Rotation:  Dermatology                            Site(s): St. Mary’s Health Center, physician  offices

 

Course Director: Luciann Hruza, M.D.                Duration: 4 weeks

 

General description and goals:

 

The goal of this rotation is to familiarize residents with common dermatologic conditions that may be primary skin disorders as well as those that are manifestations of underlying systemic illnesses. The residents will evaluate patients for initial dermatologic consultation and continuity care of their chronic skin disorders predominantly in the ambulatory care setting and on inpatient dermatology consults. They are expected to develop competence in the evaluation and treatment of common skin disorders. The residents will also have the opportunity to perform minor procedures important for the skills of a competent internist, such as epidermal scrapings and skin biopsies under close supervision of the dermatology attending.

 

Resident responsibilities:

 

Residents will attend all outpatient clinics with the dermatology attending and perform inpatient dermatology consultation as directed. They will actively participate in patient care and engage in self directed and problem based learning.

 

Educational objectives:

 

1.      Develop skills in basic dermatologic pattern recognition. Obtain a history pertaining to a dermatologic problem and perform a physical examination of the skin using correct descriptive terminology.

2.      Learn basic knowledge about the structure and function of the skin.

3.      Identify common dermatological manifestations of systemic diseases.

4.      Distinguish benign skin lesions requiring no intervention from malignant lesions.

5.      Understand the indications, dosage, mechanism of action, side effect profile and interactions of commonly used oral and topical medications in dermatology.

6.      Recognize conditions requiring referral to a dermatologist.

7.      Perform punch/shave skin biopsies and learn to remove warts and skin tags competently. Perform curettage, intralesional corticosteroid injections, cautery, cryotherapy, KOH preparations and examination under Wood’s light as necessary.

8.      Develop competence in the diagnosis, pathogenesis and management of common dermatologic entities including, but not limited to the following:

·        Common dermatoses and cutaneous bacterial, viral and fungal infections

·        Sexually transmitted diseases

·        Bullous skin disorders

·        Cutaneous manifestations of systemic diseases including connective tissue disorders and vasculitis.

·        Cutaneous tumors including malignant melanoma and premalignant skin conditions, effects of radiation and sun exposure

·        Disorders of nails, hair and pigmentation

·        Cutaneous manifestations of HIV disease

·        Acne, psoriasis, alopecia,  rosacea, erythema multiforme, pityriasis rosea and versicolor, lichen planus, contact, atopic, seborrheic and eczematous dermatitis

·        Actinic and seborrheic keratoses

·        Urticarial and allergic reactions including drug induced skin eruptions

·        Insect bites and stings

·        Corns, callosities, burn wounds and ulcers

 

9.      Develop and demonstrate practice-based learning and improvement, interpersonal/communication skills, professionalism, and systems-based practice through interactions with patients, attendings, and staff.

10.  Attain competence in counseling patients on nutrition, skin hygiene and preventive care

 

Learning Venues:

 

Dermatology attending’s offices and inpatient floors at St. Mary’s Health Center. Teaching methods will include patient management discussions with the attending, learning from direct patient care, performance of procedures and assigned reading exercises, review of diagnostic studies and histopathology specimens, didactic conferences and bedside clinical rounds. A procedure log must be maintained by each resident. Residents are expected to attend all didactic sessions including noon conferences, grand rounds and M&Ms.

 

Required Reading:

 

As per Dermatology course director. Also view website – http://www.telemedicine.org/stamford.htm

 

Competency Evaluation:

 

An end-of-rotation web-based global evaluation form will be completed by the attending and reviewed face-to-face with the resident to assess all six competencies.   This is a good opportunity for feedback.  The resident will also be required to evaluate the rotation and provide feedback on the attending’s teaching skills and other attributes. The resident will be required to take a written examination prepared by the program director and the course director at the end of the rotation. A procedure log must be kept by the resident.

 

Outcomes Assessment:

 

The national in-service examination will be used to assess outcomes and provide feedback on the rotation.  A score of 50^th percentile or better for each resident is a reasonable goal.