Our next speaker is Dr. Claudia Hernandez,
who was assistant professor of dermatology in the UIC College of Medicine, and directs
dermatological and clinical studies in the UIC residency program. She graduated from
Northwestern University Medical School, completed her internship at the University of Chicago,
and completed her residency in dermatology at Northwestern’s Medical Center. She received
the 2009 Women’s Health Career Development Award from the Dermatology Foundation, which
provided funding for her research on designing public health strategies to reduce skin cancer
disparities. Please welcome Dr. Claudia Hernandez. (applause) Dermatology has been an important presence here at UIC. We have provided care for those
affected with skin diseases for over a hundred and ten years, making us one of the oldest
dermatology departments in the country. I joined the department back in 2005. One of
the things that attracted me to UIC was that it had much more diverse patient population
than where I did my residency. This meant that I started to see diseases that were more
common among individuals of color. One example is called Vitiligo. It produces milky white
patches on the skin. It is also known as Michael Jackson’s disease for its most famous patient.
Because of the sharp contrast between the white patches and an individual’s normal skin,
it is psychologically devastating. I wrote an essay about how unfair it was to
deny individuals of color treatment for Vitiligo because insurance companies consider the disease
cosmetic. My essay about the overlooked personal impact of Vitiligo in skin of color patients
earned me a national fellowship. I received training on how policy issues and learn how
to advocate for my patients. I even got to travel and practice my skills on Capitol Hill.
I decided to make health care inequalities or health care disparities the focus of my
research. Now, in 2007, researchers made a surprising find about skin cancer. If you’re
black or Hispanic, and were diagnosed with a skin cancer, you were much more likely to
die from it than if you were white. I was finishing my health policy fellowship
around this time, and realized a new health care disparity had been described in my own field.
Skin cancer affects everyone, no matter what skin color, but most public education programs
gave the impression that only whites got skin cancer, and individuals of color may have
believed they were not at risk, and ignored the message. I decided to develop a program
to disseminate skin care education to Spanish-speaking communities using lay health workers. Now,
lay health workers are motivated community volunteers. They are natural leaders and are
often the people that community members turn to if they need advice.
Lay workers can be trained on health care issues so they can share their knowledge.
They are also less likely to encounter mistrust and language barriers since they work in their
own community. We focused on Spanish speakers with limited English language skills on the
south and west sides of Chicago, and began by conducting community surveys.
We found that most did not believe they were are risk for skin cancer, they did not get
regular skin checks from a doctor, and they did not know how to check their skin for warning
signs of skin cancer. We developed a skin cancer education program
and trained lay workers to spread the word. We got people to check their skin and attend
skin cancer screenings. Because our program motivated change in health behaviors, I received
the International Award for Social Responsibility in Dermatology in 2011.
Next, I decided to develop Spanish-language educational videos about sun protection, since
most U.S. Hispanics do not use sunscreen. Two UIC medical students spent their summer
in Pilsen showing the video in area businesses such as beauty salons. Their efforts to motivate
healthy behaviors helped the students win the UIC Gold Humanism Award for their work.
Although I was able to educate, I wanted to find a way to deliver, care and reduce delays
for those living in underserved areas where many face months of delays to get access to
a doctor. I am working on a telemedicine project that
uses a portable device that sends high-resolution photographs of skin lesions to doctors using
a data link. The device is small and can be carried by a lay health worker or nurse practitioner,
and then send the photograph to a doctor for an opinion about the potential risk.
Those living in underserved areas could be more effectively triaged and sent to specialty
care. This could potentially reduce wait times among the poor. The last project I want to
tell you about is my work on medical simulation. I first learned its potential applications
as part of a UIC program called Scholars for Teaching Excellence.
Simulation allows medical students to practice and perfect their clinical skills in a safe
environment. They can repeatedly practice a skill and master it before they see a patient.
Now, medical students and residents may rarely get a chance to encounter skin cancer in an
individual of color. My idea was to develop a medical simulation that would allow students to
practice skin cancer detection and develop confidence on examining patients.
I partnered with UIC’s Dr. Allan and Mary L. Graham Clinical Performance Center. I was
quite lucky because the performance center had over a decade of experience using simulated
patients. They also use only professional actors that you might see if you were to go
see a professional theater production, allowing us to do realistic simulations.
By combining these trained actors with what we call a moulage, or temporary skin tattoo,
we were able to create simulated scenarios that allowed students to practice examining
a patient with skin cancer. We’ve been able to allow hundreds of students to practice
and this technique has become a valuable learning tool. We have developed scenarios that can
assess a medical student’s ability using patients of different ethnicities. We’ve also figured
out that students needed more training on how to correctly ask about skin cancer risk factors.
Simulation has allowed us to figure out ways to help patients. Residents are not immune
to the uses of simulation. We have developed communication and interpersonal skill exercises
for dermatology residents. This allows us to assess how residents handle difficult patient
encounters, such as patients who refuse a biopsy of an obvious skin cancer, and if they
know how to effectively use a medical interpreter. We have even developed scenarios and trained
actors to become ‘secret shoppers.’ These actors are trained to any extremely high level
to escape detection by a doctor in their own private office. This allows us to see what
happens behind closed doors and if doctors are following recommended guidelines. Our
skin cancer education program using actors was recently funded by the National Institutes
of Health. The emphasis on education is essential because treatments for advanced skin cancer
such as melanoma remain limited, making early detection key to survival. So, I encourage
you to wear sunscreen and not to be afraid to ask your doctor for a skin check. It will
have a transformative impact on your well-being. (applause)