Identification and Prioritization of Dermatological Disorders Influenced by Female Hormonal Fluctuations during and beyond Menopause
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Menopause is a natural and universal milestone achieved by every living female by the time of midlife. Worldwide, the number of postmenopausal women is expected to rise to 1.1 billion by 2025. Therefore, medical education and healthcare trainings are consistently going through updates and curricular transformations to incorporate teachings of age and gender related disorders, their diagnostic protocols and effective therapeutic options. The dermatology residents’ current curriculum is predominantly taught on the basis of skin type and color and rarely on the gender-, hormonal- or age- related context. Knowledge about how to evaluate and manage disorders pertaining to skin, hair and nails in the midst of aging and hormonal fluctuations of menopause is not being strategically taught or included in the current resident dermatology curriculum. In order to diversify the curricula, this research effort was focused on identifying and prioritizing the most significant dermatological disorders influenced by female hormonal fluctuations during and beyond natural and induced menopause, using the Delphi Method. A convenience sample of thirty physicians from five different departments (dermatology, gynecology, rheumatology, internal medicine, and family medicine) of a large medical institute, in southwest of United States was recruited to participate in the study. In round 1, there was 100% participation of five experts, invited to form Panel A of the Delphi study. The experts in Panel A, gave profound feedback to refine and reorganize the list of skin disorders created by the researcher through the intense evidence- based medical literature review. There was an 89% of participation rate among the twenty-eight faculty members invited to become Panel B experts in round 2 of this study. During round 3, 100% of the experts who previously participated as Panel B provided feedback. The calculated median for the ranking of each skin disorder by Panel B was three or above in round 2 and 3, with significant convergence and minimum variability. The most highly ranked category of skin disorders affected by hormone changes at menopause was identified to be gynecological disorders. Among the subcategories, the overall most highly ranked skin disorder was identified to be hirsutism followed by vulvovaginal atrophy. In conclusion, the need for curriculum enrichment has been identified during and at the completion of this Delphi study by the ranking and feedback given by the majority of the Panel A and Panel B experts of the study. This entails bringing in more knowledge and resources into a preexisting curriculum to teach the medical students and residents about the influence of hormone changes at menopause on skin disorders prioritized via this research study. The results of this Delphi study can be utilized to extend the core curriculum by restoring the excitement of teaching the same known skin disorders, in the context of hormonal changes at menopause. It can reinforce the same concepts and knowledge with broader application and understanding of effects of age, gender and hormones on common skin disorders. This understanding can further potentially assist in correctly risk-stratifying patients to be treated or not treated by hormone replacement therapy at menopause.