Dermatology

Curriculum Background

Family physicians are often the first contact for patients with skin conditions.   Pattern recognition is key to properly caring for patients with skin complaints.  Family physicians must develop keen observational skills and use appropriate terminology to characterize different skin lesions.  Family physicians must have knowledge of different diagnoses associated with certain skin lesions and must know where to access correct information in a timely manner.  Early diagnostic biopsy and definitive medical and surgical treatment are within the scope of care for a family physician.  Family physicians should understand at the systems level how to provide timely, cost-effective and cosmetically excellent skin surgery.  Patient education on realistic expectations for wound healing are important.  Timely and appropriate referral to a dermatologist can assist in managing challenging or potentially life-threatening cases.  Family physicians also have the opportunity to promote healthy behaviors that can prevent skin cancer and other diseases. 

Curriculum Goals

The ACGME has outlined six core competencies for all residents in training. The primary goal of the Care of the Skin experience is for residents to develop the following six competencies in the context of evaluating and treating patients of all ages with acute and chronic skin conditions to include minor surgery.

1. Patient care that is compassionate, appropriate, and effective for the treatment of health

problems and the promotion of health.

2. Medical Knowledge about established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care.

3. Practice-based learning and improvement that involves the investigation and evaluation of care for their patients, the appraisal and assimilation of scientific evidence, and improvements in patient care based on constant self-evaluation and lifelong learning.

4. Interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and other health professionals.

5. Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to patients of diverse backgrounds.

6. Systems-based practice, as manifested by actions that 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.

Key Rotation Specific Milestones

  Patient Care

         PC1:  Care of the Acutely Ill Patient

         PC2:  Care of Patients with Chronic illness

         PC5:  Management of Procedural Care

  Medical Knowledge

MK1:  Demonstrates Medical Knowledge of Sufficient Breadth and Depth to Practice

         Family Medicine

  Communication

         C1:  Patient- and Family-Centered Communication

Rotation

PGY-1 Dermatology – Four weeks in the PGY-1 year in the dermatology clinic, focused on pattern recognition, diagnosis, and treatment of common skin conditions.  Diagnostic biopsy techniques and surgical treatments are developed here.

Other Learning Activities

Family Medicine Clinic – PGY1, 2 and 3 residents diagnose and manage acute and chronic skin conditions and perform minor skin surgery to include destruction of premalignant and benign lesions, excisional biopsy, punch biopsy, cyst removal and lipoma removal.

General Surgery Clinic – PGY1 residents on the dermatology rotation spend time working in the General Surgery outpatient procedure clinic developing procedural skills.

Didactics – PGY-1, 2, and 3 residents attend didactic lectures; approximately 6 hours per year are devoted to common skin conditions and skin procedures.

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ACGME Program Requirements:

Residents must have experience in diagnosing and managing common dermatologic conditions.  (July 2020 Family Medicine Requirements)

Administrative Information:

Last review: November 2021

Family Medicine Coordinator:  CAPT Noa Hammer

Dermatology Coordinator:  LCDR Aubrey Winn

Length of rotation: 1 month

Number of months to be completed: PGY1 – 1 month

Maximal time away allowed from rotation:  One week

Number of half days in FM clinic: 3 including Minor Procedures Clinic

Preferred FM clinic times: Monday AM, Tuesday AM, Tuesday Minor Clinic PM

A.M. Report attendance required: Yes

Thursday afternoon conference attendance required: Yes

FM call required: Yes

Responsible for hospitalized FM panel patients: Yes; a supplementary note must be completed

Responsible for OB panel patients: Yes

Selected Rotation Specific Objectives by ACGME Competency Category:

The following is a listing of selected knowledge, skills and abilities (K.S.A.s) that residents are expected to gain competency in during their PGY-1 Dermatology rotation and over the course of their entire 3 years of residency. 

The rotation-specific objectives will be reviewed with each resident prior to rotating on PGY-1 Dermatology in order to clarify which objectives the resident is trying to attain. The resident will hold onto the curriculum, and use it as a reference point for areas to focus on during the rotation. At the mid-point and end of the rotation, the rotation specific objectives will be reviewed with the rotation coordinator to assure all objectives are met.

Rotation Specific Objectives for PGY-1 Dermatology

Patient Care:

Gather essential and accurate information about their patients:

___ Perform a comprehensive, complete and accurate dermatologic history

___ Initiate treatment programs for dermatologic problems

___ Assess the patient’s understanding of dermatologic diseases and the facilitation of patient education.

___ Assess the psychosocial and economic impact of dermatologic disease on the patient and the family.

Perform competently all medical and invasive procedures considered essential for the area of practice: Proficiency will be determined by several factors including understanding of indications, total attempted, total completed, skill level, confidence and outcome of procedure

___ Proper and safe use of steroids

___ Local Anesthesia

___ Cryotherapy

___ Perform skin biopsies to include:

    ___ Shave biopsy

    ___ Excisional biopsy

    ___ Punch biopsy

___ Intralesional injections

Medical Knowledge

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.

The resident should gain understanding of pathophysiology, presentation, initial evaluation, management and appropriate follow-up of patients who have the following conditions:

___ ABCDE’s of Skin Cancer Recognition

___ Acne

___ Dermatoses secondary to infections

___ Eczema

___ Nevi

___ Keratoses

___ Neoplasm

___Primary

___Metastatic

___ Allergic versus Irritant Contact Dermatitis

___Psoriasis

___Pityriasis Rosea

___Erythema Multiforme

___Lichen Planus

___Erythema Nodosum

___Exanthems

___Drug Eruptions

___Dermatoses due to arthropod bites

___Disturbances of pigmentation

___Disturbances of sweating

___Disturbances of hair and nails

___Vasculitis

___Connective Tissue Disease

___Recognition of Dermatologic Emergencies

Practice-Based Learning and Improvement

Use information technology and on-line medical information to support education:

___ Web-based teaching modules at http://www.aad.org/education/basic-derm-curriculum

___ Utilize hospital’s evidence-based medicine resources (UpToDate; MD Consult Ovid; Medical Letter; Prescribers Letter; Athens, other resources on Clinical Portal) to obtain current information on patient management.

Identify strengths, deficiencies, and limits in one’s knowledge and expertise; and set learning and improvement goals:

___ Set specific learning goals at the beginning of the rotation based on knowledge and skill gaps

Analyze practice experience and perform practice-based improvements:

___ Develop time management skills to increase efficiency in patient care.

Interpersonal and Communication Skills

Work effectively with others as a member or leader of a health care team or other professional group

___ Communicate effectively with physicians, other health professionals, and health related agencies

___ Interactions with other physicians and health care professionals will be collaborative with the patients’ interests held foremost.                                        

Provide information using effective nonverbal, explanatory, questioning and writing skills

___ Demonstrate skills for complete, concise and relevant patient presentations to staff attendings and consultants, including accurate description of skin findings.

Professionalism

Residents must demonstrate a commitment to carrying out professional responsibilities and adherence to ethical principles.

___ Residents will be on-time to all work-related events, will complete all administrative work within hospital/departmental policies and will present themselves with an appropriate/professional appearance/demeanor at all times.

Systems-Based Practice

Demonstrate an awareness of and responsiveness to the larger context and system of health care.

­­­___ Incorporate considerations of cost awareness and risk-benefit analysis in patient and/or population-based care as appropriate by utilizing applying EBM principles and utilizing EBM databases

Specific Expectations of Residents:

1.  Record all procedures in New Innovations in a timely manner and identify a supervising physician

2.  Complete rotation evaluation on New Innovations within 2 weeks of completion of rotation.

3.  Complete review of rotation specific objectives with the rotation coordinator at the mid-point and end of the rotation.

4.  Required attendance at:

a.  Morning report

b.  Academic conferences

5.  Routine call responsibilities

6.  Coverage on OB panel patients and deliveries

7.  Family Medicine Clinic as scheduled

8.  Comply with the NHCP Duty Hours policy

Evaluation: 

Resident Evaluation:

Daily evaluation

The dermatology attending should provide daily and weekly oral feedback to the residents on progress and performance. Attendings will also provide feedback on the quality of written communication by critically reviewing resident chart entries.

Mid-rotation feedback:

With dermatology attending at completion of week 2. Resident must ensure time is scheduled with staff.  Written feedback required if resident is failing at mid-rotation evaluation or at any other time.

Final Evaluation

All attendings should be sent an evaluation by the resident via New Innovations.  Evaluations should be completed within two weeks after rotation.

Methods of Evaluation:

Direct observation of patient care and procedures

Presentations to dermatology attending physicians

Presentations to Family Medicine and General Surgery preceptors in clinic and minor procedures

Resident Training File

The following items will be entered in the residents training record by the GME coordinator:

-Procedures documented in New Innovations

-Resident New Innovation evaluation

Rotation Evaluation (the rotation is evaluated):

Resident assesses quality of the rotation by completing the New Innovations standard rotation evaluation form. Evaluations should be completed within two weeks after rotation.

Recommend reading list:

It is expected that residents will read, at a minimum, UpToDate or web-based articles on the conditions of the patients they are following. They will check off in the knowledge portion of the goals and objectives those conditions they have seen. They should check off each of the specific conditions they have gained knowledge in, and they should have checked off all the knowledge specific objectives by the time they have completed the rotation.  In addition, the following resources are recommended as alternatives:

• Clinical Dermatology:  A Color Guide to Diagnosis and Therapy.  Thomas Habif

• Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology.  Klaus Wolff

• Andrew’s Diseases of the Skin:  Clinical Dermatology.  William D. James

• Disease and the Environment, Part III:  Military Dermatology.  Ed. COL William D. James

• Marks JG, Miller JJ.  Lookingbill and Marks’ Principles of Dermatology. 4th ed. W.B. Saunders Co.; 2006.

References:

1. Program Requirements for Graduate Medical Education in Family Medicine; effective July, 2020.

2. AAFP’s Residency Solutions: Recommended Curriculum Guidelines for Family Medicine Residents: Conditions of the Skin.  Recommended Curriculum Guidelines for Family Medicine Residents Conditions of the Skin AAFP Reprint No. 271