Mixed Topics

Visible light is part of the electromagnetic spectrum and is confined to a range of 400 to 700 nm. Visible light phototherapy can be delivered across various wavelengths within this spectrum, with most research focusing on blue light (BL)(400-500 nm) and red light (RL)(600-700 nm). Blue light commonly is used to treat acne as well as actinic keratosis and other inflammatory disorders,^1,2 while RL largely targets signs of skin aging and fibrosis.^2,3 Because of its shorter wavelength, the clinically meaningful skin penetration of BL reaches up to1 mm and is confined to the epidermis; in contrast, RL can access the dermal adnexa due to its penetration depth of more than 2 mm.⁴ Therapeutically, visible light can be utilized alone (eg, photobiomodulation [PBM]) or in combination with a photosensitizing agent (eg, photodynamic therapy [PDT]).^5,6

Our laboratory’s prior research has contributed to a greater understanding of the safety profile of visible light at various wavelengths.^1,3 Specifically, our work has shown that BL (417 nm [range, 412-422 nm]) and RL (633 nm [range, 627-639 nm]) demonstrated no evidence of DNA damage—via no formation of cyclobutane pyrimidine dimers and/or 6-4 photoproducts, the hallmark photolesions caused by UV exposure—in human dermal fibroblasts following visible light exposure at all fluences tested.^1,3 This evidence reinforces the safety of visible light at clinically relevant wavelengths, supporting its integration into dermatologic practice. In this editorial, we highlight the key clinical applications of PBM and PDT and outline safety considerations for visible light-based therapies in dermatologic practice.

Photobiomodulation

Photobiomodulation is a noninvasive treatment in which low-level lasers or light-emitting diodes deliver photons from a nonionizing light source to endogenous photoreceptors, primarily cytochrome C oxidase.^7-9 On the visible light spectrum, PBM primarily encompasses RL.^7-9 Photoactivation leads to production of reactive oxygen species as well as mitochondrial alterations, with resulting modulation of cellular activity.^7-9 Upregulation of cellular activity generally occurs at lower fluences (ie, energy delivered per unit area) of light, whereas higher fluences cause downregulation of cellular activity.⁵

Recent consensus guidelines, established with expert colleagues, define additional key parameters that are crucial to optimizing PBM treatment, including distance from the light source, area of the light beam, wavelength, length of treatment time, and number of treatments.⁵ Understanding the effects of different parameter combinations is essential for clinicians to select the best treatment regimen for each patient. Our laboratory has conducted National Institutes of Health–funded phase 1 and phase 2 clinical trials to determine the safety and efficacy of red-light PBM.^10-13 Additionally, we completed several pilot phase 2 clinical studies with commercially available light-emitting diode face masks using PBM technology, which demonstrated a favorable safety profile and high patient satisfaction across multiple self-reported measures.^14,15 These findings highlight PBM as a reliable and well-tolerated therapeutic approach that can be administered in clinical settings or by patients at home.

Adverse effects of PBM therapy generally are mild and transient, most commonly manifesting as slight irritation and erythema.⁵ Overall, PBM is widely regarded as safe with a favorable and nontoxic profile across treatment settings. Growing evidence supports the role of PBM in managing wound healing, acne, alopecia, and skin aging, among other dermatologic concerns.⁸

Photodynamic Therapy

Photodynamic therapy is a noninvasive procedure during which a photosensitizer—typically 5-aminolevulinic acid (5-ALA) or a derivative, methyl aminolevulinate—reacts with a light source and oxygen, resulting in reactive oxygen species.^6,16 This reaction ultimately triggers targeted cellular destruction of the intended lesional skin but with negligible effects on adjacent nonlesional tissue.⁶ The efficacy of PDT is determined by several parameters, including composition and concentration of the photosensitizer, photosensitizer incubation temperature, and incubation time with the photosensitizer. Methyl aminolevulinate is a lipophilic molecule and may promote greater skin penetration and cellular uptake than 5-ALA, which is a hydrophilic molecule.⁶

Our research further demonstrated that apoptosis increases in a dose- and temperature-dependent manner following 5-ALA exposure, both in cutaneous and mucosal squamous cell carcinoma cells and in human dermal fibroblasts.^17,18 Our mechanistic insights have clinical relevance, as evidenced by an independent pilot study demonstrating that temperature-modulated PDT significantly improved actinic keratosis lesion clearance rates (P<.0001).¹⁹ Additionally, we determined that even short periods of incubation with 5-ALA (ie, 15-30 minutes) result in statistically significant increases in apoptosis (P<.05).²⁰ Thus, these findings highlight that the choice of photosensitizing agent and the administration parameters are critical in determining PDT efficacy as well as the need to optimize clinical protocols.

Photodynamic therapy also has demonstrated general clinical and genotoxic safety, with the most common potential adverse events limited to temporary inflammation, erythema, and discomfort.²¹ A study in murine skin and human keratinocytes revealed that 5-ALA PDT had a photoprotective effect against previous irradiation with UVB (a known inducer of DNA damage) via removal of cyclobutane pyrimidine dimers.²² Thus, PDT has been recognized as a safe and effective therapeutic modality with broad applications in dermatology, including treatment of actinic keratosis and nonmelanoma skin cancers.¹⁶

Clinical Safety, Photoprotection, and Precautions

While visible light has shown substantial therapeutic potential in dermatology, there are several safety measures and precautions to be aware of. Visible light constitutes approximately 44% of the solar output; therefore, precautions against both UV and visible light are recommended for the general population.²³ Cumulative exposure to visible light has been shown to trigger melanogenesis, resulting in persistent erythema, hyperpigmentation, and uneven skin tones across all Fitzpatrick skin types.²⁴ Individuals with skin of color are more photosensitive to visible light due to increased baseline melanin levels.²⁴ Similarly, patients with pigmentary conditions such as melasma and postinflammatory hyperpigmentation may experience worsening of their dermatologic symptoms due to underlying visible light photosensitivity.²⁵

Patients undergoing PBM or PDT could benefit from visible light protection. The primary form of photoprotection against visible light is tinted sunscreen, which contains iron oxides and titanium dioxide.²⁶ Iron (III) oxide is capable of blocking nearly all visible light damage.²⁶ Use of physical barriers such as wavelength-specific sunglasses and wide-brimmed hats also is important for preventing photodamage from visible light.²⁶

Final Thoughts

Visible light has a role in the treatment of a variety of skin conditions, including actinic keratosis, nonmelanoma skin cancers, acne, wound healing, skin fibrosis, and photodamage. Photobiomodulation and PDT represent 2 noninvasive phototherapeutic options that utilize visible light to enact cellular changes necessary to improve skin health. Integrating visible light phototherapy into standard clinical practice is important for enhancing patient outcomes. Clinicians should remain mindful of the rare pigmentary risks associated with visible light therapy devices. Future research should prioritize optimization of standardized protocols and expansion of clinical indications for visible light phototherapy.

Visible light is part of the electromagnetic spectrum and is confined to a range of 400 to 700 nm. Visible light phototherapy can be delivered across various wavelengths within this spectrum, with most research focusing on blue light (BL)(400-500 nm) and red light (RL)(600-700 nm). Blue light commonly is used to treat acne as well as actinic keratosis and other inflammatory disorders,^1,2 while RL largely targets signs of skin aging and fibrosis.^2,3 Because of its shorter wavelength, the clinically meaningful skin penetration of BL reaches up to1 mm and is confined to the epidermis; in contrast, RL can access the dermal adnexa due to its penetration depth of more than 2 mm.⁴ Therapeutically, visible light can be utilized alone (eg, photobiomodulation [PBM]) or in combination with a photosensitizing agent (eg, photodynamic therapy [PDT]).^5,6

Our laboratory’s prior research has contributed to a greater understanding of the safety profile of visible light at various wavelengths.^1,3 Specifically, our work has shown that BL (417 nm [range, 412-422 nm]) and RL (633 nm [range, 627-639 nm]) demonstrated no evidence of DNA damage—via no formation of cyclobutane pyrimidine dimers and/or 6-4 photoproducts, the hallmark photolesions caused by UV exposure—in human dermal fibroblasts following visible light exposure at all fluences tested.^1,3 This evidence reinforces the safety of visible light at clinically relevant wavelengths, supporting its integration into dermatologic practice. In this editorial, we highlight the key clinical applications of PBM and PDT and outline safety considerations for visible light-based therapies in dermatologic practice.

Photobiomodulation

Photobiomodulation is a noninvasive treatment in which low-level lasers or light-emitting diodes deliver photons from a nonionizing light source to endogenous photoreceptors, primarily cytochrome C oxidase.^7-9 On the visible light spectrum, PBM primarily encompasses RL.^7-9 Photoactivation leads to production of reactive oxygen species as well as mitochondrial alterations, with resulting modulation of cellular activity.^7-9 Upregulation of cellular activity generally occurs at lower fluences (ie, energy delivered per unit area) of light, whereas higher fluences cause downregulation of cellular activity.⁵

Recent consensus guidelines, established with expert colleagues, define additional key parameters that are crucial to optimizing PBM treatment, including distance from the light source, area of the light beam, wavelength, length of treatment time, and number of treatments.⁵ Understanding the effects of different parameter combinations is essential for clinicians to select the best treatment regimen for each patient. Our laboratory has conducted National Institutes of Health–funded phase 1 and phase 2 clinical trials to determine the safety and efficacy of red-light PBM.^10-13 Additionally, we completed several pilot phase 2 clinical studies with commercially available light-emitting diode face masks using PBM technology, which demonstrated a favorable safety profile and high patient satisfaction across multiple self-reported measures.^14,15 These findings highlight PBM as a reliable and well-tolerated therapeutic approach that can be administered in clinical settings or by patients at home.

Adverse effects of PBM therapy generally are mild and transient, most commonly manifesting as slight irritation and erythema.⁵ Overall, PBM is widely regarded as safe with a favorable and nontoxic profile across treatment settings. Growing evidence supports the role of PBM in managing wound healing, acne, alopecia, and skin aging, among other dermatologic concerns.⁸

Photodynamic Therapy

Photodynamic therapy is a noninvasive procedure during which a photosensitizer—typically 5-aminolevulinic acid (5-ALA) or a derivative, methyl aminolevulinate—reacts with a light source and oxygen, resulting in reactive oxygen species.^6,16 This reaction ultimately triggers targeted cellular destruction of the intended lesional skin but with negligible effects on adjacent nonlesional tissue.⁶ The efficacy of PDT is determined by several parameters, including composition and concentration of the photosensitizer, photosensitizer incubation temperature, and incubation time with the photosensitizer. Methyl aminolevulinate is a lipophilic molecule and may promote greater skin penetration and cellular uptake than 5-ALA, which is a hydrophilic molecule.⁶

Our research further demonstrated that apoptosis increases in a dose- and temperature-dependent manner following 5-ALA exposure, both in cutaneous and mucosal squamous cell carcinoma cells and in human dermal fibroblasts.^17,18 Our mechanistic insights have clinical relevance, as evidenced by an independent pilot study demonstrating that temperature-modulated PDT significantly improved actinic keratosis lesion clearance rates (P<.0001).¹⁹ Additionally, we determined that even short periods of incubation with 5-ALA (ie, 15-30 minutes) result in statistically significant increases in apoptosis (P<.05).²⁰ Thus, these findings highlight that the choice of photosensitizing agent and the administration parameters are critical in determining PDT efficacy as well as the need to optimize clinical protocols.

Photodynamic therapy also has demonstrated general clinical and genotoxic safety, with the most common potential adverse events limited to temporary inflammation, erythema, and discomfort.²¹ A study in murine skin and human keratinocytes revealed that 5-ALA PDT had a photoprotective effect against previous irradiation with UVB (a known inducer of DNA damage) via removal of cyclobutane pyrimidine dimers.²² Thus, PDT has been recognized as a safe and effective therapeutic modality with broad applications in dermatology, including treatment of actinic keratosis and nonmelanoma skin cancers.¹⁶

Clinical Safety, Photoprotection, and Precautions

While visible light has shown substantial therapeutic potential in dermatology, there are several safety measures and precautions to be aware of. Visible light constitutes approximately 44% of the solar output; therefore, precautions against both UV and visible light are recommended for the general population.²³ Cumulative exposure to visible light has been shown to trigger melanogenesis, resulting in persistent erythema, hyperpigmentation, and uneven skin tones across all Fitzpatrick skin types.²⁴ Individuals with skin of color are more photosensitive to visible light due to increased baseline melanin levels.²⁴ Similarly, patients with pigmentary conditions such as melasma and postinflammatory hyperpigmentation may experience worsening of their dermatologic symptoms due to underlying visible light photosensitivity.²⁵

Patients undergoing PBM or PDT could benefit from visible light protection. The primary form of photoprotection against visible light is tinted sunscreen, which contains iron oxides and titanium dioxide.²⁶ Iron (III) oxide is capable of blocking nearly all visible light damage.²⁶ Use of physical barriers such as wavelength-specific sunglasses and wide-brimmed hats also is important for preventing photodamage from visible light.²⁶

Final Thoughts

Visible light has a role in the treatment of a variety of skin conditions, including actinic keratosis, nonmelanoma skin cancers, acne, wound healing, skin fibrosis, and photodamage. Photobiomodulation and PDT represent 2 noninvasive phototherapeutic options that utilize visible light to enact cellular changes necessary to improve skin health. Integrating visible light phototherapy into standard clinical practice is important for enhancing patient outcomes. Clinicians should remain mindful of the rare pigmentary risks associated with visible light therapy devices. Future research should prioritize optimization of standardized protocols and expansion of clinical indications for visible light phototherapy.

Visible light is part of the electromagnetic spectrum and is confined to a range of 400 to 700 nm. Visible light phototherapy can be delivered across various wavelengths within this spectrum, with most research focusing on blue light (BL)(400-500 nm) and red light (RL)(600-700 nm). Blue light commonly is used to treat acne as well as actinic keratosis and other inflammatory disorders,^1,2 while RL largely targets signs of skin aging and fibrosis.^2,3 Because of its shorter wavelength, the clinically meaningful skin penetration of BL reaches up to1 mm and is confined to the epidermis; in contrast, RL can access the dermal adnexa due to its penetration depth of more than 2 mm.⁴ Therapeutically, visible light can be utilized alone (eg, photobiomodulation [PBM]) or in combination with a photosensitizing agent (eg, photodynamic therapy [PDT]).^5,6

Our laboratory’s prior research has contributed to a greater understanding of the safety profile of visible light at various wavelengths.^1,3 Specifically, our work has shown that BL (417 nm [range, 412-422 nm]) and RL (633 nm [range, 627-639 nm]) demonstrated no evidence of DNA damage—via no formation of cyclobutane pyrimidine dimers and/or 6-4 photoproducts, the hallmark photolesions caused by UV exposure—in human dermal fibroblasts following visible light exposure at all fluences tested.^1,3 This evidence reinforces the safety of visible light at clinically relevant wavelengths, supporting its integration into dermatologic practice. In this editorial, we highlight the key clinical applications of PBM and PDT and outline safety considerations for visible light-based therapies in dermatologic practice.

Photobiomodulation

Photobiomodulation is a noninvasive treatment in which low-level lasers or light-emitting diodes deliver photons from a nonionizing light source to endogenous photoreceptors, primarily cytochrome C oxidase.^7-9 On the visible light spectrum, PBM primarily encompasses RL.^7-9 Photoactivation leads to production of reactive oxygen species as well as mitochondrial alterations, with resulting modulation of cellular activity.^7-9 Upregulation of cellular activity generally occurs at lower fluences (ie, energy delivered per unit area) of light, whereas higher fluences cause downregulation of cellular activity.⁵

Recent consensus guidelines, established with expert colleagues, define additional key parameters that are crucial to optimizing PBM treatment, including distance from the light source, area of the light beam, wavelength, length of treatment time, and number of treatments.⁵ Understanding the effects of different parameter combinations is essential for clinicians to select the best treatment regimen for each patient. Our laboratory has conducted National Institutes of Health–funded phase 1 and phase 2 clinical trials to determine the safety and efficacy of red-light PBM.^10-13 Additionally, we completed several pilot phase 2 clinical studies with commercially available light-emitting diode face masks using PBM technology, which demonstrated a favorable safety profile and high patient satisfaction across multiple self-reported measures.^14,15 These findings highlight PBM as a reliable and well-tolerated therapeutic approach that can be administered in clinical settings or by patients at home.

Adverse effects of PBM therapy generally are mild and transient, most commonly manifesting as slight irritation and erythema.⁵ Overall, PBM is widely regarded as safe with a favorable and nontoxic profile across treatment settings. Growing evidence supports the role of PBM in managing wound healing, acne, alopecia, and skin aging, among other dermatologic concerns.⁸

Photodynamic Therapy

Photodynamic therapy is a noninvasive procedure during which a photosensitizer—typically 5-aminolevulinic acid (5-ALA) or a derivative, methyl aminolevulinate—reacts with a light source and oxygen, resulting in reactive oxygen species.^6,16 This reaction ultimately triggers targeted cellular destruction of the intended lesional skin but with negligible effects on adjacent nonlesional tissue.⁶ The efficacy of PDT is determined by several parameters, including composition and concentration of the photosensitizer, photosensitizer incubation temperature, and incubation time with the photosensitizer. Methyl aminolevulinate is a lipophilic molecule and may promote greater skin penetration and cellular uptake than 5-ALA, which is a hydrophilic molecule.⁶

Our research further demonstrated that apoptosis increases in a dose- and temperature-dependent manner following 5-ALA exposure, both in cutaneous and mucosal squamous cell carcinoma cells and in human dermal fibroblasts.^17,18 Our mechanistic insights have clinical relevance, as evidenced by an independent pilot study demonstrating that temperature-modulated PDT significantly improved actinic keratosis lesion clearance rates (P<.0001).¹⁹ Additionally, we determined that even short periods of incubation with 5-ALA (ie, 15-30 minutes) result in statistically significant increases in apoptosis (P<.05).²⁰ Thus, these findings highlight that the choice of photosensitizing agent and the administration parameters are critical in determining PDT efficacy as well as the need to optimize clinical protocols.

Photodynamic therapy also has demonstrated general clinical and genotoxic safety, with the most common potential adverse events limited to temporary inflammation, erythema, and discomfort.²¹ A study in murine skin and human keratinocytes revealed that 5-ALA PDT had a photoprotective effect against previous irradiation with UVB (a known inducer of DNA damage) via removal of cyclobutane pyrimidine dimers.²² Thus, PDT has been recognized as a safe and effective therapeutic modality with broad applications in dermatology, including treatment of actinic keratosis and nonmelanoma skin cancers.¹⁶

Clinical Safety, Photoprotection, and Precautions

While visible light has shown substantial therapeutic potential in dermatology, there are several safety measures and precautions to be aware of. Visible light constitutes approximately 44% of the solar output; therefore, precautions against both UV and visible light are recommended for the general population.²³ Cumulative exposure to visible light has been shown to trigger melanogenesis, resulting in persistent erythema, hyperpigmentation, and uneven skin tones across all Fitzpatrick skin types.²⁴ Individuals with skin of color are more photosensitive to visible light due to increased baseline melanin levels.²⁴ Similarly, patients with pigmentary conditions such as melasma and postinflammatory hyperpigmentation may experience worsening of their dermatologic symptoms due to underlying visible light photosensitivity.²⁵

Patients undergoing PBM or PDT could benefit from visible light protection. The primary form of photoprotection against visible light is tinted sunscreen, which contains iron oxides and titanium dioxide.²⁶ Iron (III) oxide is capable of blocking nearly all visible light damage.²⁶ Use of physical barriers such as wavelength-specific sunglasses and wide-brimmed hats also is important for preventing photodamage from visible light.²⁶

Final Thoughts

Visible light has a role in the treatment of a variety of skin conditions, including actinic keratosis, nonmelanoma skin cancers, acne, wound healing, skin fibrosis, and photodamage. Photobiomodulation and PDT represent 2 noninvasive phototherapeutic options that utilize visible light to enact cellular changes necessary to improve skin health. Integrating visible light phototherapy into standard clinical practice is important for enhancing patient outcomes. Clinicians should remain mindful of the rare pigmentary risks associated with visible light therapy devices. Future research should prioritize optimization of standardized protocols and expansion of clinical indications for visible light phototherapy.

I was accepted into my fellowship almost 1 year ago: major milestones on my curriculum vitae are now met, fellowship application materials are complete, and the stress of the match is long gone. At the start of my fellowship, I had 2 priorities: (1) to learn as much as I could about dermatologic surgery and (2) to be the best dad possible to my newborn son, Jay. However, most nights I still find myself up late editing a manuscript draft or chasing down references, long after the “need” to publish has passed. Recently, my wife asked me why—what’s left to prove?

I’ll be the first to admit it: early on, publishing felt almost purely transactional. Each project was little more than a line on an application or a way to stand out or meet a new mentor. I have reflected before on how easily that mindset can slip into a kind of research arms race, in which productivity overshadows purpose.¹ This time, I wanted to explore the other side of that equation: the “why” behind it all.

I have learned that writing forces me to slow down and actually think about what I am seeing every day. It turns routine work into something I must understand well enough to explain. Even a small write-up can make me notice details I would otherwise skim past in clinic or surgery. These days, most of my projects start small: a case that taught me something, an observation that made me pause and think. Those seemingly small questions are what eventually grow into bigger ones. The clinical trial I am designing now did not begin as a grand plan—it started because I could not stop thinking about how we manage pain and analgesia after Mohs surgery. That curiosity, shaped by the experience of writing those earlier “smaller” papers, evolved into a study that might actually help improve patient care one day. Still, most of what I write will not revolutionize the field. It is not cutting-edge science or paradigm-shifting data; it is mostly modest analyses with a few interesting conclusions or surgical pearls that might cut down on a patient’s procedural time or save a dermatologist somewhere a few sutures. But it still feels worth doing.

While rotating with Dr. Anna Bar at Oregon Health & Science University, Portland, I noticed a poster hanging on the wall titled, “Top 10 Reasons Why Our Faculty Are Dedicated to Academics and Teaching,” based on the wisdom of Dr. Jane M. Grant-Kels.² My favorite line on the poster reads, “Residents make us better by asking questions.” I think this philosophy is the main reason why I still write. Even though I am not a resident anymore, I am still asking questions. But if I had to sum up my “why” into a neat list, here is what it might look like:

Because asking questions keeps your brain wired for curiosity. Even small projects train us to remain curious, and this curiosity can mean the difference between just doing your job and continuing to evolve within it. As Dr. Rodolfo Neirotti reminds us, “Questions are useful tools—they open communication, improve understanding, and drive scientific research. In medicine, doing things without knowing why is risky.”³

Because the small stuff builds the culture. Dermatology is a small world. Even short case series, pearls, or “how we do it” pieces can shape how we practice. They may not change paradigms, but they can refine them. Over time, those small practical contributions become part of the field’s collective muscle memory.

Because it preserves perspective. Residency, fellowship, and early practice can blur together. A tiny project can become a timestamp of what you were learning or caring about at that specific moment. Years later, you may remember the case through the paper.

Because the act of writing is the point. Writing forces clarity. You cannot hide behind saying, “That’s just how I do things,” when you have to explain it to others. The discipline of organizing your thoughts sharpens your clinical reasoning and keeps you honest about what you actually know.

Because sometimes it is simply about participating. Publishing, even small pieces, is a way of staying in touch with your field. It says, “I’m still here. I’m still paying attention.”

I think about how Dr. Frederic Mohs developed the technique that now bears his name while he was still a medical student.⁴ He could have said, “I already made it into medical school. That’s enough.” But he did not. I guess my point is not that we are all on the verge of inventing something revolutionary; it is that innovation happens only when curiosity keeps moving us forward. So no, I do not write to check boxes anymore. I write because it keeps me curious, and I have realized that curiosity is a habit I never want to outgrow.

Or maybe it’s because Jay keeps me up at night, and I have nothing better to do.

I was accepted into my fellowship almost 1 year ago: major milestones on my curriculum vitae are now met, fellowship application materials are complete, and the stress of the match is long gone. At the start of my fellowship, I had 2 priorities: (1) to learn as much as I could about dermatologic surgery and (2) to be the best dad possible to my newborn son, Jay. However, most nights I still find myself up late editing a manuscript draft or chasing down references, long after the “need” to publish has passed. Recently, my wife asked me why—what’s left to prove?

I’ll be the first to admit it: early on, publishing felt almost purely transactional. Each project was little more than a line on an application or a way to stand out or meet a new mentor. I have reflected before on how easily that mindset can slip into a kind of research arms race, in which productivity overshadows purpose.¹ This time, I wanted to explore the other side of that equation: the “why” behind it all.

I have learned that writing forces me to slow down and actually think about what I am seeing every day. It turns routine work into something I must understand well enough to explain. Even a small write-up can make me notice details I would otherwise skim past in clinic or surgery. These days, most of my projects start small: a case that taught me something, an observation that made me pause and think. Those seemingly small questions are what eventually grow into bigger ones. The clinical trial I am designing now did not begin as a grand plan—it started because I could not stop thinking about how we manage pain and analgesia after Mohs surgery. That curiosity, shaped by the experience of writing those earlier “smaller” papers, evolved into a study that might actually help improve patient care one day. Still, most of what I write will not revolutionize the field. It is not cutting-edge science or paradigm-shifting data; it is mostly modest analyses with a few interesting conclusions or surgical pearls that might cut down on a patient’s procedural time or save a dermatologist somewhere a few sutures. But it still feels worth doing.

While rotating with Dr. Anna Bar at Oregon Health & Science University, Portland, I noticed a poster hanging on the wall titled, “Top 10 Reasons Why Our Faculty Are Dedicated to Academics and Teaching,” based on the wisdom of Dr. Jane M. Grant-Kels.² My favorite line on the poster reads, “Residents make us better by asking questions.” I think this philosophy is the main reason why I still write. Even though I am not a resident anymore, I am still asking questions. But if I had to sum up my “why” into a neat list, here is what it might look like:

Because asking questions keeps your brain wired for curiosity. Even small projects train us to remain curious, and this curiosity can mean the difference between just doing your job and continuing to evolve within it. As Dr. Rodolfo Neirotti reminds us, “Questions are useful tools—they open communication, improve understanding, and drive scientific research. In medicine, doing things without knowing why is risky.”³

Because the small stuff builds the culture. Dermatology is a small world. Even short case series, pearls, or “how we do it” pieces can shape how we practice. They may not change paradigms, but they can refine them. Over time, those small practical contributions become part of the field’s collective muscle memory.

Because it preserves perspective. Residency, fellowship, and early practice can blur together. A tiny project can become a timestamp of what you were learning or caring about at that specific moment. Years later, you may remember the case through the paper.

Because the act of writing is the point. Writing forces clarity. You cannot hide behind saying, “That’s just how I do things,” when you have to explain it to others. The discipline of organizing your thoughts sharpens your clinical reasoning and keeps you honest about what you actually know.

Because sometimes it is simply about participating. Publishing, even small pieces, is a way of staying in touch with your field. It says, “I’m still here. I’m still paying attention.”

I think about how Dr. Frederic Mohs developed the technique that now bears his name while he was still a medical student.⁴ He could have said, “I already made it into medical school. That’s enough.” But he did not. I guess my point is not that we are all on the verge of inventing something revolutionary; it is that innovation happens only when curiosity keeps moving us forward. So no, I do not write to check boxes anymore. I write because it keeps me curious, and I have realized that curiosity is a habit I never want to outgrow.

Or maybe it’s because Jay keeps me up at night, and I have nothing better to do.

I was accepted into my fellowship almost 1 year ago: major milestones on my curriculum vitae are now met, fellowship application materials are complete, and the stress of the match is long gone. At the start of my fellowship, I had 2 priorities: (1) to learn as much as I could about dermatologic surgery and (2) to be the best dad possible to my newborn son, Jay. However, most nights I still find myself up late editing a manuscript draft or chasing down references, long after the “need” to publish has passed. Recently, my wife asked me why—what’s left to prove?

I’ll be the first to admit it: early on, publishing felt almost purely transactional. Each project was little more than a line on an application or a way to stand out or meet a new mentor. I have reflected before on how easily that mindset can slip into a kind of research arms race, in which productivity overshadows purpose.¹ This time, I wanted to explore the other side of that equation: the “why” behind it all.

I have learned that writing forces me to slow down and actually think about what I am seeing every day. It turns routine work into something I must understand well enough to explain. Even a small write-up can make me notice details I would otherwise skim past in clinic or surgery. These days, most of my projects start small: a case that taught me something, an observation that made me pause and think. Those seemingly small questions are what eventually grow into bigger ones. The clinical trial I am designing now did not begin as a grand plan—it started because I could not stop thinking about how we manage pain and analgesia after Mohs surgery. That curiosity, shaped by the experience of writing those earlier “smaller” papers, evolved into a study that might actually help improve patient care one day. Still, most of what I write will not revolutionize the field. It is not cutting-edge science or paradigm-shifting data; it is mostly modest analyses with a few interesting conclusions or surgical pearls that might cut down on a patient’s procedural time or save a dermatologist somewhere a few sutures. But it still feels worth doing.

While rotating with Dr. Anna Bar at Oregon Health & Science University, Portland, I noticed a poster hanging on the wall titled, “Top 10 Reasons Why Our Faculty Are Dedicated to Academics and Teaching,” based on the wisdom of Dr. Jane M. Grant-Kels.² My favorite line on the poster reads, “Residents make us better by asking questions.” I think this philosophy is the main reason why I still write. Even though I am not a resident anymore, I am still asking questions. But if I had to sum up my “why” into a neat list, here is what it might look like:

Because asking questions keeps your brain wired for curiosity. Even small projects train us to remain curious, and this curiosity can mean the difference between just doing your job and continuing to evolve within it. As Dr. Rodolfo Neirotti reminds us, “Questions are useful tools—they open communication, improve understanding, and drive scientific research. In medicine, doing things without knowing why is risky.”³

Because the small stuff builds the culture. Dermatology is a small world. Even short case series, pearls, or “how we do it” pieces can shape how we practice. They may not change paradigms, but they can refine them. Over time, those small practical contributions become part of the field’s collective muscle memory.

Because it preserves perspective. Residency, fellowship, and early practice can blur together. A tiny project can become a timestamp of what you were learning or caring about at that specific moment. Years later, you may remember the case through the paper.

Because the act of writing is the point. Writing forces clarity. You cannot hide behind saying, “That’s just how I do things,” when you have to explain it to others. The discipline of organizing your thoughts sharpens your clinical reasoning and keeps you honest about what you actually know.

Because sometimes it is simply about participating. Publishing, even small pieces, is a way of staying in touch with your field. It says, “I’m still here. I’m still paying attention.”

I think about how Dr. Frederic Mohs developed the technique that now bears his name while he was still a medical student.⁴ He could have said, “I already made it into medical school. That’s enough.” But he did not. I guess my point is not that we are all on the verge of inventing something revolutionary; it is that innovation happens only when curiosity keeps moving us forward. So no, I do not write to check boxes anymore. I write because it keeps me curious, and I have realized that curiosity is a habit I never want to outgrow.

Or maybe it’s because Jay keeps me up at night, and I have nothing better to do.

The Diagnosis: Fibroelastolytic Papulosis

Histopathology demonstrated decreased density and fragmentation of elastic fibers in the superficial reticular and papillary dermis consistent with an elastolytic disease process (Figure). Of note, elastolysis typically is visualized with Verhoeff-van Gieson stain but cannot be visualized well with standard hematoxylin and eosin staining. Additional staining with Congo red was negative for amyloid, and colloidal iron did not show any increase in dermal mucin, ruling out amyloidosis and scleromyxedema, respectively. Based on the histopathologic findings and the clinical history, a diagnosis of fibroelastolytic papulosis (FP) was made. Given the benign nature of the condition, the patient was prescribed a topical steroid (clobetasol 0.05%) for symptomatic relief. 

Cutaneous conditions can arise from abnormalities in the elastin composition of connective tissue due to abnormal elastin formation or degradation (elastolysis).¹ Fibroelastolytic papulosis is a distinct elastolytic disorder diagnosed histologically by a notable loss of elastic fibers localized to the papillary dermis.² Fibroelastolytic papulosis is an acquired condition linked to exposure to UV radiation, abnormal elastogenesis, and hormonal factors that commonly involves the neck, supraclavicular area, and upper back.^1-3 Predominantly affecting elderly women, FP is characterized by soft white papules that often coalesce into a cobblestonelike plaque.² Because the condition rarely is seen in men, there is speculation that it may involve genetic, hereditary, and hormonal factors that have yet to be identified.¹ 

Fibroelastolytic papulosis can be classified as either pseudoxanthoma elasticum–like papillary dermal elastolysis or white fibrous papulosis.^2,3 White fibrous papulosis manifests with haphazardly arranged collagen fibers in the reticular and deep dermis with papillary dermal elastolysis and most commonly develops on the neck.³ Although our patient’s lesion was on the neck, the absence of thickened collagen bands on histology supported classification as the pseudoxanthoma elasticum– like papillary dermal elastolysis subtype. 

Fibroelastolytic papulosis can be distinguished from other elastic abnormalities by its characteristic clinical appearance, demographic distribution, and associated histopathologic findings. The differential diagnosis of FP includes pseudoxanthoma elasticum (PXE), anetoderma, scleromyxedema, and lichen amyloidosis. 

Pseudoxanthoma elasticum is a hereditary or acquired multisystem disease characterized by fragmentation and calcification of elastic fibers in the mid dermis.^1,4 Its clinical presentation resembles that of FP, appearing as small, asymptomatic, yellowish or flesh-colored papules in a reticular pattern that progressively coalesce into larger plaques with a cobblestonelike appearance.1 Like FP, PXE commonly affects the flexural creases in women but in contrast may manifest earlier (ie, second or third decades of life). Additionally, the pathogenesis of PXE is not related to UV radiation exposure. The hereditary form develops due to a gene variation, whereas the acquired form may be due to conditions associated with physiologic and/or mechanical stress.¹ 

Anetoderma, also known as macular atrophy, is another condition that demonstrates elastic tissue loss in the dermis on histopathology.¹ Anetoderma commonly is seen in younger patients and can be differentiated from FP by the antecedent presence of an inflammatory process. Anetoderma is classified as primary or secondary. Primary anetoderma is associated with prothrombotic abnormalities, while secondary anetoderma is associated with systemic disease including but not limited to sarcoidosis, systemic lupus erythematous, and Graves disease.¹

Neither lichen myxedematosus (LM) nor lichen amyloidosis (LA) are true elastolytic conditions. Lichen myxedematosus is considered in the differential diagnosis of FP due to the associated loss of elastin observed with disease progression. An idiopathic cutaneous mucinosis, LM is a localized form of scleromyxedema, which is characterized by small, firm, waxy papules; mucin deposition in the skin; fibroblast proliferation; and fibrosis. On histologic analysis, typical findings of LM include irregularly arranged fibroblasts, diffuse mucin deposition within the upper and mid reticular dermis, increased collagen deposition, and a decrease in elastin fibers.⁵ 

Lichen amyloidosis is a subtype of primary localized cutaneous amyloidosis, a rare condition characterized by the extracellular deposition of amyloid proteins in the skin and a lack of systemic involvement. Although it is not an elastolytic condition, LA is clinically similar to FP, often manifesting as multiple localized, pruritic, hyperpigmented papules that can coalesce into larger plaques; it tends to develop on the shins, calves, ankles, and thighs.^6,7 The condition commonly manifests in the fifth and sixth decades of life; however, in contrast to FP, LA is more prevalent in men and individuals from Central and South American as well as Middle Eastern and non-Chinese Asian populations.⁸ Lichen amyloidosis is a keratin-derived amyloidosis with cytokeratin-based amyloid precursors that only deposit in the dermis.⁶ Histopathology reveals colloid bodies due to the presence of apoptotic basal keratinocytes. The etiology of LA is unknown, but on rare occasions it has been associated with multiple endocrine neoplasia 2A rearranged during transfection mutations.⁶ 

In summary, FP is an uncommonly diagnosed elastolytic condition that often is asymptomatic or associated with mild pruritus. Biopsy is warranted to help differentiate it from mimicker conditions that may be associated with systemic disease. Currently, there is no established therapy that provides successful treatment. Research suggests unsatisfactory results with the use of topical tretinoin or topical antioxidants.3 More recently, nonablative fractional resurfacing lasers have been evaluated as a possible therapeutic strategy of promise for elastic disorders.⁹

The Diagnosis: Fibroelastolytic Papulosis

Histopathology demonstrated decreased density and fragmentation of elastic fibers in the superficial reticular and papillary dermis consistent with an elastolytic disease process (Figure). Of note, elastolysis typically is visualized with Verhoeff-van Gieson stain but cannot be visualized well with standard hematoxylin and eosin staining. Additional staining with Congo red was negative for amyloid, and colloidal iron did not show any increase in dermal mucin, ruling out amyloidosis and scleromyxedema, respectively. Based on the histopathologic findings and the clinical history, a diagnosis of fibroelastolytic papulosis (FP) was made. Given the benign nature of the condition, the patient was prescribed a topical steroid (clobetasol 0.05%) for symptomatic relief. 

Cutaneous conditions can arise from abnormalities in the elastin composition of connective tissue due to abnormal elastin formation or degradation (elastolysis).¹ Fibroelastolytic papulosis is a distinct elastolytic disorder diagnosed histologically by a notable loss of elastic fibers localized to the papillary dermis.² Fibroelastolytic papulosis is an acquired condition linked to exposure to UV radiation, abnormal elastogenesis, and hormonal factors that commonly involves the neck, supraclavicular area, and upper back.^1-3 Predominantly affecting elderly women, FP is characterized by soft white papules that often coalesce into a cobblestonelike plaque.² Because the condition rarely is seen in men, there is speculation that it may involve genetic, hereditary, and hormonal factors that have yet to be identified.¹ 

Fibroelastolytic papulosis can be classified as either pseudoxanthoma elasticum–like papillary dermal elastolysis or white fibrous papulosis.^2,3 White fibrous papulosis manifests with haphazardly arranged collagen fibers in the reticular and deep dermis with papillary dermal elastolysis and most commonly develops on the neck.³ Although our patient’s lesion was on the neck, the absence of thickened collagen bands on histology supported classification as the pseudoxanthoma elasticum– like papillary dermal elastolysis subtype. 

Fibroelastolytic papulosis can be distinguished from other elastic abnormalities by its characteristic clinical appearance, demographic distribution, and associated histopathologic findings. The differential diagnosis of FP includes pseudoxanthoma elasticum (PXE), anetoderma, scleromyxedema, and lichen amyloidosis. 

Pseudoxanthoma elasticum is a hereditary or acquired multisystem disease characterized by fragmentation and calcification of elastic fibers in the mid dermis.^1,4 Its clinical presentation resembles that of FP, appearing as small, asymptomatic, yellowish or flesh-colored papules in a reticular pattern that progressively coalesce into larger plaques with a cobblestonelike appearance.1 Like FP, PXE commonly affects the flexural creases in women but in contrast may manifest earlier (ie, second or third decades of life). Additionally, the pathogenesis of PXE is not related to UV radiation exposure. The hereditary form develops due to a gene variation, whereas the acquired form may be due to conditions associated with physiologic and/or mechanical stress.¹ 

Anetoderma, also known as macular atrophy, is another condition that demonstrates elastic tissue loss in the dermis on histopathology.¹ Anetoderma commonly is seen in younger patients and can be differentiated from FP by the antecedent presence of an inflammatory process. Anetoderma is classified as primary or secondary. Primary anetoderma is associated with prothrombotic abnormalities, while secondary anetoderma is associated with systemic disease including but not limited to sarcoidosis, systemic lupus erythematous, and Graves disease.¹

Neither lichen myxedematosus (LM) nor lichen amyloidosis (LA) are true elastolytic conditions. Lichen myxedematosus is considered in the differential diagnosis of FP due to the associated loss of elastin observed with disease progression. An idiopathic cutaneous mucinosis, LM is a localized form of scleromyxedema, which is characterized by small, firm, waxy papules; mucin deposition in the skin; fibroblast proliferation; and fibrosis. On histologic analysis, typical findings of LM include irregularly arranged fibroblasts, diffuse mucin deposition within the upper and mid reticular dermis, increased collagen deposition, and a decrease in elastin fibers.⁵ 

Lichen amyloidosis is a subtype of primary localized cutaneous amyloidosis, a rare condition characterized by the extracellular deposition of amyloid proteins in the skin and a lack of systemic involvement. Although it is not an elastolytic condition, LA is clinically similar to FP, often manifesting as multiple localized, pruritic, hyperpigmented papules that can coalesce into larger plaques; it tends to develop on the shins, calves, ankles, and thighs.^6,7 The condition commonly manifests in the fifth and sixth decades of life; however, in contrast to FP, LA is more prevalent in men and individuals from Central and South American as well as Middle Eastern and non-Chinese Asian populations.⁸ Lichen amyloidosis is a keratin-derived amyloidosis with cytokeratin-based amyloid precursors that only deposit in the dermis.⁶ Histopathology reveals colloid bodies due to the presence of apoptotic basal keratinocytes. The etiology of LA is unknown, but on rare occasions it has been associated with multiple endocrine neoplasia 2A rearranged during transfection mutations.⁶ 

In summary, FP is an uncommonly diagnosed elastolytic condition that often is asymptomatic or associated with mild pruritus. Biopsy is warranted to help differentiate it from mimicker conditions that may be associated with systemic disease. Currently, there is no established therapy that provides successful treatment. Research suggests unsatisfactory results with the use of topical tretinoin or topical antioxidants.3 More recently, nonablative fractional resurfacing lasers have been evaluated as a possible therapeutic strategy of promise for elastic disorders.⁹

The Diagnosis: Fibroelastolytic Papulosis

Histopathology demonstrated decreased density and fragmentation of elastic fibers in the superficial reticular and papillary dermis consistent with an elastolytic disease process (Figure). Of note, elastolysis typically is visualized with Verhoeff-van Gieson stain but cannot be visualized well with standard hematoxylin and eosin staining. Additional staining with Congo red was negative for amyloid, and colloidal iron did not show any increase in dermal mucin, ruling out amyloidosis and scleromyxedema, respectively. Based on the histopathologic findings and the clinical history, a diagnosis of fibroelastolytic papulosis (FP) was made. Given the benign nature of the condition, the patient was prescribed a topical steroid (clobetasol 0.05%) for symptomatic relief. 

Cutaneous conditions can arise from abnormalities in the elastin composition of connective tissue due to abnormal elastin formation or degradation (elastolysis).¹ Fibroelastolytic papulosis is a distinct elastolytic disorder diagnosed histologically by a notable loss of elastic fibers localized to the papillary dermis.² Fibroelastolytic papulosis is an acquired condition linked to exposure to UV radiation, abnormal elastogenesis, and hormonal factors that commonly involves the neck, supraclavicular area, and upper back.^1-3 Predominantly affecting elderly women, FP is characterized by soft white papules that often coalesce into a cobblestonelike plaque.² Because the condition rarely is seen in men, there is speculation that it may involve genetic, hereditary, and hormonal factors that have yet to be identified.¹ 

Fibroelastolytic papulosis can be classified as either pseudoxanthoma elasticum–like papillary dermal elastolysis or white fibrous papulosis.^2,3 White fibrous papulosis manifests with haphazardly arranged collagen fibers in the reticular and deep dermis with papillary dermal elastolysis and most commonly develops on the neck.³ Although our patient’s lesion was on the neck, the absence of thickened collagen bands on histology supported classification as the pseudoxanthoma elasticum– like papillary dermal elastolysis subtype. 

Fibroelastolytic papulosis can be distinguished from other elastic abnormalities by its characteristic clinical appearance, demographic distribution, and associated histopathologic findings. The differential diagnosis of FP includes pseudoxanthoma elasticum (PXE), anetoderma, scleromyxedema, and lichen amyloidosis. 

Pseudoxanthoma elasticum is a hereditary or acquired multisystem disease characterized by fragmentation and calcification of elastic fibers in the mid dermis.^1,4 Its clinical presentation resembles that of FP, appearing as small, asymptomatic, yellowish or flesh-colored papules in a reticular pattern that progressively coalesce into larger plaques with a cobblestonelike appearance.1 Like FP, PXE commonly affects the flexural creases in women but in contrast may manifest earlier (ie, second or third decades of life). Additionally, the pathogenesis of PXE is not related to UV radiation exposure. The hereditary form develops due to a gene variation, whereas the acquired form may be due to conditions associated with physiologic and/or mechanical stress.¹ 

Anetoderma, also known as macular atrophy, is another condition that demonstrates elastic tissue loss in the dermis on histopathology.¹ Anetoderma commonly is seen in younger patients and can be differentiated from FP by the antecedent presence of an inflammatory process. Anetoderma is classified as primary or secondary. Primary anetoderma is associated with prothrombotic abnormalities, while secondary anetoderma is associated with systemic disease including but not limited to sarcoidosis, systemic lupus erythematous, and Graves disease.¹

Neither lichen myxedematosus (LM) nor lichen amyloidosis (LA) are true elastolytic conditions. Lichen myxedematosus is considered in the differential diagnosis of FP due to the associated loss of elastin observed with disease progression. An idiopathic cutaneous mucinosis, LM is a localized form of scleromyxedema, which is characterized by small, firm, waxy papules; mucin deposition in the skin; fibroblast proliferation; and fibrosis. On histologic analysis, typical findings of LM include irregularly arranged fibroblasts, diffuse mucin deposition within the upper and mid reticular dermis, increased collagen deposition, and a decrease in elastin fibers.⁵ 

Lichen amyloidosis is a subtype of primary localized cutaneous amyloidosis, a rare condition characterized by the extracellular deposition of amyloid proteins in the skin and a lack of systemic involvement. Although it is not an elastolytic condition, LA is clinically similar to FP, often manifesting as multiple localized, pruritic, hyperpigmented papules that can coalesce into larger plaques; it tends to develop on the shins, calves, ankles, and thighs.^6,7 The condition commonly manifests in the fifth and sixth decades of life; however, in contrast to FP, LA is more prevalent in men and individuals from Central and South American as well as Middle Eastern and non-Chinese Asian populations.⁸ Lichen amyloidosis is a keratin-derived amyloidosis with cytokeratin-based amyloid precursors that only deposit in the dermis.⁶ Histopathology reveals colloid bodies due to the presence of apoptotic basal keratinocytes. The etiology of LA is unknown, but on rare occasions it has been associated with multiple endocrine neoplasia 2A rearranged during transfection mutations.⁶ 

In summary, FP is an uncommonly diagnosed elastolytic condition that often is asymptomatic or associated with mild pruritus. Biopsy is warranted to help differentiate it from mimicker conditions that may be associated with systemic disease. Currently, there is no established therapy that provides successful treatment. Research suggests unsatisfactory results with the use of topical tretinoin or topical antioxidants.3 More recently, nonablative fractional resurfacing lasers have been evaluated as a possible therapeutic strategy of promise for elastic disorders.⁹

The original four HPEER Advanced Fellowship sites were established by the Department of Veterans Affairs (VA) Office of Academic Affiliation in 2014, and expanded in 2020 to include 8 sites and a national coordinating center with leadership shared between VA facilities in Houston and White River Junction. The VA invests heavily in training the nation’s healthcare professionals. The mission of HPEER is to develop leaders who can educate, evaluate, and innovate in Health Professions Education for the VA and the nation. All HPEER sites take part in a nationally coordinated curriculum covering topics in curriculum design, learner assessment, leadership, interprofessional education, as well as scholarship and educational research.

As part of the national HPEER curriculum covering scholarship and educational research, and in concert with Wednesday, May 14, 2025 VA Research Week 2025, HPEER organized a joint conference with the Center for Health Professions Education at the Uniformed Services University of the Health Sciences (USUHS). This interagency online event included poster sessions and oral presentations from HPEER fellows and students in USUHS certificate and graduate degree programs.

Education scholarship is broad, ranging from descriptions of curricular innovations and works in progress to advanced research using techniques drawn from psychology, sociology, anthropology, economics, and other scientific disciplines. The abstracts presented here summarize some of the work being done by HPEER fellows. Dougherty et al (Boston) described a project to create a primer outlining methodology for conducting and interpreting cost-effectiveness evaluations in the context of proposed HPE innovations. Cohen et al (Cleveland) found reduction in potentially problematic orders in the context of life-sustaining treatment following a multifaceted intervention program. Sorenson (Dublin, Georgia) reported an expanded Tai Chi program that included modifications allowing seated positions for veterans with mobility limitations. Young et al (Dublin) described an interprofessional curriculum to strengthen communication between nurses and social workers in their conversations with women veterans living in rural settings. Misedah-Robinson et al (Houston) showed that a new training program strengthened coordinators’ self-reports of preparedness and confidence in their ability to support veterans who have experienced human trafficking. Tovar et al (Salt Lake City) describe a methodology for using data from the VHA Corporate Data Warehouse to optimize schedules of HPE students assigned to VA clinical rotations. Yanez et al (San Francisco) presented initial observations of learner-centered outcomes following participation in a new multidisciplinary integrative health elective. Resto et al (West Haven) reported that implementation of self-serve kiosks increased distribution of substance use harm reduction resources beyond usual clinical care.

A second joint conference between VA HPEER and USUHS is planned for VA Research Week 2026; we look forward to the abstracts that will be produced by this new cohort of fellows, as well as to the future scholarship and contributions to the field that will be made by alumni of the HPEER Advanced Fellowship.

The original four HPEER Advanced Fellowship sites were established by the Department of Veterans Affairs (VA) Office of Academic Affiliation in 2014, and expanded in 2020 to include 8 sites and a national coordinating center with leadership shared between VA facilities in Houston and White River Junction. The VA invests heavily in training the nation’s healthcare professionals. The mission of HPEER is to develop leaders who can educate, evaluate, and innovate in Health Professions Education for the VA and the nation. All HPEER sites take part in a nationally coordinated curriculum covering topics in curriculum design, learner assessment, leadership, interprofessional education, as well as scholarship and educational research.

As part of the national HPEER curriculum covering scholarship and educational research, and in concert with Wednesday, May 14, 2025 VA Research Week 2025, HPEER organized a joint conference with the Center for Health Professions Education at the Uniformed Services University of the Health Sciences (USUHS). This interagency online event included poster sessions and oral presentations from HPEER fellows and students in USUHS certificate and graduate degree programs.

Education scholarship is broad, ranging from descriptions of curricular innovations and works in progress to advanced research using techniques drawn from psychology, sociology, anthropology, economics, and other scientific disciplines. The abstracts presented here summarize some of the work being done by HPEER fellows. Dougherty et al (Boston) described a project to create a primer outlining methodology for conducting and interpreting cost-effectiveness evaluations in the context of proposed HPE innovations. Cohen et al (Cleveland) found reduction in potentially problematic orders in the context of life-sustaining treatment following a multifaceted intervention program. Sorenson (Dublin, Georgia) reported an expanded Tai Chi program that included modifications allowing seated positions for veterans with mobility limitations. Young et al (Dublin) described an interprofessional curriculum to strengthen communication between nurses and social workers in their conversations with women veterans living in rural settings. Misedah-Robinson et al (Houston) showed that a new training program strengthened coordinators’ self-reports of preparedness and confidence in their ability to support veterans who have experienced human trafficking. Tovar et al (Salt Lake City) describe a methodology for using data from the VHA Corporate Data Warehouse to optimize schedules of HPE students assigned to VA clinical rotations. Yanez et al (San Francisco) presented initial observations of learner-centered outcomes following participation in a new multidisciplinary integrative health elective. Resto et al (West Haven) reported that implementation of self-serve kiosks increased distribution of substance use harm reduction resources beyond usual clinical care.

A second joint conference between VA HPEER and USUHS is planned for VA Research Week 2026; we look forward to the abstracts that will be produced by this new cohort of fellows, as well as to the future scholarship and contributions to the field that will be made by alumni of the HPEER Advanced Fellowship.

The original four HPEER Advanced Fellowship sites were established by the Department of Veterans Affairs (VA) Office of Academic Affiliation in 2014, and expanded in 2020 to include 8 sites and a national coordinating center with leadership shared between VA facilities in Houston and White River Junction. The VA invests heavily in training the nation’s healthcare professionals. The mission of HPEER is to develop leaders who can educate, evaluate, and innovate in Health Professions Education for the VA and the nation. All HPEER sites take part in a nationally coordinated curriculum covering topics in curriculum design, learner assessment, leadership, interprofessional education, as well as scholarship and educational research.

As part of the national HPEER curriculum covering scholarship and educational research, and in concert with Wednesday, May 14, 2025 VA Research Week 2025, HPEER organized a joint conference with the Center for Health Professions Education at the Uniformed Services University of the Health Sciences (USUHS). This interagency online event included poster sessions and oral presentations from HPEER fellows and students in USUHS certificate and graduate degree programs.

Education scholarship is broad, ranging from descriptions of curricular innovations and works in progress to advanced research using techniques drawn from psychology, sociology, anthropology, economics, and other scientific disciplines. The abstracts presented here summarize some of the work being done by HPEER fellows. Dougherty et al (Boston) described a project to create a primer outlining methodology for conducting and interpreting cost-effectiveness evaluations in the context of proposed HPE innovations. Cohen et al (Cleveland) found reduction in potentially problematic orders in the context of life-sustaining treatment following a multifaceted intervention program. Sorenson (Dublin, Georgia) reported an expanded Tai Chi program that included modifications allowing seated positions for veterans with mobility limitations. Young et al (Dublin) described an interprofessional curriculum to strengthen communication between nurses and social workers in their conversations with women veterans living in rural settings. Misedah-Robinson et al (Houston) showed that a new training program strengthened coordinators’ self-reports of preparedness and confidence in their ability to support veterans who have experienced human trafficking. Tovar et al (Salt Lake City) describe a methodology for using data from the VHA Corporate Data Warehouse to optimize schedules of HPE students assigned to VA clinical rotations. Yanez et al (San Francisco) presented initial observations of learner-centered outcomes following participation in a new multidisciplinary integrative health elective. Resto et al (West Haven) reported that implementation of self-serve kiosks increased distribution of substance use harm reduction resources beyond usual clinical care.

A second joint conference between VA HPEER and USUHS is planned for VA Research Week 2026; we look forward to the abstracts that will be produced by this new cohort of fellows, as well as to the future scholarship and contributions to the field that will be made by alumni of the HPEER Advanced Fellowship.

Background

Veterans may have a greater risk of experiencing human trafficking (HT) than the general population because of social aspects of health, including housing insecurity, justice involvement, food insecurity, and adverse childhood events.^1-4 Since 2023, the U.S. Department of Veterans Affairs (VA) has explored veterans’ experiences of HT through the Anti-Human Trafficking (AHT) Pilot Project.  This quality improvement project evaluated: 1) development of clinician AHT training materials to enhance identification and response to Veterans experiencing HT, and 2) educational resources aimed at raising awareness tailored to veterans and clinicians.

Methods

South Central Mental Illness Research, Education and Clinical Center (SCMIRECC) facilitated two focus group discussions with AHT coordinators implementing the pilot at six sites. Based on discussions and leadership input, SCMIRECC developed a training curriculum, with bi-weekly readings culminating in a two-hour workshop. Training evaluation followed Kirkpatrick’s model using questions adapted from the Provider Responses, Treatment, and Care for Trafficked People (PROTECT) Survey.^5,6 Veteran-facing materials, including a brochure and whiteboard video, were reviewed by two Veteran Consumer Advisory Boards (CAB). The brochures, whiteboard video, and awareness modules were developed and revised based on feedback from focus group discussions. VA Central Office cleared all materials.

Results

Coordinators were satisfied with the training (mean, 4.20). After the training, none of the coordinators (n = 6) felt unprepared to assist Veterans (pre-training mean, 2.25; post-training mean, 1.40), and confidence in documentation improved (pre-training mean, 3.00; post-training mean, 3.40). Veteran CAB members recommended simplified language and veteran-centered messaging. The coordinators found the brochures and training useful. Recommendations included adding more representation to brochure covers, advanced training, a list of commonly asked questions, and a simplified screening tool. Barriers included delays in material development due to language guidance under recent executive orders.

Conclusions

The AHT training improved coordinators’ preparedness and confidence in supporting Veterans with trafficking experiences. Feedback emphasized the value of concise, Veteran-centered materials and a practical HT screening tool. These findings support the continued implementation of AHT education across VA settings to enhance identification and response for Veterans at risk of HT.

Background

Veterans may have a greater risk of experiencing human trafficking (HT) than the general population because of social aspects of health, including housing insecurity, justice involvement, food insecurity, and adverse childhood events.^1-4 Since 2023, the U.S. Department of Veterans Affairs (VA) has explored veterans’ experiences of HT through the Anti-Human Trafficking (AHT) Pilot Project.  This quality improvement project evaluated: 1) development of clinician AHT training materials to enhance identification and response to Veterans experiencing HT, and 2) educational resources aimed at raising awareness tailored to veterans and clinicians.

Methods

South Central Mental Illness Research, Education and Clinical Center (SCMIRECC) facilitated two focus group discussions with AHT coordinators implementing the pilot at six sites. Based on discussions and leadership input, SCMIRECC developed a training curriculum, with bi-weekly readings culminating in a two-hour workshop. Training evaluation followed Kirkpatrick’s model using questions adapted from the Provider Responses, Treatment, and Care for Trafficked People (PROTECT) Survey.^5,6 Veteran-facing materials, including a brochure and whiteboard video, were reviewed by two Veteran Consumer Advisory Boards (CAB). The brochures, whiteboard video, and awareness modules were developed and revised based on feedback from focus group discussions. VA Central Office cleared all materials.

Results

Coordinators were satisfied with the training (mean, 4.20). After the training, none of the coordinators (n = 6) felt unprepared to assist Veterans (pre-training mean, 2.25; post-training mean, 1.40), and confidence in documentation improved (pre-training mean, 3.00; post-training mean, 3.40). Veteran CAB members recommended simplified language and veteran-centered messaging. The coordinators found the brochures and training useful. Recommendations included adding more representation to brochure covers, advanced training, a list of commonly asked questions, and a simplified screening tool. Barriers included delays in material development due to language guidance under recent executive orders.

Conclusions

The AHT training improved coordinators’ preparedness and confidence in supporting Veterans with trafficking experiences. Feedback emphasized the value of concise, Veteran-centered materials and a practical HT screening tool. These findings support the continued implementation of AHT education across VA settings to enhance identification and response for Veterans at risk of HT.

Background

Veterans may have a greater risk of experiencing human trafficking (HT) than the general population because of social aspects of health, including housing insecurity, justice involvement, food insecurity, and adverse childhood events.^1-4 Since 2023, the U.S. Department of Veterans Affairs (VA) has explored veterans’ experiences of HT through the Anti-Human Trafficking (AHT) Pilot Project.  This quality improvement project evaluated: 1) development of clinician AHT training materials to enhance identification and response to Veterans experiencing HT, and 2) educational resources aimed at raising awareness tailored to veterans and clinicians.

Methods

South Central Mental Illness Research, Education and Clinical Center (SCMIRECC) facilitated two focus group discussions with AHT coordinators implementing the pilot at six sites. Based on discussions and leadership input, SCMIRECC developed a training curriculum, with bi-weekly readings culminating in a two-hour workshop. Training evaluation followed Kirkpatrick’s model using questions adapted from the Provider Responses, Treatment, and Care for Trafficked People (PROTECT) Survey.^5,6 Veteran-facing materials, including a brochure and whiteboard video, were reviewed by two Veteran Consumer Advisory Boards (CAB). The brochures, whiteboard video, and awareness modules were developed and revised based on feedback from focus group discussions. VA Central Office cleared all materials.

Results

Coordinators were satisfied with the training (mean, 4.20). After the training, none of the coordinators (n = 6) felt unprepared to assist Veterans (pre-training mean, 2.25; post-training mean, 1.40), and confidence in documentation improved (pre-training mean, 3.00; post-training mean, 3.40). Veteran CAB members recommended simplified language and veteran-centered messaging. The coordinators found the brochures and training useful. Recommendations included adding more representation to brochure covers, advanced training, a list of commonly asked questions, and a simplified screening tool. Barriers included delays in material development due to language guidance under recent executive orders.

Conclusions

The AHT training improved coordinators’ preparedness and confidence in supporting Veterans with trafficking experiences. Feedback emphasized the value of concise, Veteran-centered materials and a practical HT screening tool. These findings support the continued implementation of AHT education across VA settings to enhance identification and response for Veterans at risk of HT.

Background

Integrative health (IH) combines conventional and complementary medicine in a coordinated, evidence-based approach to treat the whole person. Nearly 40% of American adults have used complementary health approaches,¹ yet IH exposure in medical training is limited. In 2022, the San Francisco VA Health Care Center launched a multidisciplinary clinical IH elective for University of California San Francisco (UCSF) internal medicine and SFVA nurse practitioner residents. Based on findings from a general and targeted needs assessment, including faculty and learner feedback, we found that the elective was well-received, but relied on one-on-one patient-based teaching. This structure created variable learning experiences and high faculty burden. Our project aims to formalize and evaluate the IH elective curriculum to better address the needs of both faculty and learners.

Methods

We used Kern’s six-step framework for curriculum development. To reduce variability, we sought to formalize the core curricular content by: 1) reviewing existing elective components, comparing them to similar curricula nationwide, and outlining foundational knowledge based on the exam domains of the American Board of Integrative Medicine (ABOIM);² 2) creating eleven learning objectives across three themes: patient-centered care, systems-based practice, and IH-specific knowledge; 3) developing IH subspecialty experience guides to standardize clinical teaching with suggested takeaways, guided reflection, and curated resources. To reduce faculty burden, we consolidated elective resources into a centralized e-learning hub. Trainees complete a pre/post self-assessment and evaluation at the end of the elective.

Results

We identified key learning opportunities in each IH shadowing experience to enhance learners’ knowledge. We developed an IH e-Learning Hub to provide easy access to elective materials and IH clinical tools. Evaluations from the first two learners who completed the elective indicate that the learning objectives were met and that learners gained increased knowledge of lifestyle medicine, mind-body medicine, manual medicine, and botanicals/dietary supplements. Learners valued increased IH subspecialty familiarity and reported high likelihood of future practice change.

Discussion

The project is ongoing. Next steps include collecting faculty evaluations about their experience, continuing to create and refine experience guides, promoting clinical tools for learner’s future practice, and developing strategies to recruit more learners to the elective.

Background

Integrative health (IH) combines conventional and complementary medicine in a coordinated, evidence-based approach to treat the whole person. Nearly 40% of American adults have used complementary health approaches,¹ yet IH exposure in medical training is limited. In 2022, the San Francisco VA Health Care Center launched a multidisciplinary clinical IH elective for University of California San Francisco (UCSF) internal medicine and SFVA nurse practitioner residents. Based on findings from a general and targeted needs assessment, including faculty and learner feedback, we found that the elective was well-received, but relied on one-on-one patient-based teaching. This structure created variable learning experiences and high faculty burden. Our project aims to formalize and evaluate the IH elective curriculum to better address the needs of both faculty and learners.

Methods

We used Kern’s six-step framework for curriculum development. To reduce variability, we sought to formalize the core curricular content by: 1) reviewing existing elective components, comparing them to similar curricula nationwide, and outlining foundational knowledge based on the exam domains of the American Board of Integrative Medicine (ABOIM);² 2) creating eleven learning objectives across three themes: patient-centered care, systems-based practice, and IH-specific knowledge; 3) developing IH subspecialty experience guides to standardize clinical teaching with suggested takeaways, guided reflection, and curated resources. To reduce faculty burden, we consolidated elective resources into a centralized e-learning hub. Trainees complete a pre/post self-assessment and evaluation at the end of the elective.

Results

We identified key learning opportunities in each IH shadowing experience to enhance learners’ knowledge. We developed an IH e-Learning Hub to provide easy access to elective materials and IH clinical tools. Evaluations from the first two learners who completed the elective indicate that the learning objectives were met and that learners gained increased knowledge of lifestyle medicine, mind-body medicine, manual medicine, and botanicals/dietary supplements. Learners valued increased IH subspecialty familiarity and reported high likelihood of future practice change.

Discussion

The project is ongoing. Next steps include collecting faculty evaluations about their experience, continuing to create and refine experience guides, promoting clinical tools for learner’s future practice, and developing strategies to recruit more learners to the elective.

Background

Integrative health (IH) combines conventional and complementary medicine in a coordinated, evidence-based approach to treat the whole person. Nearly 40% of American adults have used complementary health approaches,¹ yet IH exposure in medical training is limited. In 2022, the San Francisco VA Health Care Center launched a multidisciplinary clinical IH elective for University of California San Francisco (UCSF) internal medicine and SFVA nurse practitioner residents. Based on findings from a general and targeted needs assessment, including faculty and learner feedback, we found that the elective was well-received, but relied on one-on-one patient-based teaching. This structure created variable learning experiences and high faculty burden. Our project aims to formalize and evaluate the IH elective curriculum to better address the needs of both faculty and learners.

Methods

We used Kern’s six-step framework for curriculum development. To reduce variability, we sought to formalize the core curricular content by: 1) reviewing existing elective components, comparing them to similar curricula nationwide, and outlining foundational knowledge based on the exam domains of the American Board of Integrative Medicine (ABOIM);² 2) creating eleven learning objectives across three themes: patient-centered care, systems-based practice, and IH-specific knowledge; 3) developing IH subspecialty experience guides to standardize clinical teaching with suggested takeaways, guided reflection, and curated resources. To reduce faculty burden, we consolidated elective resources into a centralized e-learning hub. Trainees complete a pre/post self-assessment and evaluation at the end of the elective.

Results

We identified key learning opportunities in each IH shadowing experience to enhance learners’ knowledge. We developed an IH e-Learning Hub to provide easy access to elective materials and IH clinical tools. Evaluations from the first two learners who completed the elective indicate that the learning objectives were met and that learners gained increased knowledge of lifestyle medicine, mind-body medicine, manual medicine, and botanicals/dietary supplements. Learners valued increased IH subspecialty familiarity and reported high likelihood of future practice change.

Discussion

The project is ongoing. Next steps include collecting faculty evaluations about their experience, continuing to create and refine experience guides, promoting clinical tools for learner’s future practice, and developing strategies to recruit more learners to the elective.

Background

The original program consisted of 12 movements that were to be split up between 3 weeks teaching 4 movements each week. Range of mobility was the main consideration for developing this HPE quality improvement project. Veterans who wanted to participate in Tai Chi were not able to engage in the activity due to the range of movement traditional Tai Chi required.

Innovation

The HPE Quality Improvement program developed a 15-movement warm-up, 12 co-ordinational movements consistent with the original program, 18 supplemental Tai Chi movements that were not included in the original program all of which focus on movements remaining below the shoulders and can be done standing or sitting. Four advanced exercises including “hip over heel” were included to target participants balance if able and to improve their hip strength, knee tendon/ligament strength. Tai Chi loses its potential to increase balance when performed in a sitting position.¹ The movements drew upon Fu style Tai Chi and the program developer was given permission from Tommy Kirchoff to use his DVD Healing Exercises. The HPE program consisted of four 30–60-minute weekly sessions of learning the movements with another 4 weekly sessions of demonstrating the movements. Instructors were given written and visual documents to learn from and were evaluated by the developer during the last 4 weeks.
.

Results

Qualitative Data: Instructors notice a difference in how they feel, and appreciate having another option to offer veterans with mobility/standing issues. Patients expressed improvement in mobility relating to bending, arm extension, arm raising, muscle strengthening, hip strengthening and rotation.

Discussion

Future research will want to look at taking measurements before and after patient implementation to determine quantitative data related to balance, strength and range of movement including grip strength, stand up and go, and one-legged stands.

Background

The original program consisted of 12 movements that were to be split up between 3 weeks teaching 4 movements each week. Range of mobility was the main consideration for developing this HPE quality improvement project. Veterans who wanted to participate in Tai Chi were not able to engage in the activity due to the range of movement traditional Tai Chi required.

Innovation

The HPE Quality Improvement program developed a 15-movement warm-up, 12 co-ordinational movements consistent with the original program, 18 supplemental Tai Chi movements that were not included in the original program all of which focus on movements remaining below the shoulders and can be done standing or sitting. Four advanced exercises including “hip over heel” were included to target participants balance if able and to improve their hip strength, knee tendon/ligament strength. Tai Chi loses its potential to increase balance when performed in a sitting position.¹ The movements drew upon Fu style Tai Chi and the program developer was given permission from Tommy Kirchoff to use his DVD Healing Exercises. The HPE program consisted of four 30–60-minute weekly sessions of learning the movements with another 4 weekly sessions of demonstrating the movements. Instructors were given written and visual documents to learn from and were evaluated by the developer during the last 4 weeks.
.

Results

Qualitative Data: Instructors notice a difference in how they feel, and appreciate having another option to offer veterans with mobility/standing issues. Patients expressed improvement in mobility relating to bending, arm extension, arm raising, muscle strengthening, hip strengthening and rotation.

Discussion

Future research will want to look at taking measurements before and after patient implementation to determine quantitative data related to balance, strength and range of movement including grip strength, stand up and go, and one-legged stands.

Background

The original program consisted of 12 movements that were to be split up between 3 weeks teaching 4 movements each week. Range of mobility was the main consideration for developing this HPE quality improvement project. Veterans who wanted to participate in Tai Chi were not able to engage in the activity due to the range of movement traditional Tai Chi required.

Innovation

The HPE Quality Improvement program developed a 15-movement warm-up, 12 co-ordinational movements consistent with the original program, 18 supplemental Tai Chi movements that were not included in the original program all of which focus on movements remaining below the shoulders and can be done standing or sitting. Four advanced exercises including “hip over heel” were included to target participants balance if able and to improve their hip strength, knee tendon/ligament strength. Tai Chi loses its potential to increase balance when performed in a sitting position.¹ The movements drew upon Fu style Tai Chi and the program developer was given permission from Tommy Kirchoff to use his DVD Healing Exercises. The HPE program consisted of four 30–60-minute weekly sessions of learning the movements with another 4 weekly sessions of demonstrating the movements. Instructors were given written and visual documents to learn from and were evaluated by the developer during the last 4 weeks.
.

Results

Qualitative Data: Instructors notice a difference in how they feel, and appreciate having another option to offer veterans with mobility/standing issues. Patients expressed improvement in mobility relating to bending, arm extension, arm raising, muscle strengthening, hip strengthening and rotation.

Discussion

Future research will want to look at taking measurements before and after patient implementation to determine quantitative data related to balance, strength and range of movement including grip strength, stand up and go, and one-legged stands.

Background

Cost-effectiveness (CE) evaluations, for existing and anticipated programs, are common in healthcare, but are rarely used in health professions education (HPE). A systematic review of HPE literature found not only few examples of CE evaluations, but also unclear and inconsistent methodology.¹ One proposed reason HPE has been slow to adopt CE evaluations is uncertainty over terminology and how to adapt this methodology to HPE.² CE evaluations present further challenges for HPE since educational outcomes are often not easily monetized. However, given the reality of constrained budgets and limited resources, CE evaluations can be a powerful tool for educators to strengthen arguments for proposed innovations, and for scholars seeking to conduct rigorous work that sustains critical review.

Innovation

This project aims to make CE evaluations more understandable to HPE educators, using a one-page infographic and glossary. This will provide a primer, operationalizing the steps involved in CE evaluations and addressing why and when CE evaluations might be considered in HPE. To improve comprehension, this is being developed collaboratively with health professions educators and an economist. This infographic will be submitted for publication, as a resource to facilitate educators’ scholarly work and conversations with fiscal administrators.

Results

The infographic includes 1) an overview of CE evaluations, 2) information about inputs required for CE evaluations, 3) guidance on interpreting results, 4) a glossary of key terminology, and 5) considerations for why educators might consider this type of analysis. A final draft will be pilot tested with a focus group to assess interdisciplinary accessibility.

Discussion

Discussions between health professions educators and an economist on this infographic uncovered concepts that were poorly understood or defined differently across disciplines, determining specific knowledge gaps and misunderstandings. For example, facilitating conversation between educators and economists highlighted key terms that were a source of misunderstanding. These were then added to the glossary, creating a shared vocabulary. This also helped clarify the steps and information necessary for conducting CE evaluations in HPE, particularly the issue of perspective choice for the analysis (educator, patient, learner, etc.). Overall, this collaboration aimed at making CE evaluations more approachable and understandable for HPE professionals through this infographic.

Background

Cost-effectiveness (CE) evaluations, for existing and anticipated programs, are common in healthcare, but are rarely used in health professions education (HPE). A systematic review of HPE literature found not only few examples of CE evaluations, but also unclear and inconsistent methodology.¹ One proposed reason HPE has been slow to adopt CE evaluations is uncertainty over terminology and how to adapt this methodology to HPE.² CE evaluations present further challenges for HPE since educational outcomes are often not easily monetized. However, given the reality of constrained budgets and limited resources, CE evaluations can be a powerful tool for educators to strengthen arguments for proposed innovations, and for scholars seeking to conduct rigorous work that sustains critical review.

Innovation

This project aims to make CE evaluations more understandable to HPE educators, using a one-page infographic and glossary. This will provide a primer, operationalizing the steps involved in CE evaluations and addressing why and when CE evaluations might be considered in HPE. To improve comprehension, this is being developed collaboratively with health professions educators and an economist. This infographic will be submitted for publication, as a resource to facilitate educators’ scholarly work and conversations with fiscal administrators.

Results

The infographic includes 1) an overview of CE evaluations, 2) information about inputs required for CE evaluations, 3) guidance on interpreting results, 4) a glossary of key terminology, and 5) considerations for why educators might consider this type of analysis. A final draft will be pilot tested with a focus group to assess interdisciplinary accessibility.

Discussion

Discussions between health professions educators and an economist on this infographic uncovered concepts that were poorly understood or defined differently across disciplines, determining specific knowledge gaps and misunderstandings. For example, facilitating conversation between educators and economists highlighted key terms that were a source of misunderstanding. These were then added to the glossary, creating a shared vocabulary. This also helped clarify the steps and information necessary for conducting CE evaluations in HPE, particularly the issue of perspective choice for the analysis (educator, patient, learner, etc.). Overall, this collaboration aimed at making CE evaluations more approachable and understandable for HPE professionals through this infographic.

Background

Cost-effectiveness (CE) evaluations, for existing and anticipated programs, are common in healthcare, but are rarely used in health professions education (HPE). A systematic review of HPE literature found not only few examples of CE evaluations, but also unclear and inconsistent methodology.¹ One proposed reason HPE has been slow to adopt CE evaluations is uncertainty over terminology and how to adapt this methodology to HPE.² CE evaluations present further challenges for HPE since educational outcomes are often not easily monetized. However, given the reality of constrained budgets and limited resources, CE evaluations can be a powerful tool for educators to strengthen arguments for proposed innovations, and for scholars seeking to conduct rigorous work that sustains critical review.

Innovation

This project aims to make CE evaluations more understandable to HPE educators, using a one-page infographic and glossary. This will provide a primer, operationalizing the steps involved in CE evaluations and addressing why and when CE evaluations might be considered in HPE. To improve comprehension, this is being developed collaboratively with health professions educators and an economist. This infographic will be submitted for publication, as a resource to facilitate educators’ scholarly work and conversations with fiscal administrators.

Results

The infographic includes 1) an overview of CE evaluations, 2) information about inputs required for CE evaluations, 3) guidance on interpreting results, 4) a glossary of key terminology, and 5) considerations for why educators might consider this type of analysis. A final draft will be pilot tested with a focus group to assess interdisciplinary accessibility.

Discussion

Discussions between health professions educators and an economist on this infographic uncovered concepts that were poorly understood or defined differently across disciplines, determining specific knowledge gaps and misunderstandings. For example, facilitating conversation between educators and economists highlighted key terms that were a source of misunderstanding. These were then added to the glossary, creating a shared vocabulary. This also helped clarify the steps and information necessary for conducting CE evaluations in HPE, particularly the issue of perspective choice for the analysis (educator, patient, learner, etc.). Overall, this collaboration aimed at making CE evaluations more approachable and understandable for HPE professionals through this infographic.

The statistics are shocking: 138,000 registered nurses (RNs) have left the workforce since 2022 and at least 40% plan to retire or leave the profession in the next 5 years — and new updates from the Department of Education could make the national nursing crisis even worse.

The reason? Nursing is no longer considered a professional degree.

A recent Department of Education rulemaking session omitted advanced nursing programs (as well as physician assistance programs, physical therapy, occupational therapy, audiology, social work, and public health programs) from the definition of professional degrees and limited the amount of student loan funding available to pursue advanced practice degrees like Master of Science in Nursing and Doctor of Nursing Practice.

“We have a primary care crisis in this country,” said Deborah Trautman PhD, RN, president and chief executive officer of the American Association of Colleges of Nursing (AACN). “The omission is not only harmful for nursing; the omission is not good for anyone who needs healthcare.”
 

Limiting Loan Access

The One Big, Beautiful Bill Act eliminated the Grad PLUS student loan program and amended the list of professional degrees to exclude advanced practice nursing. Although the change doesn’t affect the licensure or legal standing of nurses, it alters access to financial aid and limits advanced education opportunities.

Starting on July 1, 2026, graduate students will be limited to a total of $100,000 in federal student loans, a decrease from the previous cap of $138,500 but loan caps for graduate students in professional degree programs will increase to $200,000. The changes led the National Association of Student Financial Aid Administrators to declare, “Many will be shut out of graduate education.”

“It would force people who need loan support and don’t have a sufficient amount through a federal loan to seek [private loans], but federal loans have better interest rates and/or other conditions, and some students may not qualify for the private loans,” Trautman said. “The risk then is that students may not pursue these advanced nursing degrees because of the financial barriers that they will face.”

The Department of Education disagrees. In a statement, the federal department said, “Placing a cap on loans will push the remaining graduate nursing programs to reduce their program costs, ensuring that nurses will not be saddled with unmanageable student loan debt.” So far, Trautman has seen “no evidence” that limiting access to advanced nursing programs would reduce tuition costs.
 

Industry-Wide Impacts

Trautman worries that omitting nursing from the list of professional degrees will reduce access to care.

Nurse practitioners are providing primary care in rural and underserved areas; certified registered nurse anesthetists make up more than 50% of anesthesia providers in the US (a number that jumps to 80% in rural areas); and the percentage of births attended by certified nurse midwives is growing fast.

“These are nurses…who are working to achieve better patient outcomes and to make the health system work better for all of us,” Trautman said. “And we would be compromising this workforce that is so critical to our nation.”

Limiting the federal student loan borrowing cap for advanced nursing degrees could also exacerbate the nursing faculty shortage. In 2023, more than 65,000 qualified applicants were denied admission to baccalaureate and graduate nursing programs; insufficient number of faculty was the top reason.

Colleges depend on nurses with advanced degrees to fill faculty vacancies. In fact, more than 80% of open positions required or preferred a doctoral degree, according to AACN. Removing nursing from the list of professional degree programs and limiting access to student loans will make it even harder to fill vacancies, limiting the number of new nurses entering the profession.

“We’re finalizing the results of [a new national survey] that showed overwhelming feedback from our member deans and students who believe enrollment in advanced nursing programs is going be impacted,” said Trautman. “We’re going to see the faculty shortage worsen; we’re going see increased financial burdens to our students, and we believe it’s going to undermine the stability of the healthcare workforce.”

Industry associations, including the American Nurses Association, American Academy of Nursing, and American Organization for Nursing Leadership have released statements opposing the change and advocating for graduate nursing degrees to be added to the list of professional programs. Trautman hopes that public pressure and cross-sector support will lead the Department of Education to reverse its current position.

“It’s the wrong decision,” she said. “There is an opportunity to make this right, and that is to include nursing on that professional list.”

A version of this article first appeared on Medscape.com.

The statistics are shocking: 138,000 registered nurses (RNs) have left the workforce since 2022 and at least 40% plan to retire or leave the profession in the next 5 years — and new updates from the Department of Education could make the national nursing crisis even worse.

The reason? Nursing is no longer considered a professional degree.

A recent Department of Education rulemaking session omitted advanced nursing programs (as well as physician assistance programs, physical therapy, occupational therapy, audiology, social work, and public health programs) from the definition of professional degrees and limited the amount of student loan funding available to pursue advanced practice degrees like Master of Science in Nursing and Doctor of Nursing Practice.

“We have a primary care crisis in this country,” said Deborah Trautman PhD, RN, president and chief executive officer of the American Association of Colleges of Nursing (AACN). “The omission is not only harmful for nursing; the omission is not good for anyone who needs healthcare.”
 

Limiting Loan Access

The One Big, Beautiful Bill Act eliminated the Grad PLUS student loan program and amended the list of professional degrees to exclude advanced practice nursing. Although the change doesn’t affect the licensure or legal standing of nurses, it alters access to financial aid and limits advanced education opportunities.

Starting on July 1, 2026, graduate students will be limited to a total of $100,000 in federal student loans, a decrease from the previous cap of $138,500 but loan caps for graduate students in professional degree programs will increase to $200,000. The changes led the National Association of Student Financial Aid Administrators to declare, “Many will be shut out of graduate education.”

“It would force people who need loan support and don’t have a sufficient amount through a federal loan to seek [private loans], but federal loans have better interest rates and/or other conditions, and some students may not qualify for the private loans,” Trautman said. “The risk then is that students may not pursue these advanced nursing degrees because of the financial barriers that they will face.”

The Department of Education disagrees. In a statement, the federal department said, “Placing a cap on loans will push the remaining graduate nursing programs to reduce their program costs, ensuring that nurses will not be saddled with unmanageable student loan debt.” So far, Trautman has seen “no evidence” that limiting access to advanced nursing programs would reduce tuition costs.
 

Industry-Wide Impacts

Trautman worries that omitting nursing from the list of professional degrees will reduce access to care.

Nurse practitioners are providing primary care in rural and underserved areas; certified registered nurse anesthetists make up more than 50% of anesthesia providers in the US (a number that jumps to 80% in rural areas); and the percentage of births attended by certified nurse midwives is growing fast.

“These are nurses…who are working to achieve better patient outcomes and to make the health system work better for all of us,” Trautman said. “And we would be compromising this workforce that is so critical to our nation.”

Limiting the federal student loan borrowing cap for advanced nursing degrees could also exacerbate the nursing faculty shortage. In 2023, more than 65,000 qualified applicants were denied admission to baccalaureate and graduate nursing programs; insufficient number of faculty was the top reason.

Colleges depend on nurses with advanced degrees to fill faculty vacancies. In fact, more than 80% of open positions required or preferred a doctoral degree, according to AACN. Removing nursing from the list of professional degree programs and limiting access to student loans will make it even harder to fill vacancies, limiting the number of new nurses entering the profession.

“We’re finalizing the results of [a new national survey] that showed overwhelming feedback from our member deans and students who believe enrollment in advanced nursing programs is going be impacted,” said Trautman. “We’re going to see the faculty shortage worsen; we’re going see increased financial burdens to our students, and we believe it’s going to undermine the stability of the healthcare workforce.”

Industry associations, including the American Nurses Association, American Academy of Nursing, and American Organization for Nursing Leadership have released statements opposing the change and advocating for graduate nursing degrees to be added to the list of professional programs. Trautman hopes that public pressure and cross-sector support will lead the Department of Education to reverse its current position.

“It’s the wrong decision,” she said. “There is an opportunity to make this right, and that is to include nursing on that professional list.”

A version of this article first appeared on Medscape.com.

The statistics are shocking: 138,000 registered nurses (RNs) have left the workforce since 2022 and at least 40% plan to retire or leave the profession in the next 5 years — and new updates from the Department of Education could make the national nursing crisis even worse.

The reason? Nursing is no longer considered a professional degree.

A recent Department of Education rulemaking session omitted advanced nursing programs (as well as physician assistance programs, physical therapy, occupational therapy, audiology, social work, and public health programs) from the definition of professional degrees and limited the amount of student loan funding available to pursue advanced practice degrees like Master of Science in Nursing and Doctor of Nursing Practice.

“We have a primary care crisis in this country,” said Deborah Trautman PhD, RN, president and chief executive officer of the American Association of Colleges of Nursing (AACN). “The omission is not only harmful for nursing; the omission is not good for anyone who needs healthcare.”
 

Limiting Loan Access

The One Big, Beautiful Bill Act eliminated the Grad PLUS student loan program and amended the list of professional degrees to exclude advanced practice nursing. Although the change doesn’t affect the licensure or legal standing of nurses, it alters access to financial aid and limits advanced education opportunities.

Starting on July 1, 2026, graduate students will be limited to a total of $100,000 in federal student loans, a decrease from the previous cap of $138,500 but loan caps for graduate students in professional degree programs will increase to $200,000. The changes led the National Association of Student Financial Aid Administrators to declare, “Many will be shut out of graduate education.”

“It would force people who need loan support and don’t have a sufficient amount through a federal loan to seek [private loans], but federal loans have better interest rates and/or other conditions, and some students may not qualify for the private loans,” Trautman said. “The risk then is that students may not pursue these advanced nursing degrees because of the financial barriers that they will face.”

The Department of Education disagrees. In a statement, the federal department said, “Placing a cap on loans will push the remaining graduate nursing programs to reduce their program costs, ensuring that nurses will not be saddled with unmanageable student loan debt.” So far, Trautman has seen “no evidence” that limiting access to advanced nursing programs would reduce tuition costs.
 

Industry-Wide Impacts

Trautman worries that omitting nursing from the list of professional degrees will reduce access to care.

Nurse practitioners are providing primary care in rural and underserved areas; certified registered nurse anesthetists make up more than 50% of anesthesia providers in the US (a number that jumps to 80% in rural areas); and the percentage of births attended by certified nurse midwives is growing fast.

“These are nurses…who are working to achieve better patient outcomes and to make the health system work better for all of us,” Trautman said. “And we would be compromising this workforce that is so critical to our nation.”

Limiting the federal student loan borrowing cap for advanced nursing degrees could also exacerbate the nursing faculty shortage. In 2023, more than 65,000 qualified applicants were denied admission to baccalaureate and graduate nursing programs; insufficient number of faculty was the top reason.

Colleges depend on nurses with advanced degrees to fill faculty vacancies. In fact, more than 80% of open positions required or preferred a doctoral degree, according to AACN. Removing nursing from the list of professional degree programs and limiting access to student loans will make it even harder to fill vacancies, limiting the number of new nurses entering the profession.

“We’re finalizing the results of [a new national survey] that showed overwhelming feedback from our member deans and students who believe enrollment in advanced nursing programs is going be impacted,” said Trautman. “We’re going to see the faculty shortage worsen; we’re going see increased financial burdens to our students, and we believe it’s going to undermine the stability of the healthcare workforce.”

Industry associations, including the American Nurses Association, American Academy of Nursing, and American Organization for Nursing Leadership have released statements opposing the change and advocating for graduate nursing degrees to be added to the list of professional programs. Trautman hopes that public pressure and cross-sector support will lead the Department of Education to reverse its current position.

“It’s the wrong decision,” she said. “There is an opportunity to make this right, and that is to include nursing on that professional list.”

A version of this article first appeared on Medscape.com.

What qualities are dermatology programs looking for that may be different from 5 years ago? 

DR. WORSWICK: Every dermatology residency program is different, and as a result, each program is looking for different qualities in its applicants. Overall, I don’t think there has been a huge change in what programs are generally looking for, though. While each program may have a particular trait it values more than another, in general, programs are looking to find residents who will be competent and caring doctors, who work well in teams, and who could be future leaders in our field. 

What are common mistakes you see in dermatology residency interviews, and how can applicants avoid them? 

DR. WORSWICK: Most dermatology applicants are highly accomplished and empathic soon-to-be physicians, so I haven’t found a lot of “mistakes” from this incredible group of people that we have the privilege of interviewing. From time to time, an applicant will lie in an interview, usually out of a desire to appear to be a certain way, and occasionally, they may be nervous and stumble over their words. The former is a really big problem when it happens, and I would recommend that applicants be honest in all their encounters. The latter is not a major problem, and in some cases, might be avoided by lots of practice in advance. 

What types of questions do you recommend applicants ask their interviewers to demonstrate genuine interest in the program? 

DR. WORSWICK: Because of the signaling system, I think that programs assume interest at baseline once an applicant has sent the signal. So, “demonstrating interest” is generally not something I would recommend to applicants during the interview day. It is important for applicants to determine on interview day if a program is a fit for them, so applicants should showcase their unique strengths and skills and find out about what makes any given program different from another. The match generally works well and gets applicants into a program that closely aligns with their strengths and interests. So, think of interview day as your time to figure out how good a fit a program is for you, and not the other way around. 

How can applicants who feel they don't have standout research or leadership credentials differentiate themselves in the interview? 

DR. WORSWICK: While leadership, and less so research experience, is a trait valued highly by most if not all dermatology programs, it is only a part of what an applicant can offer a program. Most programs employ holistic review and consider several factors, probably most commonly grades in medical school, leadership experience, mentorship, teaching, volunteering, Step 2 scores, and letters of recommendation. Any given applicant does not need to excel in all of these. If an applicant has not done a lot of research, they may not match into a research-heavy program, but it doesn’t mean they won’t match. They should determine in which areas they shine and signal the programs that align with those interests/strengths. 

How should applicants discuss nontraditional experiences in a way that adds value rather than raising red flags? 

DR. WORSWICK: In general, my recommendation would be to explain what happened leading up to the change or challenge so that someone reading the application clearly understands the circumstances of the experience, then add value to the description by explaining what was learned and how this might relate to the applicant being a dermatology resident. For example, if a resident took time off for financial reasons and had to work as a medical assitant for a year, a concise description that explains the need for the leave (financial) as well as what value was gained (a year of hands-on patient care experience that validated their choice of going into medicine) could be very helpful.

What qualities are dermatology programs looking for that may be different from 5 years ago? 

DR. WORSWICK: Every dermatology residency program is different, and as a result, each program is looking for different qualities in its applicants. Overall, I don’t think there has been a huge change in what programs are generally looking for, though. While each program may have a particular trait it values more than another, in general, programs are looking to find residents who will be competent and caring doctors, who work well in teams, and who could be future leaders in our field. 

What are common mistakes you see in dermatology residency interviews, and how can applicants avoid them? 

DR. WORSWICK: Most dermatology applicants are highly accomplished and empathic soon-to-be physicians, so I haven’t found a lot of “mistakes” from this incredible group of people that we have the privilege of interviewing. From time to time, an applicant will lie in an interview, usually out of a desire to appear to be a certain way, and occasionally, they may be nervous and stumble over their words. The former is a really big problem when it happens, and I would recommend that applicants be honest in all their encounters. The latter is not a major problem, and in some cases, might be avoided by lots of practice in advance. 

What types of questions do you recommend applicants ask their interviewers to demonstrate genuine interest in the program? 

DR. WORSWICK: Because of the signaling system, I think that programs assume interest at baseline once an applicant has sent the signal. So, “demonstrating interest” is generally not something I would recommend to applicants during the interview day. It is important for applicants to determine on interview day if a program is a fit for them, so applicants should showcase their unique strengths and skills and find out about what makes any given program different from another. The match generally works well and gets applicants into a program that closely aligns with their strengths and interests. So, think of interview day as your time to figure out how good a fit a program is for you, and not the other way around. 

How can applicants who feel they don't have standout research or leadership credentials differentiate themselves in the interview? 

DR. WORSWICK: While leadership, and less so research experience, is a trait valued highly by most if not all dermatology programs, it is only a part of what an applicant can offer a program. Most programs employ holistic review and consider several factors, probably most commonly grades in medical school, leadership experience, mentorship, teaching, volunteering, Step 2 scores, and letters of recommendation. Any given applicant does not need to excel in all of these. If an applicant has not done a lot of research, they may not match into a research-heavy program, but it doesn’t mean they won’t match. They should determine in which areas they shine and signal the programs that align with those interests/strengths. 

How should applicants discuss nontraditional experiences in a way that adds value rather than raising red flags? 

DR. WORSWICK: In general, my recommendation would be to explain what happened leading up to the change or challenge so that someone reading the application clearly understands the circumstances of the experience, then add value to the description by explaining what was learned and how this might relate to the applicant being a dermatology resident. For example, if a resident took time off for financial reasons and had to work as a medical assitant for a year, a concise description that explains the need for the leave (financial) as well as what value was gained (a year of hands-on patient care experience that validated their choice of going into medicine) could be very helpful.

What qualities are dermatology programs looking for that may be different from 5 years ago? 

DR. WORSWICK: Every dermatology residency program is different, and as a result, each program is looking for different qualities in its applicants. Overall, I don’t think there has been a huge change in what programs are generally looking for, though. While each program may have a particular trait it values more than another, in general, programs are looking to find residents who will be competent and caring doctors, who work well in teams, and who could be future leaders in our field. 

What are common mistakes you see in dermatology residency interviews, and how can applicants avoid them? 

DR. WORSWICK: Most dermatology applicants are highly accomplished and empathic soon-to-be physicians, so I haven’t found a lot of “mistakes” from this incredible group of people that we have the privilege of interviewing. From time to time, an applicant will lie in an interview, usually out of a desire to appear to be a certain way, and occasionally, they may be nervous and stumble over their words. The former is a really big problem when it happens, and I would recommend that applicants be honest in all their encounters. The latter is not a major problem, and in some cases, might be avoided by lots of practice in advance. 

What types of questions do you recommend applicants ask their interviewers to demonstrate genuine interest in the program? 

DR. WORSWICK: Because of the signaling system, I think that programs assume interest at baseline once an applicant has sent the signal. So, “demonstrating interest” is generally not something I would recommend to applicants during the interview day. It is important for applicants to determine on interview day if a program is a fit for them, so applicants should showcase their unique strengths and skills and find out about what makes any given program different from another. The match generally works well and gets applicants into a program that closely aligns with their strengths and interests. So, think of interview day as your time to figure out how good a fit a program is for you, and not the other way around. 

How can applicants who feel they don't have standout research or leadership credentials differentiate themselves in the interview? 

DR. WORSWICK: While leadership, and less so research experience, is a trait valued highly by most if not all dermatology programs, it is only a part of what an applicant can offer a program. Most programs employ holistic review and consider several factors, probably most commonly grades in medical school, leadership experience, mentorship, teaching, volunteering, Step 2 scores, and letters of recommendation. Any given applicant does not need to excel in all of these. If an applicant has not done a lot of research, they may not match into a research-heavy program, but it doesn’t mean they won’t match. They should determine in which areas they shine and signal the programs that align with those interests/strengths. 

How should applicants discuss nontraditional experiences in a way that adds value rather than raising red flags? 

DR. WORSWICK: In general, my recommendation would be to explain what happened leading up to the change or challenge so that someone reading the application clearly understands the circumstances of the experience, then add value to the description by explaining what was learned and how this might relate to the applicant being a dermatology resident. For example, if a resident took time off for financial reasons and had to work as a medical assitant for a year, a concise description that explains the need for the leave (financial) as well as what value was gained (a year of hands-on patient care experience that validated their choice of going into medicine) could be very helpful.