancing. The use of dermatology resources on social media for professionals and by educational institutions may also be a suitable approach.

Many of the pre‐existing threats to dermatology education, such as overwhelming patient numbers and educator shortages, are likely to be exacerbated in the aftermath of the pandemic. Educators must adapt and seek to sustainably supplement any clinic‐based teaching both during the pandemic and beyond. Indeed, the Medical Schools Council has provided initial guidance on how education may be successfully continued in the upcoming academic year (Fig. 1).

Figure 1

Potential solutions for delivery of undergraduate education in the upcoming academic year, from Medical Schools Council.

While these recommendations are promising, we have highlighted a number of practical solutions for offering flexible, nonpatient‐facing opportunities to deliver content (Table 2).

Table 2

Potential solutions for delivery of undergraduate education with respect to the domains of clinical teaching, small group teaching and assessment.

Domain	Potential solutions
Clinical teaching	Wide‐scale integration of NHS‐approved telemedicine and video communication platforms into clinical education. This must feature thorough induction and flexibility in terms of student registration and attendance. Examples may include AccuRx, Zoom or EMIS health. Students should attend such sessions from an appropriate, socially distanced clinical setting. Verbal consent is likely to be sufficient, as teaching may take place at short notice. Longer‐term solutions include the educational community engaging actively with relevant parties on the NHS Digital Care Services Framework
Small group teaching	Construction of virtual communities of practice via collaborative platforms such as Slack or Blackboard, and development of evidence base for such communities. Collaboration between dermatology educators at different institutions to pool relevant and emerging digital resources. Such resources should be identified by both students and faculty. Innovation in delivery techniques may include gamified learning3 (students take part in games that consolidate lecture‐based teaching, which can aid revision) and flipped classrooms (students complete online tasks, such as reviewing pre‐recorded lectures, prior to attending a face‐to‐face meeting). These methods have been shown to significantly enhance learning5
Assessment	Examinations in the format of MCQs and ‘spotter’ tests can be reconfigured to take place online. Virtual OSCEs may become necessary as we make a move towards teledermatology. The curriculum and assessment need to reflect current practice

The COVID‐19 pandemic has served as a stark reminder that medical education must adapt to keep up with an increasingly changing world, to ensure continued delivery of teaching when traditional methods cannot be relied upon. Clinical experience should remain at the cornerstone of dermatology education; however, the traditional delivery of such education may not survive the pandemic. As medical education inevitably reorganizes, it is essential that the dermatology educational community reflects on innovation so as to deliver effective, sustainable approaches to teaching. We strongly suggest that it would be timely to consider a new review of the undergraduate dermatology curriculum, prioritizing collaborative working and technology‐enhanced learning in the domains of workplace and classroom education.