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  • 1. University of Arkansas for Medical Sciences Department of Dermatology Handbook Revised August 2005
  • 2. 1 Table of Contents Page(s) Department of Dermatology Mission Statement 2 Overview of the Residency Program 3-5 Resident Educational Goals and Objectives 6-8 Arkansas Children’s Hospital Clinic 8 JL McClellan Veterans Hospital Clinic 8 UAMS Medical Center Clinic 8 Pigmented Lesions Clinic 9 Surgery Clinics 9 Inpatient Rounds 10 Admissions 10 Rotating Resident’s Schedule 10 Conference Schedule 10-12 Dermatology Resident Rotations 13 Dermatopathology Signout 13 Consultation Service 14 Referrals 14 The Medical Record 15 Call Schedule 15 Vacation Policy 15 Sick leave Policy 16 Procedure Logs 17 Phototherapy Experience 17 The Resident’s Role in Teaching and Evaluation 17 Senior Student Dermatology Clerkship Schedule 17 Department of Dermatology Housestaff/Business Office 17-18 Department of Dermatology/ Lines of Responsibilities 18 Criteria for Promotion 19-20 Probation, Suspension, and Dismissal 21-23 Evaluations 24-26 ACGME Competencies 27-36
  • 3. 2 MISSION STATEMENT DEPARTMENT OF DERMATOLOGY UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES The Department of Dermatology at the University of Arkansas for Medical Sciences strives to excel in three areas: the care of patients with skin disease using evidence-based medicine; the education of dermatology residents, medical students, and residents from other departments; and the advancement of knowledge pertaining to the skin and skin disease. CARE OF PATIENTS WITH SKIN DISEASE We seek to provide compassionate and cost-effective care for all patients, regardless of ability to pay. We have a special responsibility to the citizens of Arkansas to treat and prevent skin disease, thereby improving the health of the population. We achieve this through the application of the latest advances in diagnostic and therapeutic knowledge based in the available literature. EDUCATION OF RESIDENTS AND MEDICAL STUDENTS Teaching is a privilege and a high priority in the Department. We seek to educate our dermatology residents in all aspects of the discipline. We also strive to meet the residents’ personal educational objectives. In addition, attendings and residents alike take responsibility for teaching non-dermatology residents and medical students. ADVANCING KNOWLEDGE Advancing and improving the care of patients is at the heart of our academic dermatology program. We strive to achieve this goal through publications based on research in the areas of clinical dermatology, basic science, dermatopharmacology, dermatology surgical, and dermatopathology. The tripartite mission requires continual revision and discussion.
  • 4. 3 Overview of the Residency Program General The resident physicians rotate between the University/Children’s hospital and the Veteran’s Affairs hospital dermatology clinics. Each resident spends several months at each institution allowing him or her to maintain a high degree of continuity of care. In addition, when residents change rotations, they assume care of the patients they had previously followed. PGY-2 residents are responsible for learning the basic diagnosis and treatment of common dermatological problems, caring for dermatology inpatients, and performing phototherapy at the VA hospital. PGY-3 residents, in addition to their clinic responsibilities, perform the majority of dermatologic consultations in the hospital. PGY-4 residents are responsible for the administrative functions and duties of the residency program and undertake an active role in resident and student evaluation and teaching. As the residents progress through their years in the program, they acquire skills allowing them to expand their responsibilities, such as more extensive surgical procedures, taking part in the consultation service, lecturing to medical students and other departments in the university, and becoming chief residents. Upon acquisition of required skills, residents begin do more basic and simple procedures (KOH, skin biopsy, phototherapy, etc.) on an autonomous basis. At this level, they also begin to teach junior residents and senior medical students. Residents also play an integral role in preparing the patient case presentations for the annual meeting of the Arkansas Dermatological Society. Patients are selected for educational value, diagnostic evaluation or therapeutic suggestion. The residents review all currently available literature on that particular patient/disease and present for discussion. A well-supplied dermatology library affords residents the opportunity to view dermatological journals to an extent that may not otherwise be available in the main university library. The residents also play a significant role in evaluating prospective resident applications during the interview process. While the dermatology program offers 4 years of training, the PGY-1 resident is under the direction of the Internal Medicine Department. The curriculum of this year is modified for dermatology trainees to include elective time in dermatology, rheumatology and infectious disease. Afterwards, as dermatology residents, they lecture to medical students, house officers, or other departments in the university. House offices from other services rotate through the dermatology service monthly affording the dermatology residents ample opportunity to teach and explain the pathogenesis of cutaneous disease. A resident is available to act as consultant (under staff supervision) to all other departments in the University. At this time, a history and physical exam is done with emphasis on the cutaneous findings. This is followed by a working differential diagnosis, diagnostic procedures (if necessary) and a therapeutic regimen is suggested. The care of the patient is followed routinely until discharge or resolution of the dermatologic problem. Responsibilities For emergency admissions, the on-call resident and staff physician will admit the patient, perform the admitting history and physical examination and write the initial orders. The PGY-2 resident assigned to inpatient duty assumes the next business day care of the patient. After discharge, the resident who was responsible for the majority of care during the patient’s inpatient course follows the patient. The PGY-2 resident based at the University Hospital is the responsible resident for all admissions during business hours. Admissions after hours are the responsibility of the on-call resident. Inpatient care is the responsibility of the same PGY-2 resident during week, at all hours. Inpatient care during the weekend is the responsibility of the on-call resident.
  • 5. 4 Students Approximately two to four senior medical students rotate through the dermatology service for one month at a time. They will attend all lectures and see patients in the clinic, writing a history and physical examination followed by a dermatology resident’s review and help in the formation of an assessment and treatment plan. An attending physician in turn reviews this. Self-directed, independent learning is encouraged based on patients seen in clinic. The PGY-4 residents and attendings may occasionally give formal didactic lectures to the students. Chief Resident The chief residents attend monthly departmental staff meetings and take an active role in helping to solve problems that may arise in scheduling, patient care, consultations, lectures, the interview process or other areas as needed. The residents also perform a role in coordinating lectures, grand rounds, defining tacks in the clinic suitable for rotating residents and activities between other university departments. Supervision Residents are supervised at all times by full or part-time staff. An attending physician covers the consult service at all times. In the event of illness or vacation, other staff members are required to cover for the physician who was originally assigned to the consult service. This also applies to coverage for on call responsibilities as well. Hospital rounds are conducted early in the morning or at a time mutually arranged by the attending physician and the consult resident. Resident Duty Hours and the Working Environment 1. Supervision of Residents a. All patient care must be supervised by qualified faculty. The program director must ensure, direct, and document adequate supervision of residents at all times. Residents must be provided with rapid, reliable systems for communicating with supervising faculty. b. Faculty schedules must be structured to provide residents with continuous supervision and consultation. c. Faculty and residents must be educated to recognize the signs of fatigue and adopt and apply policies to prevent and counteract the potential negative effects. 2. Duty Hours a. Duty hours are defined as all clinical and academic activities related to the residency program, i.e., patient care (both inpatient and outpatient), administrative duties related to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled academic activities such as conferences. Duty hours do not include reading and preparation time spent away from the duty site. b. Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities. c. Residents must be provided with 1 day in 7 free from all educational and clinical responsibilities, averaged over a 4-week period, inclusive of call. One day is defined as one continuous 24-hour period free from all clinical, educational, and administrative activities. d. Adequate time for rest and personal activities must be provided. This should consist of a 10 hour time period provided between all daily duty periods and after in-house call.
  • 6. 5 3. On-Call Activities The objective of on-call activities is to provide residents with continuity of patient care experiences throughout a 24-hour period. In-house call is defined as those duty hours beyond the normal work day when residents are required to be immediately available in the assigned institution. a. In-house call must occur no more frequently than every third night, averaged over a four-week period. b. Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours. Residents may remain on duty for up to 6 additional hours to participate in didactic activities, transfer care of patients, conduct outpatient clinics, and maintain continuity of medical and surgical care as defined in Specialty and Subspecialty Program Requirements. c. No new patients, as defined in Specialty and Subspecialty Program Requirements, may be accepted after 24 hours of continuous duty. d. At-home call (pager call) is defined as call taken from outside the assigned institution. 1.) The frequency of at-home call is not subject to the every third night limitation. However, at-home call must not be so frequent as to preclude rest and reasonable personal time for each resident. Residents taking at-home call must be provided with 1 day in 7 completely free from all educational and clinical responsibilities, averaged over a 4-week period. 2.) When residents are called into the hospital from home, the hours residents spend in-house are counted toward the 80-hour limit. 3.) The program director and the faculty must monitor the demands of at-home call in their programs and make scheduling adjustments as necessary to mitigate excessive service demands and/or fatigue. 4. Monitoring of Duty Hours a. Monitoring of duty hours is performed at the biannual resident reviews. This is at a frequency sufficient to ensure a balance between education and service. If duty hours become a concern prior to the biannual review, the chief resident should be notified and the schedule will be rearranged accordingly. 5. Back-up Support System a. When patient care responsibilities are unusually difficult or prolonged, or if unexpected circumstances create resident fatigue sufficient to jeopardize patient care, then the resident on the Dermatopathology rotation will cover clinical responsibilities for the fatigued resident until they have recovered sufficiently to resume clinical responsibilities.
  • 7. 6 Resident Educational Goals and Objectives by Year The general goal of the residency-training program in Dermatology is to provide comprehensive practical and theoretical training in clinical and investigative cutaneous medicine. The residency comprises three years. Over this time, the residents maintain a continuity clinic at UAMS and the Veterans Administration Hospital. Broad exposure to dermatopathology, dermatologic surgery, pediatric dermatology, mycology, and all other topics mandated by the American Board of Dermatology is provided. Weekly conferences are as follows: book review, dermatopathology unknown slides, didactic dermatopathology, journal review, grand rounds, and didactic lectures series. By the end of the year specified below, a resident should be able to: First Year (PGY-2) • Accurately describe cutaneous eruptions • Generate a differential diagnosis appropriate to the clinical description • Correlate the cutaneous disease with underlying medical problems • Identify several therapeutic options for a given disease with familiarity of side effects of the various medications • Demonstrate a mastery of basic dermatopathology with ability to generate differential diagnoses • Demonstrate the surgical skills of punch biopsy, shave excision, simple excision and closure, cryosurgery, electrodessication and curettage • Correctly perform and interpret KOH and Tzanck preparations Second Year (PGY-3) • Demonstrate a greater ability to merge cutaneous findings with underlying disease in complex patients on the consultation service • Demonstrate a more extensive differential diagnosis with identification of the most likely diagnosis • Select the most appropriate therapy for a given cutaneous disease • Generate a differential diagnosis including the correct diagnosis of dermatopathology • Demonstrate the surgical skills of layered closures, simple flaps, and advanced suturing techniques Third Year (PGY-4) • Manage medically complicated patients with evidence of judgment necessary to merge management of cutaneous disease with overall treatment plans • Generate a concise differential diagnosis and identify the correct diagnosis with weighted consideration of most likely diagnostic options • Demonstrate an extensive knowledge of dermatologic therapeutics with selection of the most appropriate therapy and recognition of risks and benefits • Correctly identify most diagnoses in dermatopathology with concise and appropriate differential diagnosis • Demonstrate the surgical skills of more advanced flaps and closures, learn the use of lasers in skin diseases and aesthetics, learn basic cosmetic procedures • Demonstrate a thorough knowledge of mycology including identification of specific fungi on basic growth media • Demonstrate a thorough knowledge of dark field examinations, hair mounts and use of ionizing radiation in dermatology
  • 8. 7 • Prepare a presentation of a national dermatologic meeting • Publish at least one article in a peer reviewed journal in cooperation with faculty member Department of Dermatology Education Goals and Objects by Rotation General dermatology clinic 1. To progressively acquire skill and knowledge pertaining to fundamental medical and surgical dermatology 2. To learn to communicate effectively with referring physicians 3. To appreciate the diversity of the human condition and the respectful and caring treatment of all patients a. differential diagnosis b. medical therapeutics c. experience with skin of color d. surgical skills from biopsy, shaving, and cryotherapy to excisions with complicated closures Dermatopathology 1. To recognize the full range of histopathology of skin disease 2. To generate progressively complex differential diagnosis and accurately establish diagnosis 3. To learn appropriate use of ancillary tests a. immunohistochemisty b. genotypic analysis of lymphoid infiltrates Dermatologic surgery 1. To learn appropriate judgment in planning excisional therapies 2 To build confidence and knowledge in surgical techniques based upon skills acquired in the general dermatology clinic a. Flaps b. Grafts c. Mohs technique 3. To experience a broad range of cosmetic procedures with acquisition of skills to perform these in practice a. chemical peels b. all laser techniques c. sclerotherapy of veins d. Botox e. fillers Pediatric dermatology 1. To gain exposure to the full range of skin disease in children 2. To generate age-appropriate differential diagnoses 3. To perform minor procedures in children 4. To observe laser therapy of hemangiomas
  • 9. 8 Veterans Administration 1. The goals and objectives parallel those of the general dermatology clinic with several areas of emphasis a. geriatric dermatology b. clinic management c. concentration on basic skills of skin cancer surgery PGY-2 Dermatology Outpatient Clinics The dermatology outpatient exposure is subdivided between the University of Arkansas for Medical Sciences Outpatient Clinic (OPC), John L. McClellan Memorial Veteran’s Hospital (VAMC), Arkansas Children’s Hospital (ACH), and the Stuttgart Regional Medical Center (SRMC). Resident dermatology clinic is held at the University every weekday morning from nine o’clock until twelve o’clock except for Tuesday morning. Monday morning is reserved for a laser cosmetic clinic and Contact Dermatology clinic. There is one PGY-2, PGY-3, PGY-4, and an attending physician. Each resident tends to about thirteen patients with an average of twenty percent considered new patients. In both of these outpatient clinics, each resident provides care for his/her patient under the supervision of the attending physician. This physician examines the patient, assists in establishing a differential diagnosis, aids in determining the best treatment and provides education. A similar clinic is held at the VA dermatology clinic, Monday through Friday morning, from 9 o’clock to 12 o’clock. Wednesday morning clinic is reserved for surgical cases and outpatient consults. The clinic is very similar to the University hospital clinic in terms of number of residents, patients, and attending physicians. At the Children’s Hospital the general pediatric dermatology clinic is conducted every Tuesday morning. The eczema, acne or general dermatology clinic is conducted every Thursday afternoon. On every other Tuesday afternoon, residents attend a Vascular Malformation Clinic at Children’s Hospital. Common and rare malformations are seen in this clinic. All of the residents rotate through the ACH Dermatology clinics under the supervision of the pediatric dermatologist. Each resident cares for about five to fifteen patients per session with approximately thirty percent considered new patients. Those residents rotating on either dermatopathology or Mohs surgery have one continuity clinic per month at the University Hospital and the VA. This allows for uninterrupted care for the more involved patient. These are also under the direct supervision of an attending physician. The chairman’s clinic is conducted three afternoons a week from one o’clock. The rotating resident assists in the management and treatment of these private patients that often have complicated or challenging dermatologic diagnosis. Attending general dermatology clinics are held every afternoon at the University Hospital except on Friday. Residents see the patients and present the findings, assessment, and possible plan of care to the attending physician. Each attending sees an average of 15-20 patients in a half-day. The contact dermatology clinic, a specialized attending clinic, takes place on Monday morning under Dr. Hoskyn’s supervision.
  • 10. 9 Cosmetic and Surgery Clinics UAMS Every Monday afternoon the residents at UAMS attend the surgery clinic, under the supervision of Dr. Davis. Three to five simple surgeries are scheduled at this time. The main focus of this clinic is the teaching of basic surgical techniques. As mentioned above, Dr. Kincannon attends a Laser Clinic at University Hospital every Monday. Patients with tattoos, pigmented lesions, vascular lesions, and rosacea are commonly seen in this clinic. Accordingly, residents learn to use the IPL, QS YAG, PDL, and Ruby lasers available in the dermatology clinic. Finally, under the direction of Dr. McCowan, senior residents participate in a monthly Cosmetic Clinic on a Friday afternoon. Residents learn the techniques of Botox and filler injection, sclerotherapy, chemical peels, along with cosmetic laser applications. VA Every Wednesday morning the residents at the VA hospital have a surgery clinic staffed by Dr. Jack Cates. Approximately 7-10 cases are scheduled and include excision of cancers and cysts with simple, layered and complex closures. Flaps are used to close many of the larger surgical defects. In addition, occasional nail avulsion with and without ablation, dermabrasions, scar revisions, sclerotherapy, chemical peels, and blepharoplasties are performed. This clinic is also a hands-on resident clinic with the cases performed by the residents under Dr. Cates’ supervision. Occasionally certain select patients may undergo hot loop surgery for rhinophyma. Dermatologic surgery rotation A PGY-3 or 4 resident works with Dr. Davis in the Mohs surgery clinic on a monthly basis. This experience includes outpatient Mohs surgery with simple, complex, and layered closures of the surgical defects. Very few patients are referred to another surgeon for closure, therefore skin grafts and many complex tissue transfer procedures are performed in the clinic. PGY-3 residents spend one month with Dr. Davis, while PGY-4 residents spend 3 months with him. Residents also participate in a weekly, multi-specialty Melanoma conference, where plans of care are developed for patients with advanced disease. Dermatopathology rotation A PGY-3 or 4 resident is assigned to the dermatopathology service monthly under the supervision of Drs. Smoller and Hiatt. Sign-out occurs each morning from 8-12 at UAMS. Afternoons are available for self-study using extensive files. The resident on this rotation spends one afternoon a week grossing skin biopsies for the following day. Other Surgical Experience In additional to these formally scheduled surgery clinics, the residents perform shave and punch biopsies and electrodessication and curettage of skin cancers on a routine basis at the University and VA clinics. Also, Drs. Carney, Cates, Yee and Stough extend an open invitation for residents to attend their private clinics to observe Mohs surgery, liposuction, sclerotherapy, facial cosmetic procedures, botulinum toxin injection, etc. Dr. Davis has developed a surgical lecture series for the residents, with lectures on a multitude of topics given twice a month. Experts in such fields as Infectious Disease, Radiation Therapy, and Anesthesia are involved in this series.
  • 11. 10 Inpatient Rounds and Admissions The Dermatology inpatient service is at the University Hospital. Patients to be admitted are evaluated by a PGY-2 resident under the direct supervision of a staff physician. It is the duty of the PGY-2 to perform the history and physical examination with emphases on the particular cutaneous pathology, write admission orders and perform skin biopsies when necessary. The PGY-2 is then responsible for the care of the patient both day and night (the exception being the weekend, when the on-call resident assumes responsibility) during the entirety of the patient’s stay, with supervision provided by the attending physician. At the appropriate time the, discharge orders, care plan, and discharge summary are completed by the PGY-2 resident upon completion of the hospital stay. The attending physician together with the PGY-2 caring for that patient conducts inpatient rounds daily. Rounds are held either prior to, or at the completion of the outpatient clinical activities. Teaching is both in the form of lectures and didactics, as well as at the bedside when appropriate. When a patient is admitted at night or on weekends, it is the responsibility of the on-call resident and staff physician to evaluate and admit the patient. The following day, (or Monday morning if the admission occurs over a weekend) the patient is turned over to the PGY-2 resident to be followed as noted above. At Arkansas Children’s Hospital, dermatological patients are admitted to the Pediatrics service and the dermatology service performs as consultants. On average, during his/her PGY-2 years, a resident will admit 5-8 patients to the University Hospital. Rotating Residents Residents from various clinical services commonly rotate through the dermatology service. These residents usually spend their time distributed between the University/Arkansas Children’s and VA hospitals. Each rotating resident is at all times under the direct supervision of a dermatology resident or attending and is expected to attend clinic every day unless excused by the chief resident. Residents are also required to attend grand rounds and any scheduled lectures. At the end of the rotation the chief residents formally evaluate each resident and this information is provided to their respective departments. Conference Schedule Monday Tuesday Wednesday Thursday Friday 8:00-9:00 Lecture 7:30-9:00 Journal 7:45-9:00 Grand Rounds 7:45-8:45 Dermpath Unknowns 7:00 – 9:00 Book Review 12:30–1:30 Barnhill Review 12:00-1:00 Lecture 12:00-1:00 Lecture 1:30-2:30 Dermpath Didactics
  • 12. 11 Journal Club Journals reviewed by all residents include Dermatologic Surgery, J Am Acad Dermatology, Archives of Dermatology, and J Investigative Dermatology. Residents are expected to read, assimilate, and condense patient information from the articles read, and be ready to discuss these with faculty present or with each other during the discussions. This conference focuses residents upon the current literature affording up to date information on new diagnostic and therapeutic applications in dermatology as well as basic research. Path Unknowns Slides are selected from interesting cases from the previous week by the dermatopathology fellow. Residents give a morphologic description and a differential diagnosis for the case. The fellow then discusses the microscopic aspects of each slide, differential diagnosis, and specific diagnosis. Dermatopathology Textbook Review Each resident must read, assimilate, and be prepared to discuss in condensed form the assigned reading from the text. The chapter will be reviewed in a resident session. Before the conference, each resident will have reviewed selected slides pertinent to the chapter assigned. The slides will be presented in conference as unknowns and discussed by each resident as well as relevant material from the assigned reading by the staff as it pertains to the diagnosis of skin diseases. Grand Rounds Educational unknown cases and difficult patient management problems are examined by resident, staff, and visiting physicians in the VA clinic every Wednesday morning. A staff physician leads the discussion of the differential diagnosis, as a final working diagnosis is developed. Therapeutic options are entertained and management is outlined. In addition, follow-up of previously discussed cases in encouraged. General Dermatology Textbook Review Assigned reading is reviewed each Friday morning. The complete text will be reviewed each year. Each resident participates in the review and discussion process. Didactic Conferences These conferences are presented in one of two forms. The first is the presentation of Kodachrome slides for unknown photographs of patients to the residents for discussion. The second is lectures on specific topics either from Dermatology staff or from invited lectures that have interests or expertise in areas that pertain to Dermatology. Professional Meetings: American Academy of Dermatology Each year 6 of 8 residents are expected to attend the annual meeting, submitting and presenting an interesting case for the “Gross and Microscopic” presentation. Each resident receives $1,100 for expenses. The remaining two residents may attend another meeting of their choice, receiving the same stipend. Arkansas State Dermatological Society Meeting All residents play a very integral role in preparing, planning, and developing a patient/case mix for presentation at this meeting. All the residents review unknown and educational cases, with certain cases assigned to each resident whereby the current pertaining literature is reviewed. At the meeting, the resident assigned to that particular case must by ready to discuss queries
  • 13. 12 regarding the case from the visiting participants. In addition, one resident per year will formally present a topic to the Society. Other Support A special fund has been developed to support the expenses of any resident who makes a presentation at other Dermatologic Meetings.
  • 14. 13 Dermatology Resident Rotations Each resident spends an equal amount of time between UAMS/Arkansas Children’s and the Veteran’s Hospitals. While assigned to the UAMS clinics, the resident is also responsible for covering the Arkansas Children’s Hospital clinics. Residents usually rotate between each institution at intervals that vary from 2 to 4 months. The schedules are made out by the chief residents at the beginning of each year and are designed so that each resident spends an equal amount of time working with each of the other residents and attending physicians. While on either rotation, a resident will be expected to attend various afternoon clinics. Regardless of where a resident is assigned, he or she is required to attend all conferences. UAMS/Arkansas Childrens Hospital Schedule Monday Tuesday Wednesday Thursday Friday AM: Laser clinic :Contact derm clinic PM: UAMS Clinic AM: Children’s Clinic PM: UAMS Clinic :Vascular Lesion Clinic AM: UAMS Clinic PM: UAMS Clinic : Stuttgart Clinic AM: UAMS Clinic PM: UAMS Clinic : Children’s Clinic AM: UAMS Clinic PM: Cosmetic/ Laser Clinic Veteran’s Hospital Schedule (AM only) Monday Tuesday Wednesday Thursday Friday VA General Dermatology Clinic VA General Dermatology Clinic VA Surgery Clinic VA General Dermatology Clinic VA General Dermatology Clinic Dermatopathology signout Dermatopathology signout is held daily with a staff dermatopathologist to review and diagnose histological specimens obtained from the previous day’s clinics as well as submissions from private dermatologists in the community. This is an opportunity for residents to obtain additional exposure to various aspects of dermatopathology, including H&E diagnoses and immunoperoxidase stains. On Thursday mornings, the previous weeks most interesting cases are presented to all residents as unknown cases. One resident attends signouts for one month at a time; additionally residents may attend other sessions on a voluntary basis. This opportunity is in addition to the rotation.
  • 15. 14 Dermatology Consult Service The Consultation Service at both the University Hospital and the VA Hospital is run by the PGY-3 resident (second-year dermatology resident) and is staffed by an attending physician. The consultation team includes the PGY-3 dermatology resident, a dermatology staff member, and all medical students and non-dermatology residents rotating on the dermatology service. Afternoon consults at the VA Hospital are covered by the consult resident, also to afternoon consults at the ACH are done by the on-call resident. Monday through Friday, the consultation resident is responsible for consults between 8:00 a.m. and 5:00 p.m. Every effort is made to see consultations the same day a consult is received or within 24 hours. Emergent consults would include, but are not limited to patients with: bone marrow or organ transplants, severe drug eruptions, bullous diseases, or systemic infections disease. These consults are given priority and are seen that same day. On weekends and holidays, the resident and staff physician on call manage consultations. When seeing a consultation, the resident performs an initial history and physical examination and offers an assessment and treatment plan. Then on consultation rounds, which usually occur at 4:00 p.m. on weekdays with the consultation team, the attending physician reviews all patients’ information, the patient is seen and examined, the differential diagnosis is discussed, and recommendations are made to the consulting physician. If a skin biopsy is indicated, it is then performed by the dermatology resident. Biopsy results are usually available within 24 hours of the biopsy procedure. The consultation resident is responsible for contacting the dermatopathologist, obtaining and reviewing the biopsy results, and delivering the results to the primary team. Any other patient follow-up is done during consultation rounds. Arkansas Children’s Hospital is physically separated from the University campus (approximately 1.5 miles), and as such, the residents do not see all the dermatology consults. However, many of the inpatient consults are seen in the dermatology clinic allowing the residents to participate in patient care. Dermatology Referrals At UAMS Department of Dermatology, referrals from outside physicians are usually handled by the head nurse. Appropriate information for the referral form concerning the patient is obtained and it is determined how soon the patient needs to be seen. If it is an emergency, the patient will be seen that same day. An appointment is scheduled, the patient is seen, and then the referring physician is contacted either by phone or letter regarding the patient visit.
  • 16. 15 The Medical Record Clinic Notes These notes are to be written in the traditional SOAP note form with a pertinent history and physician, assessment of each dermatologic problem, and a clear plan of care. Medical Students may write the history section of the note but no other components. Each note is to be signed by any person who has composed a part of the note including medical students, rotation residents, etc. Dermatology residents are to sign all notes regardless who wrote the note after carefully reviewing the note. Attending physicians are to write a separate note with appropriate documentation according to HCFA guidelines. Consultation Notes Consultations are to be written on the appropriate consultation forms in the traditional history and physical form. Each note is again to be signed by the person writing the note and the dermatology resident if he or she did not write the note. The consult attending is to write a separate note documenting his or her own history and physical and assessment and plan. Inpatient Notes Admission history and physicals are to be done by the admitting resident in the traditional form documenting early the reason for admission, goals for the hospitalization, and the means of reaching those goals. The attending that is responsible for the admission should also write an admitting note. Daily progress notes are to be written by the resident and attending. The resident on call should also write them on the weekends. Progress notes should document changes in the patient’s condition as well as any updates in the treatment plan. Upon discharge, a discharge summary is to be dictated according to hospital policy. It should include a concise review of the patient’s hospital course and clear instructions for care at home and follow up. Copies should be sent to any referring physicians and to the dermatology clinic. Call Schedule Dermatology residents first start taking call in October of their PGY-2 year. At that time, the PGY-4 residents no longer have on call responsibilities. Call is taken for one week at a time. While on call, the resident must at all times be available for emergency consultation. Call responsibilities began at 5:00 PM each weekday and span the weekend from 5:00 PM on Friday to 8:00 AM Monday. At all times, there is an attending physician on call whom the on call resident may contact if needed. It is the responsibility of the on call resident and the on call attending to arrange for call coverage in their absence. The call schedule is made out by the chief resident at the beginning of each year. Vacation Policy Each resident of the Dermatology departments gets three weeks of vacation per year. Three weeks equals fifteen days Monday through Friday. Only one resident is allowed vacation at a time and vacation requests are approved on a first come first served basis. Requests should be submitted to the chief resident at least one month ahead of time to allow appropriate reduction of the schedules. It is preferred to take two of the weeks as complete weeks and not broken up into separate days. Any vacation not used in a work year (July through June) will be forfeited.
  • 17. 16 Sick Leave Policy Sick leave is paid absence from scheduled work for reason of illness or accident. A separate maternity policy exists. A resident can be placed on sick leave in excess of one consecutive week only by approval of the Chairman. Leave of absence for medical reasons will be granted with pay for a maximum of 12 working days per year. Leave of absence may be extended beyond twelve days with pay when the nature of the illness is job-related and is decided upon by the Chairman. It may not exceed the termination date of the appointment. A sick leave request in excess of twelve days requires a special review by the Associate Dean for Academic Affairs and the Chairman. A letter stating the nature of the illness and the reason for the requested extension of sick leave must be provided by the personal physician of the resident. Unused vacation time can be used to extend the pay period, but when maximum sick leave and vacation time has been exhausted, the resident is placed on leave without pay. When the resident has been absent for longer than eight consecutive weeks, a decision about the ability to return to full duties must be reached and a decision made based upon the circumstances involved. The personnel needs of the department will be given primary consideration and it may be necessary to terminate the resident and employ another to fulfill his or her duties. The Chairman will determine whether or not the resident will be required to spend additional time in training to compensate for the leave period and be eligible for certification for a full training year. That decision will be based upon the requirements of the American Academy of Dermatology. The UAMS House Staff guidelines include the following special provisions for pregnancy. In recognition of the various physical demands placed on each resident, and to insure optimum consideration for both the mother and the unborn child, the following provisions are suggested: A. The resident should see a physician as soon as she believes she may be pregnant. When the pregnancy is confirmed, she should notify the Chairman to permit cooperation in planning future training assignments. She should also provide the date on which she will most likely cease training program responsibility. B. By the end of the six month of pregnancy, the resident should provide the Chairman with a statement from her physician certifying the expected date of delivery, the residents ability to continue working and the date to which she is permitted to work. Any change in medical condition subsequently that might alter these health guidelines is to be documented with an additional statement from her physician. C. The maximum period of maternity leave with pay has been set by the Board of Trustees of the University of Arkansas as 12 days of unused sick leave plus 14 days (two weeks) of unused vacation time. Time off beyond that will be without compensation.
  • 18. 17 Procedure Logs Documentation of procedures performed is kept by each resident in a logbook. This recording of information usually consists of the patient’s name. ID number, procedure performed (i.e., punch biopsy, shave ED&C, culture, etc.), and differential diagnosis. Later, when the histological diagnoses are available, the earlier records provide an organized system to ensure adequate follow-up, as well as a useful learning tool. Upon completion of residency, the documentation is used in many instances as proof of experience to obtain hospital privileges. Light therapy NBUVB, UVB or UVA (psoralens given either topically or orally in conjunctions with UVA) are frequently used regimens in the treatment of a variety of skin conditions. A 1st year resident rotating at the VA is responsible for administering light therapy to patients, evaluating the clinical response, and adjusting light dosages according. The light sources are calibrated periodically to determine the amount of energy delivered per unit of time. With each patient’s visit, the time of light therapy administered, light source, and previous clinical response is documented. Safety precautions for the patient, including protective eyewear and genital coverage, are enforced. Resident’s Role in Teaching and Evaluation Dermatology residents may provide feedback regarding both student and rotating residents. At times, this feedback is direct and immediate particularly in clinic on a daily basis. Sometimes it is in the form of a formal written resident evaluation provided by the respective rotating resident’s department. Dr. Kincannon is responsible for medical student evaluations. Senior Medical Student Rotation The senior student dermatology rotation is coordinated by Dr. Kincannon (course director). Students are closely supervised by dermatology residents at all times and rotate between clinics associated with UAMS, Arkansas Children’s Hospital and the VA hospital. The dermatology rotation students are not responsible for call or weekend duties. Students will however be expected to see consults, attend grand rounds and any scheduled lectures in addition to their clinic duties. For further details, see course syllabus. Department of Dermatology Business Office The Department of Dermatology business office controls all business functions involving resident affairs. The official work hours extend from 8:00 AM to 5:00 PM Monday through Friday. The office staff consists of a business administrator, administrative support, and a billing expert. The business administrator oversees the staff of the business office. He helps manage the finances and is responsible for business development. The project program specialist is primarily for the staff physicians and for office needs, but some administrative support of the residents for the function of dermatology business is available. The following information should help you identify certain areas where the office staff can be of help to you.
  • 19. 18 1. Paychecks- You may pick up your paycheck from the office the last day of the month. Direct deposit is available. 2. Beepers- A pager will be assigned to you and will remain with you throughout each year. New papers may be assigned each year. The exception is in the second year where the consult paper will be work by the resident on the University side. 3. Mail- Each resident has a mailbox located in the office. Please check your mailbox on a frequent basis. 4. The project program specialist handles all residency forms and correspondence from the Academy of Dermatology. Any information required concerning this is found in the office. LINES OF RESPONSIBILITY Educational goals and objectives are stated elsewhere. Performance evaluations are also compiled and stored separately. The following information is intended to outline frameworks of responsibility within the department. This structure indicates the person to whom a resident should raise concerns within the designated clinic. All issues raised and the resident’s name will be confidential, as per ACGME guidelines. Concerns may be communicated either verbally or in writing. General Dermatology Clinic • Resident reports to attending physician staffing the clinic • Attending physician reports to Dr. Horn VA Dermatology Clinic • Resident reports to attending physician staffing the clinic • Attending physician reports to Dr. Carrington, head of the dermatology service at the VA • Dr. Carrington reports to Dr. Horn Dermatopathology • Resident reports to Dr. Smoller, chairman of pathology Dermatologic Surgery • Resident reports to Dr. Davis, head of dermatologic surgery • Dr. Davis reports to Dr. Horn
  • 20. 19 DEPARTMENT OF DERMATOLOGY CRITERIA FOR PROMOTION Fulfillment of American Board of Dermatology and Residency Review Committee criteria for training including competencies Overall satisfactory evaluation by faculty in twice yearly surveys Evidence of acquisition of knowledge appropriate for level of training -Oral presentations at grand rounds -Performance on in-training examination -Evidence of ethical and compassionate care of patients We also comply with the UAMS GMEC policies for evaluation and promotion. (www.uams.edu/gme/1.300.html) CRITERIA FOR SELECTION Selection of trainees is based upon many elements, some objective, some subjective. Specific parameters that form the basis for selection include, but are not limited to the following: -Grade point average in medical school -Nomination to AOA -USMLE scores -Letters of reference -Communication skills -Misdemeanor involving moral turpitude or any felony conviction
  • 21. 20 Then following is the evaluation form used during our interview process: DERMATOLOGY APPLICANT EVALUATION FORM • OBJECTIVE USMLE SCORE 5 4 3 2 1 (5=high, 1=low) TRANSCRIPT GRADES 5 4 3 2 1 Max score 10 Min score 2 • OBJECTIVE (SECOND TIER) DEAN’S LETTER 5 4 3 2 1 LETTERS OF RECOMMENDATION 5 4 3 2 1 MEDICAL SCHOOL HONORS/AWARDS 3 2 1 0 WORK EXPERIENCE 3 2 1 0 RESEARCH EXPERIENCE 3 2 1 0 PUBLICATION/PRESENTATIONS 3 2 1 0 VOLUNTEER EXPERIENCE 3 2 1 0 Max score 25 Min score 2 • SUBJECTIVE INTERPERSONAL/INTERVIEW SKILLS 5 4 3 2 1 PERSONAL STATEMENT 5 4 3 2 1 INTERESTS/HOBBIES 3 2 1 Max score 13 Min score 3 COMMENTS: _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ __________________________________________________________ We also comply with the UAMS GMEC policies for recruitment and appointment (www.uams.edu/gme/1.200.html)
  • 22. 21 PROBATION, SUSPENSION, AND DISMISSAL DEFINITIONS Probation: a trial period in which a resident is permitted to redeem academic performance or behavioral conduct that does not meet the standard of the program. Suspension: a period of time in which a resident is not allowed to take part in all or some of the activities of the program. Time spent on suspension may not be counted toward the completion of program requirements. Dismissal: the condition in which a resident is directed to leave the residency program, with no award of credit for the current year, termination of the resident’s Agreement of Appointment, and termination of all association the University of Arkansas for Medical Sciences College of Medicine and its participating teaching hospitals. PROCEDURE Probation 1. A resident may be placed on probation by the Program Director for reasons including, but not limited to, any of the following: a. failure to meet the performance standards of the program; b. failure to comply with the policies and procedures of the GME Committee, the UAMS Medical Center, CAVHS, ACH, and the Department of Dermatology. c. misconduct that infringes on the principles and guidelines set forth by the training program; d. documented and recurrent failure to complete medical records in a timely and appropriate manner; e. when reasonably documented professional misconduct or ethical charges are brought against a resident which bear on his/her fitness to participate in the training program. 2. When a resident is placed on probation, the Program Director shall notify the resident in writing in a timely manner, usually within a week of the notification of probation. The written statement of probation will include a length of time in which the resident must correct the deficiency or problem, the specific remedial steps and the consequences of non- compliance with the remediation. 3. Based upon a resident’s compliance with the remedial steps and other performance during probation, a resident may be: a. continued on probation; b. removed from probation; c. placed on suspension; or d. dismissed from the residency program. Suspension 1. A resident may be suspended from a residency program for reasons including, but not limited to, any of the following: a. failure to meet the requirements of probation; b. failure to meet the performance standards of the program; c. failure to comply with the policies and procedures of the GME Committee, the
  • 23. 22 UAMS Medical Center, the participating institutions, or the Dept of Dermatology; d. misconduct that infringes on the principles and guidelines set forth by the training program; e. documented and recurrent failure to complete medical records in a timely and appropriate manner; f. when reasonably documented professional misconduct or ethical charges are brought against a resident which bear on his/her fitness to participate in the training program g. when reasonably documented legal charges have been brought against a resident which bear on his/her fitness to participate in the training program; h. if a resident is deemed an immediate danger to patients, himself or herself or to others; i. if a resident fails to comply with the medical licensure laws of the State of Arkansas. 2. When a resident is suspended, the Program Director shall notify the resident with a written statement of suspension to include: a. reasons for the action; b. appropriate measures to assure satisfactory resolution of the problem(s); c. activities of the program in which the resident may and may not participate; d. the date the suspension becomes effective; e. consequences of non-compliance with the terms of the suspension; f. whether or not the resident is required to spend additional time in training to compensate for the period of suspension and be eligible for certification for a full training year. A copy of the statement of suspension shall be forwarded to the Associate Dean for Graduate Medical Education and the Director of Housestaff Records. 3. During the suspension, the resident will be placed on “administrative leave”, with or without pay as appropriate depending on the circumstances. 4. At any time during or after the suspension, resident may be: a. reinstated with no qualifications; b. reinstated on probation; c. continued on suspension; or d. dismissed from the program. Dismissal 1. Dismissal from a residency program may occur for reasons including, but not limited to, any of the following: a. failure to meet the performance standards of the Dermatology program; b. failure to comply with the policies and procedures of the GME Committee, the UAMS Medical Center, the participating institutions, or Dept of Dermatology; c. illegal conduct; d. unethical conduct; e. performance and behavior which compromise the welfare and of patients, self, or others; f. failure to comply with the medical licensure laws of the State of Arkansas; g. inability of the resident to pass the requisite examinations for licensure to practice medicine in the United States, if required by the individual residency program.
  • 24. 23 2. The Program Director shall contact the Associate Dean for GME and provide written documentation which led to the proposed action. 3. When performance or conduct is considered sufficiently unsatisfactory that dismissal is being considered, the Program Director shall notify the resident with a written statement to include: a. reasons for the proposed action, b. the appropriate measures and timeframe for satisfactory resolution of the problem(s). 4. If the situation is not improved within the timeframe, the resident will be dismissed. 5. Immediate dismissal can occur at any time without prior notification in instances of gross misconduct including, but not limited to theft of money or property; physical violence directed at an employee, visitor or patient; use of, or being under the influence of alcohol or controlled substances while on duty, patient endangerment, illegal conduct. 6. When a resident is dismissed, the Program Director shall provide the resident with a written letter of dismissal stating the reason for the action and the date the dismissal becomes effective. A copy of this letter shall be forwarded to the Associate Dean for GME and the Director of Housestaff Records. For more information, see: http://www.uams.edu/gme/1.420.htm
  • 25. 24 Evaluations The UAMS Dermatology Residency Program has a comprehensive evaluation system in place that provides feedback on the performance of the residents, faculty, and program itself. The evaluation system is described below and summarized in tabular form at the end of the text section. A sample of each form is appended. This information and a sample of each type of evaluation form used by the Program is available to the public on the Department’s website. Evaluation of the Residents Resident evaluations are undertaken twice yearly. At six-month intervals, the Program Director schedules a confidential meeting with each resident, in which the results of the resident’s evaluations are reviewed. At mid-year, the review is based upon the Mid-Year Resident Evaluation forms (previous version entitled “Resident Evaluation”) completed by faculty and general impressions on the part of the Program Director. The Program Director does not complete a separate form at the Mid-Year Conference. The year-end review covers the Program Director’s general impressions, the Global 360° Evaluation, an assessment of the resident’s performance of the six ACGME competencies, the resident’s results on the in-training examination, a record review, and a chart-stimulated recall exercise. For each year-end evaluation, the Residency Competency Review form and the appropriate American Board of Dermatology (ABD) form are used, with the ABD form for third-year residents serving as the resident’s final written evaluation. The final evaluation specifically states that the resident “has satisfactorily completed the prescribed residency training in dermatology and has demonstrated sufficient professional ability to practice competently and independently.” Evaluations of each resident are accessible to the resident and maintained as a part of his or her permanent file. Evaluation of the Faculty by the Residents Residents evaluate the faculty annually using the Staff Evaluation Form. Faculty reviews are based on teaching ability, involvement in the educational program, clinical knowledge, and scholarly activity. These evaluations are submitted confidentially to Teresa Taylor, Program Coordinator, who compiles the results and comments and gives a summary for each faculty member to the Program Director and Department Chairman. The results of these faculty evaluations are communicated to each faculty member during his or her confidential annual review meeting with the Chairman. Evaluation of the Program by the Residents Residents evaluate the training program at the end of each year of training and once after graduation. Current residents complete an Annual Evaluation of the Program by Resident form, which may be submitted on paper or via e-mail, and exiting residents complete the Exit Evaluation Instrument, which is a comprehensive review of the training program as a whole. These year-end evaluations are submitted confidentially to Teresa Taylor, Program Coordinator, who compiles the results and anonymously forwards the summary to the Program Director. At the following monthly faculty meeting, the Program Director discusses the findings of the evaluation, and a plan for appropriate change is formulated after faculty review. The third-year (Chief) residents are present at this and all other faculty meetings.
  • 26. 25 Table. Summary of evaluation system for the UAMS Dermatology Residency Program Evaluation of Done By Type/Title Frequency Mid-Year Resident Evaluation (Previous version entitled “University of Arkansas for Medical Sciences Department of Dermatology — Resident Evaluation”) Mid yearFaculty Attending’s/Faculty Survey Year end (as part of Global 360° evaluation) Mid-Year Conference (no form) Mid year Residency Competency Review (previous version was not titled) Year end Program Director Evaluation of Graduate Trainee for First Year of Dermatology Residency Training OR Evaluation of Graduate Trainee for Second Year of Dermatology Residency Training OR Evaluation of Graduate Trainee for Third Year of Dermatology Residency Training (American Board of Dermatology forms) Year end (Third Year form serves as final evaluation) Residents Nurse Administrative Staff Patient Self Peer Nurse’s Survey Administrative Staff Patient Satisfaction Survey Resident Self-Evaluation Peer Evaluation Year end (Global 360° evaluation) Faculty Residents Staff Evaluation Form Year end Annual Evaluation of Program by Resident Year endProgram Residents Exit Evaluation Instrument After graduation
  • 27. 26 List of Evaluation Forms Appended 1. University of Arkansas for Medical Sciences Department of Dermatology — Resident Evaluation 2. Mid-Year Resident Evaluation (updated version of Resident Evaluation form listed above) 3. Attending’s/Faculty Survey 4. Residency Competency Review (Note: old version, has no title) 5. Residency Competency Review (updated version, with title) 6. Evaluation of Graduate Trainee for First Year of Dermatology Residency Training (ABD) 7. Evaluation of Graduate Trainee for Second Year of Dermatology Residency Training (ABD) 8. Evaluation of Graduate Trainee for Third Year of Dermatology Residency Training (ABD) 9. Nurse’s Survey 10. Administrative Staff 11. Patient Satisfaction Survey 12. Resident Self-Evaluation 13. Peer Evaluation 14. Staff Evaluation Form 15. Annual Evaluation of Program by Resident 16. Exit Evaluation Instrument ABD = American Board of Dermatology
  • 28. 27 UAMS and CAVHS Rotations in Clinical Dermatology Subject: Goals, Objectives and Requirements Purpose: The purpose of this policy is to define goals, objectives, and requirements of specific clinical rotations in the UAMS Dermatology residency clinical training program. Scope: The policy applies to all UAMS Dermatology residents. Implementation: Implementation of the policy is the responsibility of the Program Director, Attending Faculty, and Residents Procedure: All Faculty and Residents will be made aware of the policy during orientation or when the policy is changed or updated. (It can be viewed at anytime in the resident handbook, or on the Department Website) Policy: Dermatology Resident Clinics Rotation Dermatology Resident Clinics Director: Dr. Horn Rotation Goals To provide an educational experience in the evaluation and management of dermatology patients in a university-based outpatient and inpatient setting. ACGME Competencies Rotation Objectives for the first (PGY-2) year resident Patient Care 1. To develop expertise in the diagnosis and management of a range of dermatologic conditions. 2. To develop the ability to formulate a differential diagnosis and treatment options with attending dermatologists. 3. To learn to provide patient care and to develop the ability to educate the patient in the relevant areas of disease prevention, detection, progression, and therapy to promote skin health. 4. To learn to treat varied colors of skin. Medical knowledge General Dermatology Clinics 1. By the end of the year, a resident should be able to accurately describe cutaneous eruptions. 2. To develop an understanding of the pathophysiology of common skin diseases. 3. To develop a knowledge base in the epidemiology of common skin pathology. 4. To learn to evaluate evidence-based medicine for treating dermatologic diseases. 5. To learn the management of dermatologic emergencies and medication side effects. 6. To learn how to correctly perform and interpret microscopy for dermatologic conditions, including KOH prep, hair mount, Tzanck smear, and ectoparasite prep. 7. To learn diagnostic and therapeutic dermatologic procedures, including punch biopsy, shave excision, cryosurgery, electrodessication and curettage.
  • 29. 28 The above objectives apply to all resident clinics. Additional objectives apply to the following specialty areas: Cosmetic Clinic 1. To learn how to evaluate the cosmetic patient, discuss therapeutic options and potential outcomes, and prepare the patient for a cosmetic procedure. 2. To understand laser safety and principles and their application to skin 3. To learn appropriate post-procedure care; identify and manage potential complications. 4. To learn medico-legal and regulatory issues regarding cosmetic procedures. Contact Dermatitis Clinic 1. Learn to perform interviews and evaluations for occupational, environmental and allergic skin conditions. 2. Learn the appropriate aspects of environmental and industrial medicine, and preventive medicine. 3. Demonstrate understanding of procedures in allergy and immunology to include appropriate patch testing, phototesting, RAST testing and consultation with an Allergist-Immunologist. Surgery Clinic 1. To learn appropriate judgment in planning surgical therapies. 2. To understand surgical techniques including punch biopsy, shave excision, simple excision and closure, cryosurgery, electrodessication and curettage. 3. To observe a range of cosmetic procedures. Pediatric Dermatology 1. To gain exposure to the full range of skin disease in children. 2. To learn age-appropriate differential diagnoses and treatment plans. 3. To learn skin manifestations of genetic disease, and the need for a multidisciplinary approach. 4. To learn and observe the course and therapies for hemangiomas. Veterans Administration 1. To learn specific dermatologic needs of geriatric patients. 2. To learn clinic management 3. To concentrate on basic skills of skin cancer surgery. 4. To evaluate phototherapy patients, and to understand the operation of UVA, UVB, and hand/foot light apparati and the administration of psoralens and light therapy.
  • 30. 29 Inpatient Consults 1. To learn to perform inpatient consults on complicated medical and surgical patients. 2. To learn to review inpatient hospital records efficiently and effectively to retrieve pertinent history pertaining to the patients admission. 3. To learn to perform diagnostic procedures at bedside and appropriately document findings. 4. To learn to interact with the primary team to facilitate care of the patient with skin manifestations. Dermatopathology 1. To recognize the basic histopathology of skin disease. 2. To appreciate the importance of providing adequate history in the interpretation of cutaneous biopsies. 3. To generate a basic differential diagnosis. 4. To understand use of ancillary tests, including: common histochemical stains, immunohistochemistry, and genotypic analysis of lymphoid infiltrates. 5. To understand the mechanics of specimen accessioning and processing including familiarity with the proper grossing of skin biopsies, and to understand limitations of these techniques when interpreting the final result. Practice-based learning and improvement 1. To review, analyze and utilize scientific evidence from the dermatologic literature in the management of dermatologic patients. 2. To learn from dermatologic patients the most effective therapeutic modalities. 3. To learn from the clinic operating procedure and patient interactions the best practice patterns to facilitate care of the patient with skin manifestations. Interpersonal and Communication Skills 1. To learn to communicate effectively with staff, peers, attending dermatologists, referring physicians and consultants. 2. To learn to listen patiently and attentively to patient history and concerns. 3. To learn to effectively discuss with the patient and/or family: diagnosis, treatment plans including side effects, and answer questions from the patient and/or family. 4. To become a teacher of dermatology to other residents, medical students, and other healthcare professionals. Professionalism 1. To perform all expected professional responsibilities. 2. To practice ethical principles in relation to patient care and confidentiality. 3. To practice ethical interactions with pharmaceutical representatives and be unbiased in prescribing habits. 4. To be sensitive to cultural, age, gender and disability issues. System-based practice 1. To learn how individual clinics function within UAMS, CAVHS, and ACH. 2. To learn proper documentation and billing skills.
  • 31. 30 3. To practice cost-effective care. 4. To learn to implement patient care taking into consideration patient/outside resources. 5. To be active in the standard operating procedures and quality improvement initiatives within the clinic. ACGME Competencies Rotation Objectives for the second (PGY-3) year resident Patient Care 1. To further develop expertise in the diagnosis and management of all dermatologic conditions. 2. To formulate an extended differential diagnosis and to systematically evaluate more advanced treatment options in order to develop a treatment plan with attending dermatologists. 3. To provide patient care that is safe and compassionate, and to further develop the ability to clearly educate the patient in the relevant areas of disease prevention, detection, progression, and therapy to promote skin health. 4. To treat varied colored skin. Medical knowledge General Dermatology Clinics 1. To extend the understanding of the pathophysiology of common and uncommon skin diseases. 2. To further develop a knowledge base in the epidemiology of dermatologic diseases including common and uncommon skin pathology. 3. To learn the most up-to-date evidence-based medicine for treating dermatologic diseases. 4. To master the management of dermatologic emergencies and medication side effects. 5. To correctly perform and interpret microscopy for dermatologic conditions, including KOH prep, hair mount, Tzanck smear, and ectoparasite prep. 6. To perform diagnostic and therapeutic dermatologic procedures, including punch biopsy, shave excision, cryosurgery, electrodessication and curettage. The above objectives apply to all resident clinics. Additional objectives apply to the following specialty areas: Continuity Clinics 1. To monitor and learn the evolution of disease in specific patients. 2. To evaluate treatment modalities and learn to manage treatment side effects and failure. 3. To establish an ongoing rapport with individual patients/families.
  • 32. 31 Cosmetic Clinic 1. To learn how to evaluate the cosmetic patient, discuss therapeutic options and potential outcomes, and prepare the patient for a cosmetic procedure. 2. To gain further experience with common cosmetic procedures such as sclerotherapy, chemical peels, botulinum toxin injection, soft tissue augmentation, and laser/intense pulsed light surgery. 3. To understand laser safety and principles and its application to skin; to select the appropriate laser for an individual patient and/or pigment target. 4. To learn appropriate post-procedure care; identify and manage potential complications. 5. To learn medico-legal and regulatory issues regarding cosmetic procedures. Contact Dermatitis Clinic 1. To learn to perform detailed interviews and evaluations for occupational, environmental and allergic skin conditions. 2. To learn the appropriate aspects of environmental and industrial medicine, and preventive medicine. 3. To demonstrate knowledge and competency in the performance of procedures in allergy and immunology to include appropriate patch testing, phototesting, RAST testing and consultation with an Allergist-Immunologist. Surgery Clinic 1. To learn appropriate judgment in planning surgical therapies. 2. To build increasing confidence in, knowledge of, and performance of surgical techniques including: punch biopsy, shave excision, simple excision and closure, cryosurgery, electrodessication and curettage, and nail avulsion. 3. By the end of the second year, the resident will have demonstrated the surgical skills of layered closures, simple flaps, and advanced suturing techniques. 4. To experience a broad range of cosmetic procedures with acquisition of skills to perform these in practice. Pediatric Dermatology 1. To gain exposure to the full range of skin disease in children. 2. To generate age-appropriate differential diagnoses and treatment plans. 3. To perform minor procedures in children. 4. To learn skin manifestations of genetic disease, and the need for a multidisciplinary approach. 5. To learn and observe the course and therapies for hemangiomas, and to understand surgical and multidisciplinary referral for selected hemangioma patients.
  • 33. 32 Veterans Administration 1. To understand the specific dermatologic needs of geriatric patients. 2. To further expand clinic management 3. To concentrate on basic skills of skin cancer surgery in the PGY-2 year. 4. To evaluate and formulate a treatment plan for phototherapy patients, and to safely and appropriately operate the UVA, UVB, and hand/foot light apparatus; and to appropriately manage side effects of psoralens and light therapy. Inpatient Consults 1. To perform inpatient consults on complicated medical and surgical patients. 2. To review inpatient hospital records efficiently and effectively to retrieve pertinent history pertaining to the patients admission. 3. To perform diagnostic procedures at bedside and appropriately document findings. 4. To interact with the primary team to facilitate care of the patient with skin manifestations. Dermatopathology 1. To recognize the full range of histopathology of skin disease. 2. To appreciate the importance of providing adequate history in the interpretation of cutaneous biopsies. 3. To generate an advanced differential diagnoses and accurately establish diagnosis. 4. To appropriately use of ancillary tests, including: common histochemical stains, immunohistochemistry, and genotypic analysis of lymphoid infiltrates. 5. To understand the mechanics of specimen accessioning and processing including familiarity with the proper grossing of skin biopsies, and to understand limitations of these techniques when interpreting the final result. 6. To review microscopic sections and understand common inflammatory dermatoses and cutaneous tumors. Practice-based learning and improvement 1. To review, analyze and utilize scientific evidence from the dermatologic literature in the management of dermatologic patients. 2. To learn from the dermatologic patient the most effective therapeutic modalities. 3. To practice standard clinic operating procedure and develop the best practice patterns to facilitate care of the patient with skin manifestations. Interpersonal and Communication Skills 1. To communicate effectively with staff, peers, attending dermatologists, referring physicians and consultants. 2. To listen patiently and attentively to patient history and concerns.
  • 34. 33 3. To effectively discuss with the patient and/or family: diagnosis, treatment plans including side effects, and answer questions from the patient and/or family. 4. To become a teacher of dermatology to junior residents, medical students, and other healthcare professionals. Professionalism 1. To perform all expected professional responsibilities. 2. To practice ethical principles in relation to patient care and confidentiality. 3. To practice ethical interactions with pharmaceutical representatives and be unbiased in prescribing habits. 4. To be sensitive to cultural, age, gender and disability issues. System-based practice 1. To understand how individual clinics function within UAMS, CAVHS, and ACH. 2. To understand proper documentation and billing skills. 3. To practice cost-effective care. 4. To implement patient care taking into consideration patient/outside resources. 5. To be active in the standard operating procedures and quality improvement initiatives within the clinic. ACGME Competencies Rotation Objectives for the third (PGY-4) year resident Patient Care 1. To develop expertise in the diagnosis and management of all dermatologic conditions, simple to complex. 2. To have the ability to formulate a complete differential diagnosis and to systematically evaluate treatment options in order to develop a comprehensive treatment plan. 3. To provide patient care that is safe and compassionate, and to develop the ability to thoroughly and clearly educate the patient in the relevant areas of disease prevention, detection, progression, and therapy to promote skin health. 4. To treat skin of varied color. In addition, for Continuity Clinic: 5. To follow a patient’s disease course during the entire 3 years of residency. 6. To schedule patients at appropriate intervals for follow up and to arrange for cross coverage when not available. Medical knowledge General Dermatology Clinics 1. To understand the pathophysiology of common and uncommon skin diseases. 2. To have a knowledge base in the epidemiology of dermatologic diseases including common and uncommon skin pathology. 3. To know the most up-to-date evidence-based medicine for treating dermatologic diseases. 4. To know the management of dermatologic emergencies and medication side effects.
  • 35. 34 5. To correctly perform and interpret microscopy for dermatologic conditions, including KOH prep, hair mount, Tzanck smear, and ectoparasite prep. 6. To perform diagnostic and therapeutic dermatologic procedures, including punch biopsy, shave excision, cryosurgery, electrodessication and curettage. The above objectives apply to all resident clinics. Additional objectives apply to the following specialty areas: Continuity Clinics 1. To monitor the evolution of disease in specific patients. 2. To evaluate treatment modalities and learn to manage treatment side effects and failure. 3. To establish an ongoing rapport with individual patients/families. Cosmetic Clinic 1. To evaluate the cosmetic patient, discuss therapeutic options and potential outcomes, and prepare the patient for a cosmetic procedure. 2. To further experience common cosmetic procedures such as sclerotherapy, chemical peels, botulinum toxin injection, soft tissue augmentation, and laser/intense pulsed light surgery. 3. To understand laser safety and principles and its application to skin; to select the appropriate laser for an individual patient and/or pigment target. 4. To practice appropriate post-procedure care; identify and manage potential complications. 5. To understand medico-legal and regulatory issues regarding cosmetic procedures. Contact Dermatitis Clinic 1. To perform detailed interviews and evaluations for occupational, environmental and allergic skin conditions. 2. To know the appropriate aspects of environmental and industrial medicine, and preventive medicine. 3. To demonstrate knowledge and competency in the performance of procedures in allergy and immunology to include appropriate patch testing, phototesting, RAST testing and consultation with an Allergist-Immunologist. Surgery Clinic 1. To practice appropriate judgment in planning surgical therapies. 2. To master surgical techniques including: punch biopsy, shave excision, simple excision and closure, cryosurgery, electrodessication and curettage, and nail avulsion. 3. By the end of the third year, the resident will demonstrate the surgical skills of advanced flaps and closures, and use of laser in skin diseases.
  • 36. 35 4. To further experience cosmetic procedures with acquisition of skills to perform these in practice. Pediatric Dermatology 1. To gain exposure to the full range of skin disease in children. 2. To generate age-appropriate differential diagnoses and treatment plans. 3. To perform minor procedures in children. 4. To know skin manifestations of genetic disease, and the need for a multidisciplinary approach. 5. To observe the course and therapies for hemangiomas, and to understand surgical and multidisciplinary referral for selected hemangioma patients. Veterans Administration 1. To assess specific dermatologic needs of geriatric patients. 2. To develop more advanced surgical skills in the third year, including excisions requiring complex closures, rhinophyma treatment, dermabrasion, blepharoplasty, and chemical peels. 3. To evaluate and formulate a treatment plan for phototherapy patients, and to safely and appropriately operate the UVA, UVB, and hand/foot light apparatus; and to appropriately manage side effects of psoralens and light therapy. Inpatient Consults 1. To perform inpatient consults on complicated medical and surgical patients. 2. To review inpatient hospital records efficiently and effectively to retrieve pertinent history pertaining to the patients admission. 3. To perform diagnostic procedures at bedside and appropriately document findings. 4. To interact with the primary team to facilitate care of the patient with skin manifestations. Dermatopathology 1. To recognize the full range of histopathology of skin disease. 2. To appreciate the importance of providing adequate history in the interpretation of cutaneous biopsies. 3. To generate progressively complex differential diagnoses and accurately establish diagnosis. 4. To learn appropriate use of ancillary tests, including: common histochemical stains, immunohistochemistry, and genotypic analysis of lymphoid infiltrates. 5. To understand the mechanics of specimen accessioning and processing including familiarity with the proper grossing of skin biopsies, and to understand limitations of these techniques when interpreting the final result.
  • 37. 36 6. To be able to review microscopic sections and confidently diagnose common inflammatory dermatoses and cutaneous tumors. Practice-based learning and improvement 1. To review, analyze and utilize scientific evidence from the dermatologic literature in the management of dermatologic patients. 2. To learn from dermatologic patient the most effective therapeutic modalities. 3. To practice standard clinic operating procedure and the best practice patterns to facilitate care of the patient with skin manifestations. Interpersonal and Communication Skills 1. To communicate effectively with staff, peers, attending dermatologists, referring physicians and consultants. 2. To listen patiently and attentively to patient history and concerns. 3. To effectively discuss with the patient and/or family: diagnosis, treatment plans including side effects, and answer questions from the patient and/or family. 4. To become a teacher of dermatology to junior residents, medical students, and other healthcare professionals. Professionalism 1. To perform all expected professional responsibilities. 2. To practice ethical principles in relation to patient care and confidentiality. 3. To practice ethical interactions with pharmaceutical representatives and be unbiased in prescribing habits. 4. To be sensitive to cultural, age, gender and disability issues. System-based practice 1. To know how individual clinics function within UAMS, CAVHS, and ACH. 2. To practice proper documentation and billing skills. 3. To practice cost-effective care. 4. To implement patient care taking into consideration patient/outside resources. 5. To be active in the standard operating procedures and quality improvement initiatives within the clinic.