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Real-time, intercontinental dermatology teaching of trainee physicians in Somaliland using a dedicated social networking portal

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Letter: Real-time, intercontinental dermatology teaching of trainee physicians in Somaliland using a dedicated social networking portal
Faisal R Ali1,2, Jordan ST Bowen2, Jamie M Strachan2, Jibriil Handuleh3, Alexander ET Finlayson2
Dermatology Online Journal 18 (4): 16

1. Dermatological Sciences, University of Manchester, Salford Royal NHS Foundation Trust, Manchester, United Kingdom
2. MedicineAfrica, Centre for Global Health, King’s College London, Denmark Hill, London, United Kingdom
3. Amoud University Medical School, Borama, Somaliland


We describe the use of, an innovative social networking portal, to deliver real-time, intercontinental, case-based dermatology teaching to geographically scattered trainee physicians in Somaliland by tutors based in the United Kingdom.

In 2007, Somaliland celebrated the graduation of its country’s first cohort of home-trained doctors following decades of civil war. New interns were often solely responsible for the full range of clinical specialties, owing to a paucity of senior supervising clinicians; postgraduate teaching is essential to ensure the safest, most effective clinical practice.

There have been multiple calls in the international literature for a dedicated global health learning system and for a coordinated effort to promote global medical education [1]. Whilst there has always been a willingness of teachers to fly from the developed world to support Somaliland’s infant postgraduate medical education system [2], there was a limited timeframe in which tuition could be delivered and no ongoing means to continue to provide this support throughout the year to trainees scattered over a wide geographical area.

To this end, was created, providing a web-based portal that combines the concepts of clinical education and social networking via a low bandwidth internet connection [3]. was used to deliver dermatology instruction in real-time to a group of final year medical students and interns (n=8) in several locations in Somaliland by a tutor located in the UK. Trainees and the tutor uploaded clinical cases and supplementary learning material, which was discussed at a designated time. The tutor questioned trainees in real-time using an instant messenger feed, providing individual feedback and highlighting areas requiring attention, simulating a “bedside” tutorial. Ethical approval was granted by the Research Ethics Panel of King’s College London.

Of six respondents to an anonymous feedback questionnaire, four reported being more confident at describing a rash following the tutorial, and all six felt the seminar was more useful than simply reading a medical education website. All requested a repeat seminar for the following semester. Initial difficulties for the tutor included the differences in the variety and prevalence of infectious and inflammatory dermatoses between Africa and the United Kingdom and limited access to systemic and biologic agents in Somaliland.

Dermatology is a discipline dependent upon visual descriptions and lends itself well to such teaching. As only one tutorial of the thirty delivered per year is devoted to dermatology, the primary focus was on descriptions of rashes and skin lesions with secondary discussion of underlying diagnoses. Our aim was to enable students to accurately and succinctly convey such lesions over the telephone or in writing to specialists in other cities or countries.

Similar applications of social networking to medical education could simulate case-based teaching in dermatology clinics, particularly where tutors, students, and patients being discussed are geographically separated.

We vehemently believe that this live, low-bandwidth online partnership can serve to support fledgling dermatological services in Sub-Saharan Africa and help to narrow the tremendous disparities in access to expertise in dermatological care.

ACKNOWLEDGEMENTS: We thank Dr. Carrie Kovarik and colleagues from African Teledermatology for use of images in tutorials.


1. Kerry VB, Auld S, Farmer P. An international service corps for health--an unconventional prescription for diplomacy. N Engl J Med. 2010;363:1199-1201. [PubMed]

2. Leather A, Ismail EA, Ali R, Abdi YA, Abby MH, Gulaid SA, Walhad SA, Guleid S, Ervine IM, Lowe-Lauri M, Parker M, Adams S, Datema M, Parry E. Working together to build healthcare in post-conflict Somaliland. Lancet. 2006;368(9541):1119-1125. [PubMed]

3. Finlayson AE, Baraco A, Cronin N, Johnson O, Little S, Nuur A, Tanasie D, Leather A. An international, case-based, distance-learning collaboration between the UK and Somaliland using a real-time clinical education website. J Telemed Telecare. 2010;16:181-184. [PubMed]

© 2012 Dermatology Online Journal