Since publication in March 2020, the podcast discussed herein has been renamed to "The Grenz Zone." The digital version of this article and its accompanying PDF have been updated to reflect the change. Updated October 27, 2020.
Health care professionals certainly understand the value of time both in and out of the office. A quick diagnosis can be critical to patient outcomes, such as starting a course of therapy for the patient with psoriatic arthritis or referring a patient with squamous cell carcinoma of the craniofacial region to a Mohs surgeon. Providing adequate patient care while maintaining an appropriate work-life balance can be difficult to achieve as well.1 Finding the time to stay up-to-date with research, earn continuing medical education credits, and learn of new differential diagnoses add a new layer to the complexity of the medical profession. Traditional forms of medical education, including reading peer-reviewed publications and attending medical conferences, require time separate from the dermatology practice—an intangible resource that could be used instead to care for patients or indulge in personal hobbies to prevent feelings of burnout.
“It’s crucial to make education convenient. Reading a journal is definitely helpful, but after a certain point, you can get oversaturated with information or you lose focus from reading,” stated Logan Kolb, DO, a PGY-4 dermatology resident at Orange Park Medical Center in Jacksonville, FL, and host of The Grenz Zone. He is one of many younger physicians beginning his career in dermatology. He cited his hour-long commutes as the perfect time to continue learning through multimedia such as podcasts, videos, and social media. “Basically, everyone has a phone in their pocket and has a commute these days. Even if you listen to an educational podcast for 10 minutes on your way to work, and then you listen to music the rest of the time, and 10 minutes on your way back, you can pick up where you left off. I think that’s an easy way to do it. Some podcasts out there now review journal articles in a 60-minute episode each week. For me, it’s a really convenient way to learn on the go.”
His experience with multimedia, like that of other medical students and residents, is helping expand what education can mean for the modern clinician.
The Power of a Podcast
Dr Kolb found podcasts the most accessible way to learn as he completed his rotations and now his residency. He recounted one of his earliest “lightbulb” moments as a dermatologist.
“It was late in my first year of residency when I saw a patient with a condition called delusions of parasitosis. It’s one of those things where it makes a lot of dermatologists cringe when they realize they’re going to see a patient with it, because patients think they’re infested with bugs, but they’re not. It’s just a delusion that they have, and it’s usually a struggle for patients and providers, since it’s very frustrating to treat,” explained Dr Kolb. “This patient was just classic for it. She was bringing in ‘bugs’ that were simply scabs off her skin, those types of things.”
Suddenly, Dr Kolb had a flashback to a podcast episode2 by DermCast.TV, the official online media resource of the Society of Dermatology Physician Assistants (SDPA). That episode, a recording of Dr John Koo’s presentation from the SDPA Annual Summer Dermatology Conference 2014,3 shared Dr Koo’s tips for managing unique patients with psychodermatologic concerns. “The whole episode is on how to start this medicine called pimozide, which is an antipsychotic that works really, really well for delusions of parasitosis.”
“Dermatologists might want to send this patient to a psychiatrist to give them that medicine, but a lot of times [the patient isn’t] accepting of that. What Dr Koo argues is that we should get comfortable with this medicine so we can get patients better.”
Dr Kolb returned back to that podcast episode2 and convinced his program director Dr Karthik Krishnamurthy to also listen to it. Using Dr Koo’s guidance, they started the patient on pimozide at her next visit.
“The patient struggled with this condition for 10 years. She had seen over 30 different doctors and spent all this money on exterminators for her home. She was miserable. We finally started pimozide for her, and for the first time in over a decade, she was feeling better,” said Dr Kolb. “Basically, thanks to that podcast episode, she was finally cured. Dr Krishnamurthy, my co-residents, and I who managed this for her are basically her heroes now. To see how a podcast episode change that patient’s life and have it become a reality for me was really just a cool moment.”
This kind of experience was one of the many that inspired Dr Kolb to record The Grenz Zone.4 The series is broken down into palatable 20- to 30-minute episodes on a specific topic based on Dr Charles Gropper’s article on reaction patterns.5 The first season of the podcast focused on papulosquamous and eczematous reactions, covering topics such as psoriasis, mycosis fungoides, annular disorders, atopic dermatitis, and stasis dermatitis. The newer second season, originally featuring a “miscellaneous” theme focused on common dermatologic disorders such as basal cell carcinomas and acne, has now moved to vascular reaction patterns, including erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis, and viral exanthems.
“After having that experience with the patient with delusions of parasitosis, I really thought that I needed to get the podcast going. If I can put some pearls into episodes that are going to help patients get better, then the effort is all worth it,” said Dr Kolb.
Each episode is structured to keep the listener engaged by providing interactive experiences with multiple choice questions based off of board examinations and a bit of comic relief with attendings such as Drs Grumpy Pants and DOOD, voiced by Dr Kolb’s coresident Shawn Schmieder, DO, and Dr Binky, voiced by Courtney Bernett, DO. Given the depth of certain dermatologic conditions, Dr Kolb will sometimes break topics up into two-part episodes to allow the audience to digest the information without getting lost in a long episode.
“It’s hard [to keep episodes compact] because I want to give people enough information where they have the confidence to treat a patient that comes to their clinic or to the hospital,” said Dr Kolb.
Given that dermatology is such a visual field, Dr Kolb's podcast attempts to keep that in mind. “I do what I can to give listeners the teaching points that are going to help them with a good history and a good physical exam. There are several times where I ask the listener to look up pictures of a rash online, because some things you need to see just like you would in a clinic.”
At the core of every episode, however, is the mission to emphasize pearls for listeners to recall when treating their next patient, just as Dr Kolb did in his earlier residency days. The podcast attempts to add multiple layers of interaction (repetition of concepts, the self-quiz, a post-episodic internet search, introductions of mnemonics such as the acronym “SICKLAB” for triggers of psoriasis6 or the “Eyes, Ears, Nose, and Mouth” tune to remember the mucosal surfaces to monitor for erythema multiforme7) to increase the likelihood of the audience remembering a pearl for patient care.
