Dermatology (PGY-2)

Description of Rotation or Educational Experience

This two-week ambulatory experience is designed to expose the resident to the evaluation and management of common diseases of the skin. The purpose of the dermatology rotation is to familiarize the rotator with basic dermatologic diseases, introduce basic treatment strategies, and teach recognition of serious conditions that present on the skin.

Goals:

1. Describe the morphology of dermatologic lesions using appropriate terminology.
2. Recognize and understand management of the common benign and malignant epidermal neoplasms, dermal neoplasms, and pigmented neoplasms.
3. Be able to define the microbiology underlying common cutaneous viral, bacterial, and fungal disorders and proper antimicrobial treatment. 

Patient Care

Goal

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

Competencies

• Receive training to perform those clinical procedures required for their future practices in the ambulatory and hospital environments.
• Receive training that focuses on the core principles of Family Medicine: including Continuity of Care, Family-Oriented Comprehensive Care Experience, Family Medicine Center Experience, Patient Care Experience, FMC Continuity and Accessibility, Medical/Surgical Experiences, and Inpatient Experiences.

Objectives

By the end of the rotation the resident is expected to be able to:

• Perform a complete but focused history and physical examination of the patient with complaints of skin disease.

Medical Knowledge

Goal

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

Competencies

• This rotation fulfills the family medicine-specific training and educational requirements for Care of the Skin.

Objectives

By the end of the rotation the resident is expected to be able to:

• Discuss the principles of dermatologic therapy including steroid treatment, potentiating agents, emollients, dry agents, antipruritics, sunscreens, and the management of complications of topical treatment
• Discuss the evaluation and management of:
• Pigmented lesions including malignant melanoma, suspicious mole, and seborreheic keratoses
• Scaling diseases including atopic dermatitis, lichen simplex chemicus, psoriasis, pityriasis rosea, or seborrheic dermatitis.
• Fungal infections of the skin including tinea capitus, tinea corporis, tinea pedis, tinea versicolor, and exfoliative dermatitis
• Vesicular dermatoses including herpes simplex and herpes zoster
• Weeping or encrusted lesions including impetigo, allergic contact dermatitis, acne vulgaris, rosacea, folliculitis, candidiasis, and urticaria
• Bacterial infections including erysipelas and cellulitis and boils
• Papular disorders including warts, callouses and corns, molluscum contagiosum
• Basal cell carcinoma and squamous cell carcinoma
• Violaceous papules and nodules including lichen planus and Kaposi's Sarcoma

Practice- Based Learning and Improvement

Goal

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

Competencies

• Identify strengths, deficiencies and limits in one’s knowledge and expertise;
• Participate in the education of patients, families, students, residents and other health professionals, as documented by evaluations of a resident’s teaching abilities by faculty and/or learners

Objectives

By the end of the rotation the resident is expected to be able to:

• Achieve a passing score on the PowerPoint slide presentation test of dermatological lesions.

Systems Based Practice

Goal

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

Competencies

• Coordinate patient care within the health care system relevant to their clinical specialty
• Incorporate considerations of cost awareness and risk-benefit analysis in patient care

Objectives

By the end of the rotation the resident is expected to be able to:

• Recognize when dermatologic consultation is appropriate.

Professionalism

Goal

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

Competencies

• Compassion, integrity, and respect for others
• Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation

Objectives

By the end of the rotation the resident is expected to be able to:

• Demonstrate skill and sensitivity in discussing skin disorders and other dermatological concerns with patients in a way that preserve their dignity.

Interpersonal and Communication Skills

Goal

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

Competencies

• Communicate effectively with patients and families across a broad range of socioeconomic and cultural backgrounds
• Communicate effectively with physicians, other health professionals, and health related agencies

Objectives

By the end of the rotation the resident is expected to be able to:

• Take a dermatologic-specific history and physical.
• Work effectively with a team of care providers.

Teaching Methods

What teaching methods are you using on this rotation or educational experience?

• Didactic lecture
• Direct role-modeling and observation

• Set of 6 Rotator Lectures during the course
• Rotators are expected to attend Grand Rounds every Wed morning during which time live patients are examined and presentations discussed in conference.
• Rotators are also expected to attend clinical resident lectures .
• Rotators are expected to attend dermatology clinic every day and observe clinical examination, diagnosis, and management. 
• Rotators are expected to observe as many patient interactions as possible, in order to develop pattern recognition for common dermatologic conditions.

Assessment Method (residents)

How do you measure the resident’s performance on this rotation or educational experience? Rotators are evaluated by both senior staff and senior residents.  Their evaluation is based on the following:

• Faculty evaluations of the rotator’s performance
• Real-time feedback during direct observation
• Attendance: Attendance in all assigned clinics is mandatory for passing the rotation.  At the end of each half clinic day, please have your attendance sheet signed by the dermatology resident or staff you worked with.  This attendance sheet is collected at the end of the rotation.
• Final Exam: All rotators are required to take the final exam.  If you missed lectures during the rotation, you can view them on your own either on slides or on the computer (ask a resident to help).  Your score on the final exam is a strong factor, but is the not the only component, of your final grade.
• Clinic Performance:  Senior Staff and Senior Residents meet at the end of the month to discuss your clinic performance which includes:
• Professional and appropriate interactions with patients and team members
• Ability to work as part of the health care team
• Ability to use clinic experience to improve their dermatologic fund of knowledge
• Ability to access, appraise, and assimilate information from various sources including the scientific literature

• Resident is to generate self-observed behavior reports in each competency at least weekly over the course of this rotation.

Assessment Method (Program Evaluation)

How do you evaluate whether this educational experience is effective?

• Resident evaluation of rotation

Level of Supervision

How is the resident supervised on this rotation?

· Directly by attending physicians

Educational Resources

List the educational resources

• Relevant orientation materials are indicated and/or given at the beginning of the rotation and used throughout.

Resources and people residents have identified as useful, and encourage new rotators to become familiar with:

• Use your time to review the common dermatological diseases
• Read the Atlas of Dermatology
• Your evaluation depends on your test results