title: Cosmetic dermatologic surgical training in US dermatology residency programs: identifying and overcoming barriers.
abstract: OBJECTIVE
  The public and other medical specialties expect dermatologists who offer cosmetic dermatology services to provide competent care. There are numerous barriers to achieving cosmetic dermatology competency during residency. Many dermatology residents enter the workforce planning to provide cosmetic services. If a training gap exists, this may adversely affect patient safety.
  
  
  OBJECTIVE
  To identify resources available for hands-on cosmetic dermatology training in US dermatology residency training programs and to assess program director (PD) attitudes toward cosmetic dermatology training during residency and strategies, including discounted pricing, used by training programs to overcome barriers related to resident-performed cosmetic dermatology procedures.
  
  
  METHODS
  An online survey in academic dermatology practices among PDs of US dermatology residency programs.
  
  
  METHODS
  Frequency of cosmetic dermatology devices and injectables used for dermatology resident hands-on cosmetic dermatology training, categorizing PD attitudes toward cosmetic dermatology training during residency and describing residency-related discounted pricing models.
  
  
  RESULTS
  Responses from PDs were received from 53 of 114 (46%) US dermatology residency programs. All but 3 programs (94%) offered hands-on cosmetic dermatology training using botulinum toxin, and 47 of 53 (89%) provided training with hyaluronic acid fillers. Pulsed dye lasers represented the most common laser use experienced by residents (41 of 52 [79%]), followed by Q-switched Nd:YAG (30 of 52 [58%]). Discounted procedures were offered by 32 of 53 (60%) programs, with botulinum toxin (30 of 32 [94%]) and fillers (27 of 32 [84%]) most prevalent and with vascular lasers (17 of 32 [53%]) and hair removal lasers (12 of 32 [38%]) less common. Various discounting methods were used. Only 20 of 53 (38%) PDs believed that cosmetic dermatology should be a necessary aspect of residency training; 14 of 52 (27%) PDs thought that residents should not be required to perform any cosmetic dermatology procedures.
  
  
  CONCLUSIONS
  Although almost every program provides hands-on cosmetic dermatology training, there are barriers to training, including patient preferences, costs of procedures and products, and PD attitudes toward cosmetic dermatology training. To promote patient safety, procedural competency is imperative.
authors: Department of Dermatology, Marshfield Clinic, Marshfield, Wisconsin.
authors: Bruce
authors: B
authors: Bauer
authors: currently a medical school student at Sanford School of Medicine, University of South Dakota, Vermillion.
authors: Erin
authors: E
authors: Williams
authors: Department of Dermatology, Marshfield Clinic, Marshfield, Wisconsin.
authors: Erik J
authors: EJ
authors: Stratman
mesh_terms: D003357:Cosmetic Techniques; D003625:Data Collection; D003880:Dermatology / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D019651:Plastic Surgery Procedures / Q000193:education*; D014481:United States