Learning in real: What learning dermatology (as an NP) taught me about learning (as an ID).

In early 2020 when COVID hit, my work world was turned upside down. Like many people, I was sent scrambling to find a job. 

At the time, I had been teaching in simulation for several years on an as-needed basis and had started picking up shifts in an Urgent Care. This type of work arrangement had been ideal for me as an adult and nurse practitioner (NP) who had returned to school to pursue additional graduate degrees in instructional design (ID).

This arrangement had allowed me to maintain my clinical skills, work as an instructor - which I loved, make the amount of money that I needed, have the time I needed to work on very time-consuming (but very satisfying) coursework, and still be present for my family.

But, all of that fell apart almost overnight. 

Simulation as it existed, which was all face-to-face at that time, shut down. The hospital organization that I worked for was forced to layoff hundreds of full-time employees - which meant no PRN workers (like me). And, my husband’s work (also healthcare) cut back on hours, hourly pay, and bonuses. 

So, there I was, trying to figure out what to do.

Thankfully, I was able to find a full-time clinical job. I was so grateful and relieved to have been able to find an opportunity during that stressful time of the pandemic.

However, there was a problem. The role was in dermatology.

The majority of my time in healthcare up to that point had been in emergency care - mainly in the emergency room and then Urgent Care. I had zero experience in medical dermatology.

So, here I was, a nurse practitioner, an educator, and equipped with a few years of instructional design training and experience, but completely unsure of how best to prepare myself for this new and foreign world.

I searched around and found a small curriculum that was an introduction to dermatology. This consisted of a set of modules created by the American Academy of Dermatology and was meant for medical residents. It was helpful, but I still found it difficult to make sense of what I was learning and to discern different conditions from one another.

Even though I had spent so much time learning about learning - I was curious about what learning a whole new field of medicine would be like in real life. Luckily, I kept a journal to record my thoughts.

Below are some (not all) of the things I learned
about learning in real life.

Less is more

When I began my training, I was overwhelmed. There was so much to know and so many conditions to consider. However, the dermatologist I was training with encouraged me to focus on trying to learn the most common conditions first - not ALL of them. He believed that by trying to learn it all first, you run the risk of not getting good at any of them.

As time went on, I found this to be a very helpful strategy. The majority of conditions seen on a day-to-day basis were the most common. Therefore, being able to recognize these and learn more about them proved very useful. It also decreased the amount of information I was trying to review - making it much easier to manage - decreasing my overwhelm and my anxiety.

Structure is key: Use a mental framework

Learning random, unstructured, and disconnected pieces of information turns out not to be the best strategy for learning a new medical specialty. Without some sort of mental framework, it can be hard to know where to organize and place various conditions and concepts for remembering.

During my initial training and beyond, I was taught to visualize conditions and their treatments as categories or “buckets''. Dermatology visits can fall into certain categories such as routine skin checks, rashes, skin lesions, hair loss, acne, and more. In order to begin to diagnose, you need to first have a way of sorting them. 

Rashes can be further divided by their locations, their color, their texture, or other types of features. For example, only certain rashes typically occur on the hands and feet.

This helps narrow down the possible causes.

Similarly, hair loss can be further divided into scarring or non-scarring types. Having these sorting structures helped me begin categorizing and narrowing down the possible diagnoses.

Immersion, practice, & repetition are essential

No matter how much I read or watched before starting in the clinic, nothing was as helpful as being immersed in the real environment.

In the real environment, I was able to see a lot of things in a short period of time. Conditions that had just been concepts or flat images came to life. 

Being able to see different conditions, on different people, over and over, was very helpful for learning. Being able to see the different variations of one condition, a systematic approach to examining and sorting them, and the most common approaches to treating them proved invaluable.

Also, in this real setting, you learn the various other factors and/or obstacles that impact your diagnoses and influence your treatments - such as a patient's ability to share their history, patient compliance, insurance, cost of medications, time constraints, side effects versus benefits of treatments, and more. 

You need a good teacher

Over the years of being in various clinical roles and other learning situations, I’d had no shortage of access to “experts”. Unfortunately, being an expert is not synonymous with being a good teacher.

• A good teacher knows how to meet the student where they are, relate concepts to real life, set reasonable expectations, and provide scaffolded learning opportunities.

• A good teacher provides support and guidance.

• A good teacher understands how people learn - through practice, repetition, and feedback.

• A good teacher also empowers the learner by helping them know where to find trustworthy resources and how to use them to independently solve problems.

• A good teacher provides structure and a psychologically safe learning environment.

A good teacher makes a huge difference.      

Learn the business side of work

The business side of work is not always talked about. Understanding how the business (and you) make money is a key piece of your success and empowerment as a professional.

In healthcare, the ability to properly bill for your time and expertise, to advocate for your patients and their needs for services, and to negotiate (prove) your worth is an important piece that often gets overlooked or avoided.

No matter our intentions, our medical knowledge, or our beliefs about our relationships with leadership at work and our responsibilities to patients - healthcare (and other organizations/entities) is a business.

Knowledge of the business side of work should be a must and a factor that is at play - even if you’d rather refuse to acknowledge it.