Medical Student Rotation – Dermatology Externship

The goal of the Department of Dermatology at the University of Virginia Health System is to provide medical students with an outstanding dermatologic experience.  This includes ensuring that they attain a basic knowledge of skin disease that will enable them to practice medicine and facilitate the passing of dermatologic questions on national accreditation examinations.

This will be accomplished by “hands on” clinical evaluation of patient with skin disease under he close supervision by dermatology faculty and residents.  The clinical experience will be complimented by completing online modules through the American Academy of Dermatology website, small group lectures specific for the medical student, textbook review and written and visual examination.

In addition, the department will provide counseling to those medical students who are interested in pursuing a career in dermatology.  Those students should notify Dr. Hal Flowers, Department of Dermatology, Rotation Supervisor, the initial day of the rotation.

Objectives

  1. Students will be able to obtain a history from patients pertinent to their presenting skin disease
  2. Students will be able to adequately perform physical examination of the skin, hair, nails and mucosal surfaces as well as describe using dermatologic terminology
  3. Students will be able to correlate history and physical findings, present a differential diagnosis and formulate diagnostic and/or treatment plans
  4. Students will be able to perform diagnostic skin tests (i.e. shave biopsy, punch biopsy) and perform appropriate suture closures as indicated
  5. Students will be able to perform and analyze office laboratory procedures used in diagnosing skin disorders. These include: potassium hydroxide preps, cytodiagnostic preps, ectoparasite preps, hair mounts, patch tests and wood’s lamp examination
  6. Students will attend all resident and medical student lectures
  7. Students on 4 week rotations must give a brief 10 minute verbal/visual presentation on an assigned or chosen topic

Safety and Infection Control

Please do not clear sharps for your own safety. Residents, faculty or nurses will accomplish this.

Wash hands with soap and water or use alcohol solution before and after each patient encounter or with any obvious contamination.

If assisting with exam or surgery and you have donned gloves, please do not touch anything that may contaminate the field, the exam room or the clinic (e.g. do not open cabinets, touch doorknobs or walk into the hallway with gloved hands).

All medical personnel will use universal precautions when in the Dermatology Clinic.

Ask for help or clarification if you are unsure how to proceed

Visiting students: In addition to the medical schools requirements for rotation, we ask that you submit a letter of intention, explaining why you are interested in rotating at the University of Virginia.

Visiting students: http://www.med-ed.virginia.edu/handbook/electives/visiting/

Time Off

We understand that you may have interviews scheduled; however, it is the policy of Student Affairs to allow no more than 4 days away from a 4 week rotation in order to receive full credit for this rotation. Similarly, one day off will be permitted for 2 week rotators for approved reasons (family emergency, etc). Please discuss time off with Dr. Flowers and the chief residents in advance

Library Computer Use

During clinic hours, please limit the Dermatology Library computer use to patient care, module review or other official business.  We understand that you may need to access computers for ERAS but this should be accomplished during non-clinic hours such as during lunch or before or after work hours

Use of Electronic Devices

We are aware that in this age much learning takes place electronically. However, we ask that you limit use of electronic devices when in front of patients (e.g. during patient interviews and exams) as well as during formal lecture times. It is expected and assumed that any use of electronic devices while in clinic is for work rather than personal use. Please do not use these devices for checking e-mail, texting and social networking during clinic hours as evidence of such will require us to ask you to stow away these devices permanently.

Interviews with Attendings – For eternal rotators applying in dermatology

Please coordinate and schedule an interview with each of the attendings while you are here so you do not have to return for an interview in the winter. You can likely schedule a date and time when you work with them in clinic

*Note, internal (UVA) rotators will interview with each attending as well, but these are conducted closer to interview season.

Education Curriculum

Each student should visit the American Academy of Dermatology (AAD) website (http://www.aad.org/education-and -quality-care/medical-student-core-curriculum) and complete the 31 core modules. Completion of these modules is required by all rotating medical students. There is a suggested order to complete the modules and we recommend using the 4 week schedule found on the website as a guide (see below). Students are expected to supplement this online curriculum through additional in-depth reading of diseases in these modules and of disease encountered in the clinic. The textbook “skin Disease: Diagnosis and Treatment” by Thomas P. Habif, if the recommended textbook for review and hard copies are available in out dermatology library. Additional texts include those available online through the UVA library website: Clinical Dermatology (Habif); Lookingbill and Marks’ Principles of Dermatology (Marks & Miller); Dermatology (Bolognia); Fitzpatrick’s Dermatology in General Medicine and Andrews’ Diseases of the Skin. http://www. hsl.virginia.edu/e-resource-books-taxonomy/Dermatology

WEEK 1

Monday: The skin exam; Morphology; Basic science of the skin; Dermatologic therapies
Tuesday: Benign skin lesions; Warts
Wednesday: Acne and rosacea; Psoriasis
Thursday: Adult fungal infections
Friday: The red face

WEEK 2

Monday: Actinic keratosis and squamous cell carcinoma; Basal cell carcinoma
Tuesday: Evaluation of pigmented lesions; Melanoma
Wednesday: Bacterial skin infection; Stasis dermatitis and leg ulcers
Thursday: Petechiae, purpura and vasculitis
Friday: The red leg

WEEK 3

Monday: Childhood atopic dermatitis; Contact dermatitis
Tuesday: Pediatric fungal infections; Infestation and bites
Wednesday: Drug reactions; Urticaria
Thursday: Light rashes; Dark rashes
Friday: Red scaly rash

WEEK 4

Monday: Blisters; Molluscum contagiosum
Tuesday: Viral exanthems
Wednesday: Optional modules
Thursday: Review/Study
Friday: Final Exam; End-of-rotation feedback

Another resource online to supplement your dermatology education:

http://www.localimages.com/educationalTools/learnDerm.htm

Lecture and Clinic Schedules are posted on the bulletin board outside the residents’ office.

Attending and Resident Clinics

Please jump in and feel free to obtain and document your history and physical exam. This is also beneficial for your education so we can clarify terminology of primary and secondary lesions and tremendously helps us, especially in our resident clinics!

Clinic Requirements

  1. All medical students will be expected to report to the clinic conference room every morning from 8:00 to 9:00 AM Monday through Friday for morning lecture, unless informed otherwise. Please see lecture schedule or ask chief residents for clarification.
  2. All medical students will be assigned to a Dermatology attending or resident clinic daily, Monday through Friday, morning and afternoon. In addition, there will opportunities to rotate in Mohs surgery clinic and on the consult service. Clinic begins every morning at 9:00 AM and every afternoon clinic begins at 1:00 PM. Promptness is mandatory. All students will actively participate in patient care under the direction and supervision of the physician with whom they are assigned. The second year residents are in charge of clinic assignments. Any scheduling problems should be addressed to them.
  3. The clinic duty ends at the conclusion of the final patient appointment. Attendings or residents may, however, release students earlier depending on any given circumstance.
  4. There is no call requirement for rotating medical students.

Presentations

Students completing a 4 week rotation (whether pursuing dermatology or not) should select a dermatologic topic of interest and prepare for a maximum 10 minute PowerPoint presentation. We encourage choosing topics that are narrow in scope instead of broad summaries of disease entities. Topics should be discussed with the chief residents to ensure they are appropriate. Presentations should be evidence-based and include clinical photographs. Students can resource the Department of Dermatology’s Kodachrome collection for photographic selection. The presentation will be held on the last day of the rotation, unless otherwise decided by the chief residents.

Evaluation

The University of Virginia School of Medicine elective evaluation form will be completed by the rotation supervisor at the completion of the 4 week time period. The rotator will be evaluated based on their performance in clinic, interaction with patients and staff, their oral presentation and examination scores.

Grievances

Any rotating medical student who has a complaint or a problem that develops during the rotation is encouraged to speak directly with the rotation supervisor.