Dermatology PGYIII

Description of Rotation or Educational Experience

The dermatology experience is conducted in the PGYIII year and is comprised of a two-week rotational block with a clinical faculty member on the dermatology service in an outpatient private-practice clinic setting. The rotational goal is to familiarize the resident physician to the most common diseases of the skin that are encountered in an outpatient clinical setting and to instruct the resident on the principles of treatment of these common disease states. Residents in all three years of training will also receive a longitudinal experience in the diagnosis and management of common skin maladies in their continuity clinics within the FMC and will gain experience in common dermatologic procedures during the monthly Dermatologic Clinics taught by Dr. James Wharton at his outpatient clinic and the weekly Surgical Clinics instructed by Dr. Wayne Hudec at the FMC’s.

Goal I: To achieve competence in diagnosing and managing common dermatological conditions as appropriate for the Family Physician

Goal II: To achieve competence in recognizing and referring complex dermatological disorders

Patient Care

Goal

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.  Residents are expected to:

Competencies

• Learn to diagnose and treat a variety of common skin diseases.
• Advocate common practices to prevent the development of dermatologic disease.
• Learn procedural techniques used in diagnosing and treating skin disorders.

Objectives

The resident physician will:

·         Learn to distinguish and classify skin lesions based on appearance; including papular, macular, pustular, vesicular, bullous, and urticarial lesions by the end of the rotational block.

• Learn to recognize and diagnose benign, pre-malignant, and malignant neoplasms of the skin including: actinic keratoses, seborrheic keratoses, basal cell carcinomas, squamous cell carcinomas, malignant melanoma, and metastatic skin lesions.
• Become familiar with various infectious diseases of the skin including: fungal, bacterial, viral, and parasitic disease entities.
• Become familiar with both systemic and topical drug delivery methods to treat skin disorders.
• Demonstrate proficiency in basic principles of skin biopsy techniques and have the opportunity to perform such procedures under the supervision of their Dermatology preceptor.
• Learn the proper technique of incision and drainage of a skin abscess.
• Educate their patients regarding preventative measures to reduce the incidence of skin diseases (such as use of sunscreen, avoiding tanning beds to prevent skin cancer) during health maintenance visits.

• Provide patients with a thorough skin examination during health maintenance visits.

Medical Knowledge

Goal

Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care.  Residents are expected to become familiar with:

Competencies

• Psoriasis
• Pityriasis Rosea
• Acne Vulgaris
• Acne Rosacea
• Fungal infections of the skin (Candida, Tinea)
• Lichen planus
• Impetigo
• Varicella/Herpes zoster
• Herpes Simplex
• Urticaria
• Cellulitis/ Skin Abcess
• Actinic Keratoses
• Seborrheic Keratoses
• Basal Cell Carcinoma
• Squamous Cell Carcinoma
• Malignant Melanoma
• Drug eruptions
• Parasitic disease of the skin (scabies)
• Atopic Dermatitis
• Contact Dermatitis (poison ivy)

Objectives

• Learn to recognize and treat common papulosquamous disorders: Psoriasis, Pityriasis Rosea, Acne vulgaris, Lichen planus, Miliaria, seborrheic dermatitis, and fungal infections of the skin (candida, tinea).
• Learn to recognize and treat common vesiculobullous disorders: Impetigo, Herpes simplex, Herpes Zoster, Varicella.
• Learn to recognize and treat Dermatitis/Eczema including: contact, atopic, exfoliative, nummular, stasis, diaper rash.
• Learn to recognize and treat Pre-malignant and Malignant skin disorders: Actinic Keratoses, basal cell carcinoma, squamous cell carcinoma, and malignant melanoma.
• Learn to recognize skin lesions due to systemic medications or treatments.
• Recognize and treat cutaneous infections: bacterial (impetigo, erysipelas, lymphangitis, cellulitis,
• Recognize and treat hair disorders including: fungal infection, non-scarring alopecia, scarring alopecia, and hypertrichosis (local and generalized).

Practice- Based Learning and Improvement

Goal

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning.  Residents are expected to develop skills and habits to be able to :

Competencies

• Identify strengths, deficiencies and limits in one’s knowledge and expertise;

Objectives

• The resident will recognize the need for proper referral and consultation to a specialist for those dermatological diseases that are beyond his/her capabilities.

Systems Based Practice

Goal

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.  Residents are expected to:

Competencies

• Work effectively in various health care delivery settings and systems relevant to their clinical specialty

Objectives

• The resident will gain and understanding of the delivery of care to the dermatology patient and be able to recognize and perform measures that will expedite the care of the patient within the healthcare delivery system. Specifically, the resident will become familiar with diagnostic procedures (such as skin biopsy) to confirm the diagnosis and expedite the care of patients with confirmed skin malignancies.

Professionalism

Goal

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.  Residents are expected to demonstrate:

Competencies

• Compassion, integrity, and respect for others

Objectives

The resident will be sensitive to concerns by their patients regarding skin disorders and address all concerns in a timely manner. The resident is expected to take time to educate their patients about the prevention of skin disorders in their continuity practice.

Interpersonal and Communication Skills

Goal

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates.  Residents are expected to:

Competencies

• Communicate effectively with other physicians, staff, patients, and families.

Teaching Methods

Direct preceptor-resident interaction which may involve didactic lectures, role-modeling, and case-based learning.  Also, monthly Dermatologic Clinics are taught by Dr. James Wharton at his outpatient clinic and the weekly Surgical Clinics are instructed by Dr. Wayne Hudec at the FMC’s.

Assessment Method

At the conclusion of each resident rotation, the residency coordinator sends a formative-type, rotation-specific performance evaluation form to the rotations’ supervising physician.  When the completed evaluation is returned, the resident physician and the resident’s faculty advisor review the evaluation and attest to reviewing it by signing/initialing the form.  Next, the program director reviews and attests to the document.  Once all three have reviewed and attested the evaluation, it is included in the resident’s permanent file. 

Each resident is asked to evaluate the rotation and supervising physician(s) at the end of the rotation.  The resident’s faculty advisor and program director review the evaluation and attest to reviewing it by signing/initialing the form. These evaluations are filed together by resident year.

Educational Resources

References available at the AHEC Library:

Dermatology for the House Officer

Online Resources:

UpToDate and DynaMed