The work, led by dermatologists and collaborators at Penn State, including Matthew Helm, Jordan Willis, Thomas N. Helm, Kelly Gerard, and Galen Foulke, tested whether the Extension for Community Healthcare Outcomes, or ECHO, model could be adapted to dermatologic biologic education. Project ECHO, originally developed at the University of New Mexico to train rural clinicians in hepatitis C management, operates on a simple but powerful premise: rather than routing patients to distant specialists, it routes specialist knowledge to the clinicians patients already see. Academic experts deliver short didactic presentations over videoconference, then participants discuss real cases together, building competence through repeated, case-based learning rather than one-off lectures.

The rationale for applying this model to biologics is grounded in a well-documented distribution problem. Research published in JAMA Dermatology found substantial disparities in dermatologist density between urban and rural counties in the United States, and more recent calls to action in the dermatology literature have emphasized that rural patients face long travel distances and long waits for specialty appointments. For conditions like chronic plaque psoriasis, where network meta-analyses of systemic treatments show that biologic agents often outperform older systemic therapies, the consequence is a two-tiered system: patients near academic centers access cutting-edge therapy while those in rural areas may go undertreated. Studies of health care resource use for psoriasis have shown that where a patient lives materially changes the care they receive.

Compounding the geography problem is the nature of the medications themselves. Biologics are large, complex proteins typically administered by injection, and their use demands knowledge of drug classes and targets, screening requirements, monitoring protocols, side effect recognition, and the labyrinthine prior authorization processes insurers impose. Surveys of physicians have found that hesitation to prescribe biologics often stems less from skepticism about efficacy than from unfamiliarity with logistics, safety management, and the paperwork of patient assistance programs. That unfamiliarity is precisely what a structured telementoring curriculum can address, and it is what the Penn State team set out to test.

The pilot was deliberately small and pragmatic. Before recruitment, the team used a survey to assess whether the program was feasible to run in their setting. They then recruited eight primary care providers through flyers and email for an eight-session series accredited for continuing medical education credit. Each session followed the classic ECHO structure: a 20-minute talk from an expert on topics such as the major biologic classes, their approved dermatologic indications, monitoring and adverse effects, and strategies for navigating prior authorization, followed by case-based discussions in which participants brought their own clinical dilemmas to the group. A pharmacist collaborator contributed expertise on prescription assistance programs, a crucial and often overlooked barrier to getting these drugs into patients’ hands.

To measure whether the curriculum moved the needle, the researchers administered surveys after each session, asking participants to self-report changes in their knowledge of biologics, their ability to care for patients who might be candidates for these drugs, their plans to change their practice, and their sense of professional isolation around biologic prescribing. Professional isolation is a recurring theme in rural medicine: clinicians who rarely interact with specialists can lose confidence in managing complex therapy, and that lost confidence translates directly into patients who are never offered the treatment. Implementation science frameworks, including validated measures of implementation outcomes referenced by the authors, informed the survey design.

The results, while preliminary, were encouraging across all measured domains. After the sessions, participants reported increased knowledge of dermatologic biologics, improved confidence in their ability to care for relevant patients, concrete plans to change their practice, and a decreased sense of professional isolation. In other words, the program did not just transfer information; it appears to have shifted self-efficacy, the belief that one can competently manage a therapy, which behavioral research consistently identifies as a key determinant of whether new practices are adopted. For a short pilot with eight participants, that pattern of self-reported movement in the intended direction is a meaningful proof of concept.

The study’s authors are careful about scope. This was a short report on a pilot program, not a trial with objective endpoints; self-reported knowledge gains are not the same as demonstrated prescribing competence, and eight providers cannot represent the full landscape of rural primary care. The participants did not consent to public sharing of their data, so detailed results are not available. Still, the findings align with a growing evidence base. A dermatology-focused ECHO program reported in Rural and Remote Health in 2018 already demonstrated the model’s promise for extending dermatologic expertise, and the landmark New England Journal of Medicine study that launched ECHO showed primary care providers could achieve hepatitis C cure rates comparable to specialists when properly mentored. The dermatologic biologic application extends that logic to one of the most consequential therapeutic shifts in modern skin medicine.

Equity considerations give the work added urgency. Studies of safety-net clinics and uninsured psoriasis populations have documented persistent barriers to biologic access even when patients do reach specialty care, suggesting that the problem spans both referral pathways and prescribing behavior. If telementoring can equip primary care providers, who see patients where they live, to identify biologic candidates, initiate workups, navigate payer requirements, and connect patients to assistance programs, it addresses the access bottleneck at multiple points simultaneously. The ECHO model’s low cost and reliance on existing videoconference infrastructure make it especially attractive for health systems with limited resources.

The Penn State pilot, supported in part by grants from the National Center for Advancing Translational Sciences and reviewed as exempt by the university’s institutional review board, offers a template rather than a finished solution. Larger cohorts, objective measures of prescribing quality and patient outcomes, and longer follow-up will be needed before telementoring can be declared a validated route to biologic access in underserved communities. But the conceptual advance is clear and, in an era when virtual education has become routine, timely. The medications that can clear a patient’s skin and transform their psychological wellbeing already exist; the challenge is moving expertise, not patients, across the distance between academic medical centers and the rural exam rooms where care actually happens. A modest series of 20-minute talks and shared cases may prove to be a surprisingly effective bridge.

Subject of Research: Telementoring of primary care providers in dermatologic biologic therapy to expand access in underserved rural communities

Article Title: Expanding access to biologics: a pilot ECHO program for primary care providers

Article References: Helm, M., Willis, J., Helm, T. N., Gerard, K., & Foulke, G. (2026). Expanding access to biologics: a pilot ECHO program for primary care providers. Archives of Dermatological Research, 318(1), Article 472. https://doi.org/10.1007/s00403-026-04976-y

Image Credits: AI Generated

DOI: 10.1007/s00403-026-04976-y

Keywords: Project ECHO, biologics, telementoring, rural dermatology, primary care, psoriasis, atopic dermatitis, access to care, continuing medical education, health equity, Expanding, access

The numbers behind dermatology’s competitiveness explain why such an experiment matters. According to data from the National Resident Matching Program cited by the authors, 2025 saw 993 applicants competing for just 524 available dermatology residency positions, a pool that included 676 U.S. MD seniors, 105 U.S. DO seniors, and 105 U.S. MD graduates. In a field this crowded, academic excellence and extracurricular achievement are only part of the equation. Mentorship and professional networking play vital roles in building a competitive application, yet these are precisely the resources that students from rural backgrounds most often lack. The result is a self-reinforcing cycle in which the specialty that most needs rural physicians recruits the fewest of them.

That cycle has measurable consequences. The authors point to research showing that only about 6 percent of dermatology applicants plan to practice in an underserved rural region after residency, and that those who do choose that path frequently come from rural backgrounds themselves. Parallel work on the broader physician workforce has documented a decline in rural medical students, a trend that threatens the geographic diversity of the profession and, with it, access to care for millions of Americans living far from major academic centers. In dermatology, where skin cancer prevention, early detection, and chronic disease management all depend on timely specialist access, the shortage of rural-trained and rural-minded dermatologists translates directly into delayed diagnoses and preventable morbidity.

Conference participation compounds the problem. Presenting research at scientific meetings is a recognized component of a competitive residency application, offering trainees the chance to share findings, receive feedback, and build the professional connections that shape future opportunities. But as the authors note, citing recent work on the financial burdens of conference attendance, the costs of registration, travel, and lodging can be prohibitive for many students. Those barriers fall hardest on trainees in rural states, particularly at institutions without academic dermatology programs or active dermatology societies that might otherwise subsidize attendance or provide local mentorship. While virtual scientific meetings became increasingly common after the COVID-19 pandemic and measurably expanded accessibility, no conference had been dedicated specifically to rural dermatology until the RADS initiative.

The Rural Access to Dermatology Society set out to close that gap using the most accessible platform available: the virtual symposium. The stated goal was twofold. First, to give students and residents with an interest in rural dermatology a national stage on which to present their research to peers and faculty. Second, to strip away the financial and geographic barriers that keep so many trainees from participating in academic life at all. The organizing model was lean and social-media driven. A call for abstracts was posted to the RADS social media accounts and amplified by partner organizations, most notably the Dermatology Interest Group Association, a national network of student dermatology interest groups.

The response was striking for a first-time, single-topic virtual meeting. The society received 76 abstract submissions, of which 15 were selected for presentation after review by RADS board members. Selection criteria emphasized relevance to rural dermatology, scientific merit, and overall quality. Recruitment of attendees relied on posted flyers and on the promotional reach of RADS faculty within the Association of Professors of Dermatology, a national organization of academic dermatologists whose members distributed the call through their own networks. The final registration count of 108 participants spanning 32 states suggests that the demand for a rural-focused dermatology forum was real and previously unmet, drawing participants from far beyond the rural states that inspired the initiative.

The scientific program itself was structured to serve the audience on both professional and practical levels. Two keynote speakers opened the symposium with rural-focused presentations, one addressing the implementation of teledermatology, the technology-enabled remote diagnosis and management of skin disease that has become a cornerstone of rural care delivery, and the other offering a pathologist’s perspective on improving skin biopsy techniques, a topic with direct implications for diagnostic accuracy in settings where specimens travel long distances to reach a laboratory. A resident panel followed, giving attendees the opportunity to ask candid questions about what it takes to pursue a career in rural dermatology, from application strategy to life in practice outside major metropolitan centers.

The fifteen student and resident presentations reflected a surprising breadth of research approaches for such a young meeting. Survey and observational studies accounted for 40 percent of the talks, database and geospatial analyses for 26.6 percent, literature reviews for 20 percent, and conceptual or pilot frameworks for the remaining 13.3 percent. Geospatial analysis in particular is a methodologically important tool in rural health research, mapping where dermatologists practice, where patients travel for care, and where gaps in coverage are widest. Thematically, the presentations clustered into five major areas: access to dermatologic care and rural health equity, with five presentations; skin cancer prevention, education, and community outreach, also with five; rural workforce and systems innovation, with three; vulnerable and occupational populations, with two; and disease-specific outcomes research, with two.

That thematic distribution mirrors the clinical realities of rural dermatology. Skin cancer prevention and early detection remain the specialty’s most visible public health priorities in rural regions, where agricultural and outdoor occupational exposure drives elevated ultraviolet radiation risk and where dermatologists are scarce. Workforce and systems research addresses the structural question of how care can be organized, through teledermatology, task-shifting, and regional referral networks, when the specialist workforce itself is thin. Studies of vulnerable and occupational populations highlight groups, from farmworkers to remote community residents, whose skin health needs are compounded by distance, cost, and occupational exposure. Taken together, the presented work demonstrates that meaningful rural dermatology research is already being produced by trainees, often at institutions with no academic dermatology department to support it.

The authors frame the 2025 symposium as a proof of concept rather than a finished model. Future iterations will incorporate participant feedback and, importantly, will begin to assess mentorship and collaboration outcomes, moving beyond attendance metrics to evaluate whether virtual meetings actually generate the professional relationships that sustain rural research careers. If those outcomes bear out, the model could extend well beyond dermatology, offering rural-focused trainees in other specialties an accessible route into academic life. What began as a workaround for the barriers of traditional conferencing may end up reshaping who gets to participate in medical science, and ultimately, who returns to care for the communities that need them most.

Subject of Research: A virtual research symposium expanding access and education in rural dermatology for medical students and residents.

Article Title: Expanding access and education: the Rural Access to Dermatology Society (RADS) Virtual Symposium showcasing student research in rural dermatology

Article References: Salmen, N. L., & Logue, M. E. (2026). Expanding access and education: the Rural Access to Dermatology Society (RADS) Virtual Symposium showcasing student research in rural dermatology. Archives of Dermatological Research, 318(1), Article 461. https://doi.org/10.1007/s00403-026-04959-z

Image Credits: AI Generated

DOI: 10.1007/s00403-026-04959-z

Keywords: rural dermatology, virtual symposium, medical education, health equity, teledermatology, skin cancer prevention, rural workforce, residency match, student research, conference accessibility, Expanding, access