Rotation: Dermatology Elective
Veterans Affairs Medical Center
Site:
- Specialty Clinic, 1st Floor, VA
Instructor:
- Dr. James Yeary
Makeup of team (responsibility of each team member):
- One upper level resident, attending
Days per week (night call):
- Monday-Friday; Weekends off. One upper level ICU night call per month possible.
Usual time of attending rounds (meeting place):
- Clinic Hours: Monday-Friday, 8:30-4:30
Types of patients encountered:
- Outpatients; majority geriatric
Educational goals/competencies:
Patient care:
The evaluation of dermatologic problems requires taking a history based on the presenting complaints. Most of the time the history and physical will be focused, but on occasion, a more extensive evaluation may be necessary to arrive at a diagnosis. Although visual recognition of common dermatologic conditions is important, some diagnostic tests and procedures may be necessary to confirm or to arrive at a diagnosis. The resident should become familiar with KOH preparations, Tzanck smears, and bacterial, fungal, and viral cultures. Other laboratory studies may be necessary especially for monitoring certain medications.
The resident will perform shave and punch biopsies and will learn the indications for special studies such as immunofluorescent biopsies. Cryotherapy with liquid nitrogen will also be a common procedure during this elective.
Medical knowledge:
The resident will acquire a basic knowledge of common cutaneous eruptions and lesions. Common inflammatory dermatoses include: psoriasis, nummular dermatitis, atopic dermatitis, seborrheic dermatitis, contact dermatitis, drug eruptions, vasculitis, acne vulgaris, and acne rosacea. Common infections include: impetigo, cellulites, dermatophyte infections, candidacies, herpetic infections, human papilloma virus, molluscum contagiosum, and scabies. Common benign tumors include: epidermal cysts, lipomas, dermatofibromas, seborrheic keratoses, and nevi. Common pre-malignant and malignant tumors include: actinic keratoses, Bowen's disease, basal cell carcinoma, squamous cell carcinoma, and melanoma.
Interpersonal/communication skills:
During the dermatology elective, interaction with patients will mainly occur in the clinic setting. Since time is limited, concise communication with the patient is necessary in order to diagnose and treat the presenting problem. At the same time, the patient should feel that he has been given enough attention to satisfy his concerns. Written records by the resident will not be required during this elective.
Professionalism:
As with other medical specialties, mutual respect with colleagues and other members of the health care team is important. Many procedures are done, and it is especially important to have a good working relationship with the nurse in order to accomplish these procedures efficiently. A cordial relationship with the nursing and laboratory staff is beneficial for the patient and will make everyone's job more pleasant.
Practice-based learning and improvement:
In the clinic setting, the resident and attending will see patients together most of the time. As the patients are being seen, the presenting condition, differential diagnosis, and treatment will be discussed so that every patient will provide a learning opportunity. The resident will be encouraged to read further for more in depth information on particular subjects encountered in the clinic.
Systems-based practice:
The majority of dermatology patients have straight forward problems which will not require the use of outside sources. However, the VA is an excellent place to learn about cost containment and how to make the most of available resources. The resident should take advantage of an excellent pharmacy staff to see how the patient's needs can be taken care of within the existing VA formulary. At times, it may be necessary to obtain medications on a nonformulary basis, and the pharmacy can again assist with these situations.
Text/references to be consulted:
Clinical Dermatology by Habif is an excellent source for basic disease description, differential diagnosis, and treatment. More detailed information can be found in Fitzpatrick's Dermatology in General Medicine.
Methods of evaluation:
Evaluation of the resident will be based on general knowledge, willingness to learn and to participate in patient care, professional behavior toward patients and staff, and performance of procedures. Dermatologic conditions are common problems in the primary care setting. The internist should have a basic knowledge of this specialty, especially when there is correlation with systemic disease.