Dermatology

I. BACKGROUND

Dermatology elective is offered to PGY1 - PGY3's at Montefiore Campus. This elective is primarily outpatient based with the opportunity to see inpatient consults.

II. TYPICAL WEEKLY CLINIC AND DIDACTIC SCHEDULE

III . GOALS AND OBJECTIVES

A. Overview:

The program of the dermatology is designed to provide the house officer with the knowledge and skills needed to diagnose and treat diseases of the skin, mucous membranes, hair, and nails. Patients are very diverse ethnically and socioeconomically, and are representative of the neighboring Montefiore communities.

The dermatology rotation/elective consists of one block of four weeks, with a 24/7 coverage by the dermatology residency training program. The dermatology rotation/elective is available to all Internal Medicine pgy1s, pgy2s and pgy3s.

Residents work in teams under the supervision of a senior dermatology resident and the core fulltime academic faculty. A core academic faculty member is responsible for supervision of all patient care in both ambulatory and inpatient settings.

B. Level based Rotation Goals and Objectives:

PGY1:

- Patient Care: Recognize the relative significance of medical and surgical disorders in relation to dermatology; recognize dermatologic emergencies and the public health implications of skin infections, understand the indications, contraindications and risks of common and uncommon dermatologic procedures; work with all providers to offer patient-focused care.

- Medical Knowledge: Use the literature and reference sources to increase knowledge base and share knowledge with colleagues and junior trainees; develop sophisticated knowledge in the areas of renal pathophysiology and the clinical aspects of renal disease states; apply knowledge to the treatment of patients.

- Professionalism: Establish trust with dermatology patients and staff; exhibit honesty, reliability and responsibility in patient care; demonstrate respect for patients, staff and medical students; work closely with the dermatology residents to care for patients; understand limitations and ask supervisors for help when indicated, accept assignments graciously; attend conferences..

- Interpersonal Skills: Write understandable and legible ambulatory care notes; listen to patients and staff and communicate verbally and non-verbally in a productive manner; counsel patients with skin problems; work effectively as a member of the health care team.

- Practice Based Learning and Improvement: Understand limitations of knowledge and use references and literature to improve your practice patterns; accept feedback and change behavior; ask for help when needed; learn from the outcomes of dermatology patients under your care and alter practice patterns to improve outcomes in the future.

- System Based Practice: Advocate for dermatology patients; develop a sophisticated understanding about the health care system/structure and how it relates to patients requiring dermatologic therapies; develop the ability to utilize ancillary services appropriately.

PGY2:

- Patient Care: Recognize the relative significance of medical and surgical disorders in relation to dermatology; recognize dermatologic emergencies and the public health implications of skin infections, understand the indications, contraindications and risks of common and uncommon dermatologic procedures; work with all providers to offer patient-focused care. Understand the rationale and implementation of skin disease treatment plans.

- Medical Knowledge: Use literature and reference sources to increase knowledge base in dermatology; demonstrate basic knowledge in the areas of underlying pathophysiology and the clinical aspects of cutaneous disease states; apply knowledge in the treatment of patients.

- Professionalism: Establish trust with dermatology patients and staff; exhibit honesty, reliability and responsibility in patient care; demonstrate respect for patients and staff; work to fulfill the needs of patients; accept assignments graciously; attend Morning Report, Grand Rounds, Journal Club, Basic Science and CPC conferences.

Dermatology Curriculum (Internal Medicine) – Page 3

- Interpersonal Skills: Write understandable and informed notes and consultation reports; improve ability to listen to patients and staff and communicate verbally and nonverbally in a productive manner; work effectively as a member of the health care team.

- Practice Based Learning and Improvement: Understand limitations of knowledge; use references and literature to improve practice patterns; accept feedback and change behavior; ask for help when needed. Do not overstep responsibilities.

- System Based Practice: Learn to be an advocate for patients with disorders of the skin; accept and try to apply necessary patient care guidelines; develop understanding about the health care systems/structure and how it relates to patients requiring specialized dermatologic therapies (e.g., biologics, retinoids, IVIg, ultraviolet treatments).

PGY3:

- Patient Care: Prioritize the daily work load for dermatology patients, working closely with dermatology house staff; recognize the relative significance of a given patients list of dermatology conditions; recognize the acuity levels of illness; fully understand the indications, contraindications and risks of common and uncommon procedures; discuss risks/benefits native of patient’s with specialists. Understand the rationale and implementation of skin disease treatment plans.

- Medical Knowledge: Use literature and reference sources to increase knowledge base and share knowledge with junior house staff; demonstrate sophisticated knowledge in the areas of underlying pathophysiology and the clinical aspects of simple and complicated disease states; apply knowledge in the treatment of patients.

- Professionalism: Establish trust with patients and staff; exhibit honesty, reliability and responsibility in patient care; demonstrate respect for patients and staff and junior house staff who you are supervising; work with team to fulfill the needs of patients; lead health care team in patient care; understand limitations and ask supervisors for help when indicated; accept assignments graciously; attend conferences.

- Interpersonal Skills: Write understandable and legible notes and consultation reports; improve ability to listen to patients and staff and communicate verbally and nonverbally in a productive manner; work effectively as a member of the health care team, and be an example for your junior house officers.

Dermatology Curriculum (Internal Medicine) –

- Practice Based Learning and Improvement: Understand limitations of knowledge; use references and literature to improve practice patterns; accept feedback and change behavior; ask for help when needed; learn from the outcomes of dermatology patients under your care and alter practice patterns to improve outcomes in the future; aid junior house staff in evaluating their practice patterns.

- System Based Practice: Advocate for patients; develop a sophisticated understanding about the health care system/structure and develop mechanisms to utilize ancillary services to benefit patients.

A. Principles, Physiology and Basic Sciences:

Develop an understanding of:

1) Epidermal anatomy and function

2) Dermal anatomy and function (apocrine glands, eccrine glands, sebaceous

glands, vasculature, nerves

3) Hair and nail anatomy and biology

B. Practice skills unique to Dermatology:

History and physical examination: with attention to skin, hair, nails, mucous

membranes, recognize diagnostic signs and phenomena associated with specific skin disorders (e.g., Koebner phenomenon, palpable purpura, Auspitz sign, Nikolsky sign)

Specific tests and procedures: provider-performed microscopy (e.g., KOH, Scabies

prep, Tzanck preparation, Wood’s Lamp examination), skin biopsy, and wound care.

Preventive care: skin protective measures for ultraviolet exposure, hydration

measures for dry skin (atopic dermatitis), prophylaxis for leg ulcers and hair care to

avoid premature hair loss.

Patient education: Skin cancer recognition, how to avoid premature cutaneous aging, care of venous insufficiency, maintaining healthy skin, hair, and nails.

Attitudes/values: Understand the psychosocial issues surrounding chronic skin

disease, disfigurement, itch and pain.

C. Approach to presenting complaints/problems in Dermatology

1) Case presentations (ambulatory clinics)

2) Medical-dermatology history

3) Focused description of 1 and 2 lesions

4) Use of laboratory, imaging, and other diagnostic tests

5) Making therapeutic decisions (topical v. systemic v. surgical options)

D. Specific Diagnoses in Dermatology

1) Papulosquamous eruptions

2) Eczematous disorders

3) Skin infections

4) Skin cancer

5) Cutaneous manifestations of internal medicine [gastroenterology,

rheumatology, oncology, endocrinology, infectious disease)

6) Drug reactions

E. Emergencies/Therapeutic Interventions:

1) Fever and rash

2) Arthritis and rash

3) Hemorrhagic eruptions

4) Herpes zoster (ophthalmic, Ramsey-Hunt, disseminated)

5) Sexually transmitted diseases

F. Technical Skills:

1) Provider-performed staining and microscopy

2) Skin biopsy

3) Cryosurgery of warts

IV. METHODS OF TEACHING COMPETENCIES AND COMPETENCY

COMPETENCY VENUES ASSESSMENT

Patient care Ambulatory clinics, Grand Rounds, Clinical Slide Sessions Elective evaluation Medical knowledge Case presentations, Journal Club, Clinical Slide Sessions Elective evaluation Professionalism Ambulatory clinics/Case presentations Elective evaluation

Interpersonal Skills Ambulatory clinics/Case presentations Elective evaluation

Practice-based learning Ambulatory clinics/Case presentations Elective evaluation

Systems-based practice Ambulatory clinics/Case presentations Elective evaluation