Teledermatology in medical education – a ‘rash’ decision?

Teledermatology in medical education Á a 'rash' decision? T he benefits of 'teledermatology' have been widely documented; most importantly, teledermatology has reduced referral times for patients saving money for the burdened NHS (1). However, with less need for face-to-face consultations (2), there may be fewer opportunities for medical students to get hands-on experience with dermatological conditions. While access to patient images will help enhance students' diagnostic abilities (3), may they be losing out on acquiring vital clinical skills, such as the art of building patient rapport? In this article, we intend to discuss the impacts of teledermatology, not on current or future patients, but on the students training to help them. As a highly visual specialty, students will undoubtedly benefit from having access to a large store of dermatolo-gical images. Not only will students have exposure to what is common, they will also have the chance to see how rarer conditions present; this is an opportunity they may not have when practicing in a general dermatology clinic. Easy access to a wide variety of presentations of skin disease will also train the eye for spot diagnoses in a much quicker period of time. In one study comparing the eye movements of consultant dermatologists to registrars, consultants made quicker diagnoses. This is because consultants have more experience and therefore more advanced skills in eye pattern recognition (4). Therein lies the rub Á there is ongoing uncertainty surrounding the use of patient images for educational purposes. Legalities regarding medical student access to the images needs to be finalized. As previously alluded to, teledermatology creates doctors with a better base of knowledge. In the only published paper to have evaluated medical students' perspective on teledermatology, 88% agreed that it is beneficial for building knowledge and practice-based learning (3). However , communication skills and professionalism were felt to be neglected. Even with real-time videoconferencing, which has also been introduced to dermatological practice, communication with patients is limited and student learning can be minimal. An endless photo bank may create a doctor who can diagnose but not necessarily one who can empathize when dealing with the many associated psychosocial aspects within dermatology. William Osler once said 'The good physician treats the disease; the great physician treats the patient who has the disease'. Could the integration of this tool lead students to become lazy in taking a holistic view of the patient? Moreover, teledermatology may affect …