Medical school dermatology curriculum - are our graduates adequately prepared and aligned to community needs?

Background: There is paucity of research based information regarding the dermatology learning needs and their fulfilment in primary care physicians

Objective: To determine skin diseases burden in the community AND adequacy of preparedness of Primary Care Physicians to deal with skin diseases

Methodology: This was a cross sectional study conducted from 1[st] January 2015 to 31[st] December 2016 at Dermatology Outpatient Department of Sheikh Zayed Medical College/Hospital [SZMC/H], Rahim Yar Khan, for burden of skin diseases and feedback from Primary Care Physicians of both SZMC/H and Primary Health Care setups [BHUs and RHCs] of District Rahim Yar Khan regarding adequacy of their preparedness to deal with skin disease patients. Records from a tertiary care teaching hospital was sought from OPD to assess skin disease burden and Primary Care Physicians from tertiary care hospital and BHU and RHC of district were surveyed regarding content AND teaching adequacy of undergraduates through their dermatology curriculum. Data was entered and analyzed by using SPSS version 20

Results: A total of 356 doctors participated in this study. Of these 233 [65.4%] were males. It was found that 10% of patients attending OPD in Sheikh Zayed Hospital [A tertiary care teaching hospital] suffered from skin disease. Frequencies of "Common skin diseases" in the community were; eczema 12.9%, scabies 10.8%, fungal infection 9%, bacterial infection 8% and acne 7%. Of all participants, 274 [77%] reported that <10% of their patients suffered from skin disease and only 30 [8.4%] of them were fully confident while treating skin disease patients and only 36 [10.1%] reported that most of their patients were cured. It was noted that 145 [40.7%] participants could name only 1-3 of the common skin diseases in the community, 182 [51.1%] named 4-6 while only 12[3.4%] could name 7 or more and 17[4.8%] had no knowledge of even a single common skin disease in the community. Only 92[25.8%] participants rated that their undergraduate training was adequate while 264[74.2%] rated it to be inadequate

Conclusion: This study concluded that primary care physician were not adequately prepared for managing common skin diseases during their undergraduate training. Appropriate exposure and adequate teaching in dermatology throughout undergraduate medical curriculum is essential because skin presentations manifest throughout all aspects of medicine, and most often dermatological problems are dealt with exclusively by non-dermatologists

Pathogens and their antibiotic sensitivity patterns in community acquired bacterial infections of skin

Background: Common infections of the skin are mostly treated empirically depending upon the personal habits or promotional efforts of the pharmaceutical industry. Scientific approach to the treatment of such infections would be either to treat the infections definitively based on the culture and sensitivity results or at least on evidence based treatment

Objective: To determine the pathogens involved and their sensitivity patterns in common skin infections in a tertiary care hospital

Subjects and Methods: This cross sectional study was conducted in Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, over a period of three months from 1[st] September to 30[th] November, 2013, involving a total of 135 subjects suffering from various common bacterial infections of skin. Their pus or blister fluid samples were taken and cultured in blood agar or Macconkey's agar to determine the pathogens involved and their antibiotic sensitivity patterns by disc method. The data was entered and analyzed by using SPSS version 15

Results: The dominant bacteria causing skin infections remain Gram Positive cocci [37.8%] followed by Gram Negative Rods [26.7%]. The most sensitive antibiotic was found to be Amikacin [20.7%], followed by sulzone/cefoparazone [19.2%], ciprofloxacin [14%], linezolid [14%] and azithromycin [9.6%]

Conclusion: From the present study, it is concluded that Gram positive cocci continue to remain the most common pathogen in bacterial infections of the skin, followed by Gram Negative Rods. Most of the pathogens were sensitive to Amikacin followed by sulzone/cefoparazone combination, ciprofloxacin, linezolid, azithromycin, levofloxacin. The results of this study emphasize the need for checking the indigenous sensitivity patterns of the pathogens and accordingly modify our empirical prescription of the antibiotics based on such studies