Dermatology

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Dermatology

  1. 1. Revised March 24, 2008 GOALS AND OBJECTIVES RESIDENT CURRICULUM FOR DERMATOLOGY ROTATION, UMC AND SUBSPECIALTY CLINIC Rotation director H.L. Greenberg, M.D. Clinical Assistant Professor of Medicine 653 North Town Center Drive, Suite 308 Las Vegas, NV 89144-0519 (702) 456-3120 OVERVIEW Educational Purpose Skin disorders represent common reasons for patients to visit their physician. Skin disorders may be self-limited but can also represent life-threatening primary disorders or indicate serious internal disorders. Because of their frequency and potential importance, internists should be able to recognize and initiate management for many common dermatologic disorders. Dermatologic disorders often provide clues to environmental and occupational hazards for the individual patient as well as larger population groups. The dermatology rotation is a 2-4 week experience available to residents at the PGY-1, PGY-2, PGY-3 levels. It is designed to introduce the resident to the principles of dermatologic diagnosis and treatment. During this rotation, residents will see common and sometimes uncommon skin disorders and have an opportunity to participate in learning skin biopsy techniques. TEACHING METHODS Residents participate in the daily office practice of a faculty dermatologist evaluating patients together. Daily didactic sessions provided by the faculty dermatologist may include review of assigned teaching slides. Residents are expected to complete the required readings assigned in addition to the rotation reading list so that they can participate fully in these didactic sessions. Residents will apply knowledge of the etiology, pathogenesis, clinical presentations, and natural history of dermatologic disorders and will receive instruction in the skills necessary for dermatologic diagnosis. At all times, the confidential nature of the medical practice is emphasized. Disease Mix
  2. 2. The following diseases are particularly emphasized: A. Diagnosis and management for malignant and pre-malignant skin lesions. B. Management of Acne C. Evaluation and management of rashes D. Allergic skin disorders E. Dermatologic manifestations of systemic illness Patient Characteristics The patients are ambulatory outpatients in a private dermatology practice, representing a broad mix of income level, age, gender, and ethnicity from Las Vegas and the surrounding area. Types of Clinical Encounters The vast majority of resident clinical encounters are outpatient on this rotation. There are occasional inpatient dermatology consultations, which the resident and attending dermatologist will complete together. The residents are constantly supervised by an on- site faculty member. Resident Supervision Residents have constant on-site supervision as well as daily personal supervision in their patient care. Procedures and Services Procedures are limited, but may include punch skin biopsy. Didactic Teaching Attending Rounds Didactic discussions will be held regarding all consultative activities occurring during the month. Each resident will be required prepare and discuss one article or dermatologic topic each week. Core Reading Materials The following articles from Up-To-Date are required reading for the Dermatology rotation: A. Approach to dermatologic diagnosis B. Approach to the patient with macular skin lesions C. Approach to the patient with pustular skin lesions D. Atopic Dermatitis E. Drug eruptions F. General principles of dermatologic therapy and topical corticosteroid use G. Keloids H. Overview of psoriasis I. Pityriasis rosea J. Erythema nodosum 2
  3. 3. K. Metabolic and inherited diseases affecting the skin L. Tinea versicolor M. Early syphilis N. Impetigo; folliculitis; furunculosis; and carbuncles O. Overview of boils P. Overview of melanoma Q. Overview of non-melanoma skin cancers R. Primary prevention of melanoma S. Prognostic factors in melanoma T. Risk factors for the development of melanoma U. Screening and early detection of melanoma V. Treatment of basal cell carcinoma W. Treatment of cutaneous squamous cell carcinoma X. Actinic keratosis Y. Staging work-up for melanoma and follow-up guidelines Z. USPSTF Guidelines: Screening for skin cancer: Recommendation and rationale Pathological Material Results of skin biopsies and excision of lesions are reviewed with the attending dermatologist. Training Sites Las Vegas Dermatology, a private practice dermatology site Competency-based Goals and Objectives Dermatology Rotation Learning Venues Evaluation Methods Level Specificity 1. Dermatology Office A. Attending Evaluation 2. Self Study B. Direct Observation R-1=1 3. Lectures-Core C. Patient evaluations R-2=2 4. Slide Reviews (If available) D. Support Staff Evaluations 5. Morning Report Presentation E. Self Evaluation R-3=3 6. Hospital Wards F. Objective Testing Competency: Patient Care Learning Venues Evaluation Methods Level Obtain focused dermatologic history including exposures to skin 1, 6 A,B,C,D,E 1,2,3 Perform full skin exam 1, 6 A,B,D 1,2,3 Review prior dermatologic and medical history 1, 6 A,B,D 1, 2,3 Make dermatologic diagnosis 1, 6 A,D,F 1,2,3 3
  4. 4. Perform skin biopsy 1, 6 A,D,F 2,3 Formulate dermatologic treatment plan 1, 6 A,F 1,2,3 Institute treatment plan 1, 6 A,C,D 2,3 Competency: Medical Knowledge Learning Venues Evaluation Methods Level Know physical and visual characteristics of common and uncommon skin conditions 1,2, 3, 4, 5 A, B, F 1,2,3 Understand diagnosis and management of malignant and pre-malignant skin lesions 1, 2, 3, 5 A, B, F 1,2,3 Understand management of acne 1, 2, 3 A, B, C 1, 2, 3 Understand management of allergic skin conditions 1, 2, 3, 4, 5 A, B, F 1, 2, 3 Understand dermatologic manifestation of systemic illnesses 1, 2, 3, 5, 6 A,B,F 1 ,2, 3 Competency: Interpersonal and Communication Skills Learning Venues Evaluation Methods Level Demonstrate understanding of patient preferences 1, 6 A, B, C, D 1, 2, 3 Maintain accurate medical records 1, 6 A, B, C, D 1, 2, 3 Treat staff, patient and colleagues in a respectful, productive manner 1, 3, 4 A, B, C, D 1, 2, 3 Competency: Professionalism Learning Venues Evaluation Methods Level Treat team members, primary care- givers, and patients with respect and empathy 1,5,6 A,B,C,,D,E 1, 2, 3 Understand, practice and adhere to a code of medical ethics 1, 2, 3, 4, 5, 6 A, B, C, D, E 1, 2, 3 Participate actively in consultations and on rounds 1,6 A 1, 2, 3 Meet schedule responsibilities and participate actively 1, 2, 3, 4, 5, 6 A, B, C, D, E 1, 2, 3 Attend and participate in all scheduled conferences 1,3,4,5 attendance, A 1, 2, 3 4
  5. 5. Competency: Practice-Based Learning Learning Venues Evaluation Methods Level Incorporate evidenced-based studies information and treatment decisions 2, 3 A, B, E, F 2,3 Review outcomes of care 1, 6 A, B, C, F 2, 3 Identify limitation of knowledge of dermatology and use literature and slide review to address gaps in knowledge 1, 2, 3, 4 A, B, F 2,3 Understand the limitations and relationship of dermatopathology in proper dermatologic diagnosis. 1,2,4 A, B, F 2, 3 Competency: Systems-Based Practice Learning Venues Evaluation Methods Level Understand the referral process for ambulatory patients, identifying those requiring hospitalization. 1 A N/A Understand clinical trial design and the statistical methods for evaluating scientific studies. 1, 2, 3, 4, 5 A, B, F 2,3 EVALUATION A. Of Residents At the completion of the rotation, all clinical faculty are required to complete the standard ABIM resident evaluation form. All clinical faculty are encouraged to provide face-to-face feedback with the residents. In addition, residents may receive interim feedback utilizing the ABIM’s Praise and Early Warning cards. B. Of Rotation and Preceptor All residents are encouraged to evaluate the rotation, and the clinical faculty member, at the completion of the rotation. This evaluation form is included at the end of this document. These evaluations are then converted to type and shared anonymously with the clinical faculty. The program director also discusses the rotation with the residents to ensure rotation quality and satisfaction. 5
  6. 6. Dermatology Rotation Intern/Resident Check List ___________ 1.Evaluation reviewed at mid-rotation end of rotation by the supervising faculty member and resident. ___________ 2. Completed assigned readings ___________ 3. Attended all assigned clinical activities (excluding scheduled time away, required clinics and emergiencies). ___________ 4. Completed required case reports abstracts and/or posters assigned by the supervising faculty member. ___________ 5. Demonstrated understanding of the essentials of performing skin biopsies. ___________ 6. Ability to recognize common malignant and pre-malignant skin conditions. ___________ 7. Demonstrated understanding of the clinical use of topical steroids as well as complications of use. ___________ 8. Demonstrated understanding of the principles of management of acne as well as the indications for different treatments. Intern/Resident Signature____________________________Date__________________ Supervising Faculty Signature_______________________ Date__________________ All items must be completed for rotation credit and checklist returned to the Department of Medicine by the rotation’s end. 6
  7. 7. Dermatology Rotation Intern/Resident Check List ___________ 1.Evaluation reviewed at mid-rotation end of rotation by the supervising faculty member and resident. ___________ 2. Completed assigned readings ___________ 3. Attended all assigned clinical activities (excluding scheduled time away, required clinics and emergiencies). ___________ 4. Completed required case reports abstracts and/or posters assigned by the supervising faculty member. ___________ 5. Demonstrated understanding of the essentials of performing skin biopsies. ___________ 6. Ability to recognize common malignant and pre-malignant skin conditions. ___________ 7. Demonstrated understanding of the clinical use of topical steroids as well as complications of use. ___________ 8. Demonstrated understanding of the principles of management of acne as well as the indications for different treatments. Intern/Resident Signature____________________________Date__________________ Supervising Faculty Signature_______________________ Date__________________ All items must be completed for rotation credit and checklist returned to the Department of Medicine by the rotation’s end. 6

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