previously published by our group [7]. As before, we utilized a wrist pain case with a melanoma moulage painted on the second digit of the SP's hand where it would be easily visible during an examination of the hands (Fig.1). Four non-Hispanic white (referred to as white) actors and 4 African American actors presented our case after a board-certified dermatologist (CH) reviewed the moulage for realism.During the SP training sessions, a dermatologist (CH) helped coach the SPs on how to answer questions about the clinical history and symptoms of the simulated melanoma. The SP was instructed not to mention the lesion unless the student noticed the moulage. It is only if the student mentions the simulated lesion that the SP would answer specific questions posed by the student. The SPs were to provide the following information if asked by the student: the lesion was noticed approximately 6-8 months prior, the lesion has been growing in size; the patient grew up in Florida with heavy sun exposure, had no prior history of skin cancer, experienced no symptoms of pain or bleeding, and noticed no other changes in any other nevi.
Discussion | Consistent with existing studies, lack of access to appropriate dermatologic care persists among urban underserved individuals. Most Boston-area CHC PCPs were unfamiliar with teledermatology but showed a strong willingness to invest in and use this technology. While all prior PCP users of teledermatology would reuse it, academic dermatologists reported significantly less willingness to do so. However, more than half of academic dermatologists reported a willingness to reuse teledermatology, representing a group of providers who are potentially able to address dermatologic needs in this population.The considerable divergence in the primary concerns of CHC PCPs and academic dermatologists may influence teledermatology adoption and implementation. 6 Because new health care delivery models that emphasize accountable care focus on PCP management choices, establishing and addressing both the obstacles that independent CHCs will encounter with teledermatology alongside the concerns of dermatologists will be important to engage with this modality. Successful models for the integration of teledermatology may engage all dermatologists who treat the underserved, including nonacademic practitioners. Further studies are needed to explore the benefits and challenges of broadly implementing teledermatology, as a triage or treatment tool, in independent CHCs, the practice setting for many urban underserved patients.
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