Dermatology Online Journal

Teaching medical students dermatology research skills: Six years of experience with the University of Texas Medical Branch dermatology non-degree research honors program, 2001-2006
Richard F Wagner Jr MD¹, Simon A Lewis PhD²
Dermatology Online Journal 12 (4): 20

1. Department of Dermatology, The University of Texas Medical Branch, Galveston, TX. rfwagner@utmb.edu
2. Departments of Neuroscience and Cell Biology, The University of Texas Medical Branch, Galveston, TX

---

Abstract

Since 2001, the Department of Dermatology at The University of Texas Medical Branch in Galveston has participated in a campus wide non-degree honors research program developed to enhance the research skills of non-dual degree (MD/PhD) medical students. From 2001 through 2006, thirteen students completed the dermatology research program, and earned research honors at graduation. Seven student manuscripts have been published or are in press at peer-review journals and ten of twelve program participants who have applied for dermatology residency positions have been successful at the time of writing.

---

Introduction

Undergraduate medical education in the United States is typically an academically rigorous 4-year degree program, with emphasis on the basic sciences during the first 2 years and transition into the clinical sciences for the last 2 years. Medical students seeking a significant research experience during this time may find it a difficult goal to achieve [1], although historically, medical students have performed important research that had high impact on the specialty of dermatology [2, 3]. According to a recent national survey about dermatology research opportunities for medical students, 8 of 36 (22 %) responding US medical schools and dermatology residency programs reported offering an advanced degree such as a Master in Science [1]. At The University of Texas Medical Branch (UTMB), a non-degree, non-academic credit research program has been developed to help students gain experience as the principle investigator of their own original scientific investigation. We describe the framework of this program as it applies to those students seeking an introductory experience in dermatology research.

Methods

The general goals of the UTMB Honors Research Program (HRP) are aim to introduce non-PhD medical students to a formal, comprehensive, and original research experience by engaging them as the principle investigator on a research project of their own design (see page 17 for details of the HRP at http:// www.som.utmb.edu/SOM%20Bulletin%2005-06.pdf ). Students interested in dermatology careers learn about the HRP through freshman orientation, the medical student research summer program, participation in the UTMB Dermatology Interest Group (http://www.digutmb.blogspot.com), or through contact with faculty and participating students. Those successfully completing the HRP should learn important skills in critical literature review, study design, regulatory issues related to research, data analysis, presentation, and scientific writing. UTMB medical students interested in participating in the HRP submit a written research proposal (NIH format) by December 31st of their third year to the UTMB Honors Research Steering Committee, a multidisciplinary university committee composed of senior faculty with expertise in basic and clinical sciences, as well as experimental design and statistics. This committee critically reviews all student proposals and approves suitable projects for HRP participation. Factors the committee considers are study design, feasibility, resources, and likelihood for completion. Dermatology HRP funding is provided through the endowed Edgar B. Smith Professorship (RFW). Upon approval, the student selects a departmental ad hoc thesis committee comprised of no fewer than four UTMB faculty, three with expertise in the topic to be studied, one of whom will serve as the student's thesis supervisor and committee chair; the fourth is a member of the Honors Research Steering Committee. Under the guidance of the thesis advisor, appropriate institutional approval (Institutional Review Board for human subjects or the Institutional Animal Care and Use Committee for Animal Research) is obtained, and the faculty supervises data collection and analysis, along with the assistance of a senior staff statistician, through completion of the study. A written thesis is submitted by the student to the departmental ad hoc thesis committee and the chair of the Honors Research Steering Committee (SAL) no later than 2 weeks prior to the thesis defense. The defense must be completed by April 1st of the graduating year. Following the student presentation and a question and answer session that is open to all interested parties, the departmental ad hoc thesis committee, along with the chair of the Honors Research Steering Committee (SAL), meets privately for candid discussion to determine if the project achieved a passing grade, and if so, what level of honors should be awarded (cum laude, magna cum laude or summa cum laude). The ad hoc thesis committee considers eight specific student goals when determining if the candidate passed and graduation research honors level:

• Was the hypothesis (proposed question, idea) generated by the student with
• little or no faculty involvement?
• Was the study carried out and data analyzed by the student, or was there significant input by the faculty advisor or other lab personnel?
• Is the study confirming the results of a previous study, or is it addressing questions not answered by previous studies?
• What is the impact of the study on the area of research?
• What new and novel findings were generated by the study?
• Can or has the study been published in a high impact journal?
• How well presented are the results of the study (both written and oral)?
• Does the student have an in-depth understanding of the research area?

In general, cum laude is usually given for satisfactorily completed projects that do not demonstrate statistical significance, magna cum laude is awarded for solid research with statistically significant findings (when applicable) and summa cum laude is reserved for studies that have discovered important new scientific information and demonstrate statistical significance. If successful, the student's project title and graduation honors designation appears on the graduation program and the student's name, year of graduation, and honors earned is added to a commemorative Dermatology Honors Program plaque in the dermatology conference room. Student research is also eligible for several named graduation research awards that are selected by an independent faulty awards committee. Although no formal academic credit is offered by UTMB to students participating in the HRP, students may use an elective research rotation and/or the fourth year basic science and humanities selective requirement (if the topic fits within the guidelines for the BSHS), to work on their honors project. Following formal completion of the HRP, successful students are encouraged, along with faculty assistance, to prepare an original manuscript about their research and submit it for peer-review.

Results

During the past 6 years, students have selected projects in dermatopathology, dermatoepidemiology, clinical dermatology, public health (lip cancer prevention) and have also designed and tested two animal models for the study of experimental tattoo removal and phototoxicity. Dermatology has enjoyed a 100 percent project completion rate. Two students have graduated with cum laude, eight with magna cum laude, and three with summa cum laude research honors. Ten of twelve students who applied for dermatology residency positions have been successful to date. Seven peer-reviewed articles, all with the student-researcher as the first author, have been published or are in press at the time of writing, and another has been submitted [4, 5, 6, 7, 8, 9, 10, 11]. Four projects have won competitive national awards at the National Student Research Forum for poster and oral presentations or at the American Society for Dermatologic Surgery Young Investigators' Writing Competition, and several participating students have been awarded named graduation prizes at UTMB for their research. Each year the UTMB Department of Dermatology also presents awards to senior medical students for the best overall medical student in dermatology (Thomas W. Freese, M.D. Memorial Endowment for Excellence in Dermatology) and for the best dermatology research by a medical student (Edgar B. Smith Endowed Scholarship in Dermatology), and participating HRP students have won nine out of twelve awards given over the past 6 years, including all 6 years the Edgar B. Smith Endowed Scholarship in Dermatology has been given.

Discussion

Dermatology experience with UTMB's HRP has been very positive, and it is hoped that sharing our educational experience may create additional interest for the development of similar programs for medical students at other institutions with the common goal of encouraging research interest and activity in dermatology. The student's thesis supervisor has an excellent vantage point to mentor and evaluate student progress longitudinally throughout the duration of the project, and is able to provide detailed information in letters of recommendation. The lack of funding is always a serious barrier for successful sustained student research programs such as the HRP, and we have been fortunate to have funds from the endowed Edgar B. Smith Professorship to help our students achieve a substantial dermatology research experience in a supportive educational environment during medical school. Perhaps program dermatology alumni would be willing to donate directed gifts for the purpose of establishing this type of program at their own schools. Ideally, medical schools would provide funding for their non-MD/PhD students who desire a substantive research experience of this type while in medical school, possibly through restricted alumni giving.

The non-degree nature of the HRP may encourage other interested institutions to develop similar programs for their students without the encumbrances of more formalized degree granting programs, especially where no such degree granting program is already in place. This feature offers interested students the opportunity to engage in the process of learning dermatology research skills by reducing potential barriers and cost to participation.

It is very likely that additional HRP manuscripts will be published in the future, owing to a 1-3 year lag time between project completion and publication. Students are expected to prepare a first draft of their manuscript, and faculty work with the student through an internal review process until the paper is suitable for peer-review submission. However, in many instances, it has been our experience that following successful thesis defense, intervening graduation activities and internship interferes with immediate manuscript preparation. Most student research write-up is not initiated until the year long internship is completed.

Because of the success of the HRP, our dermatology residency program has recently initiated a scholarly research program for incoming dermatology residents. During the first 6 months of residency training, the new residents are expected to identify a research area of interest and work with a faculty research mentor on a research proposal and attain institutional approval for the research, continue with their HRP if magna cum laude graduation research honors were achieved and no related manuscript has been submitted for publication, or in the case of non-UTMB medical students, have completed a similar type of research project while a visiting medical student under UTMB faculty supervision where no paper has yet been submitted for publication. Financial support for this resident research is through the Edgar B. Smith Professorship or from faculty research grants. Over the next 2 years, the resident collects and analyses the data, culminating in preparing and submitting an original manuscript for peer-review publication by January of their senior year, although earlier completion is encouraged. Over the course of this resident research activity, the faculty research mentor has a unique opportunity to observe and evaluate the applicable six core competencies (patient care, medical knowledge, practice-based learning & improvement, interpersonal & communication skills, professionalism, and systems-based practice) of residents developed by the Accreditation Council of Graduate Medical Education (ACGME) to evaluate trainees. The dermatology department faculty has dedicated an annual award for the best research by a senior dermatology resident. The major award selection criteria factors to be considered are whether the resident research has been accepted for publication or published in a peer-reviewed journal and if the research has won any awards. The dermatology chair presents a certificate to the awardee at the annual graduation dinner, and the resident's name will be added to the Dermatology Faculty Award for Excellence in Resident Research Plaque in the dermatology conference room.

Conclusions

Analysis of our 6-year experience with the dermatology HRP at UTMB has exceeded our expectations for this non-degree program designed to introduce medical students to research skills. This type of program may provide an opportunity for more medical students to participate in dermatology research if similar programs are developed elsewhere.

Acknowledgments: Drs. Sharon S. Raimer, Dayna G. Diven, Maria I. Colome-Grimmer and Erica B. Kelly have contributed their expertise and time to serve on ad hoc thesis committees and serve as thesis supervisors (DGD, EBK). Mr. Tatsuo Uchida provided statistical expertise for dermatology student honors research projects. We are greatly indebted to the generosity of Edgar B. Smith, MD (1932-2005), former UTMB Department of Dermatology Chair and Program Director, for establishing the Edgar B. Smith Professorship and to his family and friends for their donations.

References

1. Wagner RF, Ioffe B. Medical student dermatology research in the United States. Dermatol Online J. 2005 Mar 1;11(1):8. PubMed

2. Mohs FE. Chemosurgery in Cancer, Gangrene and Infections. Springfield, Illinois: Charles C. Thomas, 1956, page 3.

3. Anderson RR, Parrish JA. Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science 220(4596):524-527, 1983.

4. Solis RR, Diven DG, Colome-Grimmer MI, Snyder N, Wagner RF. Experimental nonsurgical tattoo removal in a guinea pig model with topical imiquimod and tretinoin. Dermatol Surg 28:83-87, 2002.

5. Shoss-Glaich A, Uchida T, Wagner RF Jr. Sunburn risk factors at Galveston beaches. Texas Medicine 100(7):62-65, 2004.

6. Chen-Tsai CP, Colome-Grimmer M, Wagner RF Jr. Correlations among NCAM, NGF and its receptors, TRK A, B, C and p75 NGFR in perineural invasion by basal cell and cutaneous squamous cell carcinomas. Dermatol Surg 30:1009-1016, 2004.

7. Magee NS, Zamora JG, Colome-Grimmer MI, Wagner RF Jr. Triweekly topical 5% imiquimod cream fades experimental tattoos in guinea pigs. Cosmetic Dermatology 18:155-158,161, 2005.

8. Warthan MM, Uchida T, Wagner RF Jr. UV light tanning as a type of substance-related disorder. Arch Dermatol 2005;141:963-966.

9. Lewis Kelso RL, Colome-Grimmer MI, Uchida T, Wang HQ, Wagner RF. p75 NGFR immunostaining for the detection of perineural invasion by cutaneous squamous cell carcinoma. Dermatol Surg 2006;32(2):177-83.

10. Poonawalla T, Diven DG. Survey of antibiotic prescription use for inflamed epidermal inclusion cysts. Journal of Cutaneous Medicine and Surgery, in press.

11. Ramirez M, Magee N, Diven D, Colome-Grimmer M, Motamedi M, Oliveira G, Zamora JG, Uchida T, Wagner RF. Topical imiquimod as an adjuvant to mature laser tattoo removal in an animal model. Submitted for publication, 2006.

© 2006 Dermatology Online Journal