We have read with great interest the review by Abbott and colleagues called 'A review of literature supporting the development of practice guidelines for teledermatology in Australia'. 1 Especially during the COVID-19 pandemic, it is crucial to have clear-cut guidelines for teledermatology visits. However, teledermatology should not be restricted to clinical patient-physician relation, but should be broadened to dermatology education, as recently reported by Reinholz and French. 2 Here, we would like to report our Italian experience in providing medical care and ensuring educational opportunities for medical students and dermatology residents during the COVID-19 pandemic. Italy has one of the highest number of COVID-19 cases (150,189 of April 13, 2020) in Europe. 3 In order to minimise the potential risks for additional viral spread, we have reduced the dermatology practice only to urgent and undeferrable visits and surgical procedures (e.g. melanoma, skin cancers and autoimmune blistering diseases), as they need a face-toface approach. If visits can be carried out by video consultations, patients can benefit from a teledermatology service of our hospital.
As in other Italian hospitals, 4 the attendance of medical students in the Dermatology Department has been suspended. Dermatology residents have been organised in reduced shifts, in order to guarantee their presence where and when needed, but not exceeding the medical supply requested in view of the reduced number of visits.
The reduction in clinic activity did not spell the end of dermatological education. Instead, we have focused on providing online material for medical students in each department to improve knowledge of skin diseases, and how these specific outpatient or inpatient services work. The educational material includes videos with detailed and updated information on common dermatological presentations, such as acne and cutaneous neoplasms, as well as information on how to perform procedures, including punch biopsies and cryotherapy. Video making was carried out by residents and supervised by a dermatologist. Videos are available on an online platform (online tutorials). The use of online platforms has also extended to supervision and assessment of students.
Residents are encouraged to continue studying and are engaged through home study, online lessons and grand rounds. Even before COVID-19, residents had access to cases and videos on surgical procedures we have a wide library of clinical, histopathological and dermoscopic pictures, as well as videos of techniques (skin biopsy, surgical excision of a naevus, cyst, etc.) With COVID-19, the amount of online teaching has increased, with daily scheduled online lessons where residents present a specific subject through clinical cases, and professors and researchers can ask for details or further insights. Each resident is designated to a specific work group, where they either contribute to update a COVID-19 and dermatology newsletter examining the disease impact on skin diseases and their treatment, to contact our patients by telephone and email, or to assist in producing videos for medical students' teaching.
We continue to conduct weekly clinical grand rounds to discuss difficult and challenging cases, but do so online to minimise the risk of viral transmission.
The COVID-19 pandemic has focused the attention of an already blossoming way of practicing medicine. 5 Dermatologists and residents, should be prepared to manage cases from anamnesis to therapy using online consultations. Residency programmes should be updated to improve competence for using technology-enabled services. 6 In conclusion, teledermatology represents an useful tool not only to guarantee clinical supply to patients, but also for keeping dermatologic research, study and update alive without unnecessary exposure risks.