The preliminary year with SIU Internal Medicine includes rotations in general internal medicine and multiple subspecialty areas, including dermatology. Our internal medicine colleagues are known for their interest in teaching and excellent patient care. Our dermatology PGY-1 residents have the opportunity to spend 3 half-days once a month on their “Y” week in our clinic, and they rotate through a teledermatology clinic as well as our general dermatology clinics.
The first year of dermatology includes approximately 6-7 half-days per week of outpatient continuity clinic, and two half-days of didactic conferences. Friday mornings are reserved for excisions, procedures, and/or work-in general dermatology patients. After acclimating to dermatology clinics, PGY2 residents begin to rotate in the schedule for inpatient consults. The initial week of call is done together with an upper level resident. Attendings are always available for supervision, and see all of the inpatients with the residents.
PGY-3 and PGY-4
Upper level residents have approximately 3-4 half-days per week of continuity clinic, and two half-days per week of didactic conferences. For 6 months of the year, one day per week is spent in Mohs surgery. During the other 6 months, there is one “float” day per week, which may be used for scholarly activity, administrative tasks, overflow patients, or attendance at dermatopathology sign-out. Friday mornings are reserved for excisions, procedures, and/or work-in general dermatology patients.
Following a structured schedule, residents read a major dermatology textbook each year, and meet weekly for a discussion of the major concepts.
There is a weekly presentation of unknown digital images, which fosters development of skills in describing cutaneous abnormalities and in formulating a differential diagnosis. Journal club is held three times per month, with Grand Rounds once per month, which typically includes live patient viewing and case discussion, as well as a resident-led discussion on a topic of interest. Grand Rounds is also an opportunity for residents to interact with and learn from our local community dermatologists. Lectures from faculty (dermatology or other related specialties) are held approximately 2-4 times per month. Melanoma Multidisciplinary Conference is held once monthly, and includes participants from dermatology, plastic surgery, surgical oncology, and medical oncology.
The foundation of clinical training in general dermatology is the resident continuity clinic. Patients in our clinics are scheduled with a specific resident (rather than with an attending), and the resident is expected to serve as the primary dermatologist for that patient throughout the duration of residency. This includes not only clinic visits, but also laboratory follow up, cutaneous surgical procedures, prescriptions, and all other aspects of patient care. At each visit, patients are also seen by an attending dermatologist, who provides the resident with guidance concerning diagnosis and management planning. By maintaining continuity with their patients over time, residents are able to follow the course of the disease, learn to manage complex medications, and build lasting relationships.
Each year, dermatologic surgery faculty offer a series of conferences covering the critical elements of surgical anatomy, instrumentation, local anesthesia, suture materials, surgical techniques, and complex repairs.
Throughout the residency, the majority of Friday mornings are reserved for surgical procedures. This allows residents to perform necessary procedures on patients seen in general dermatology clinics, permitting excellent continuity of care and early surgical experience. Surgeries are supervised by a Mohs surgeon or general dermatology attending, with one-on-one teaching and guidance.
During the PGY3 and PGY4 years, residents spend one day per week in Mohs surgery, and are able to gain considerable exposure to the Mohs procedure as well as advanced reconstruction techniques. The longitudinal nature of these surgical experiences allows residents to progressively build expertise in dermatologic surgery over the course of training.
In addition to clinical experience and didactic review, residents have the opportunity to attend Hugh Greenway's Annual Superficial Anatomy & Cutaneous Surgery course at Scripps during their PGY4 year.
Dermatopathology conference is held once weekly from 7-9 am at a multiheaded microscope. Each week, there is an assigned reading from a thoroughly illustrated textbook, and residents concomitantly study an accompanying set of slides representing the major entities from that week’s reading. The major teaching points are then highlighted during the group session. Additional examples and unknowns are also reviewed. Biopsies performed by the residents during the preceding week are brought to the conference, and are reviewed to aid in clinicopathologic correlation and management planning, as well as to provide feedback on biopsy technique.
Our dermatopathologist is situated across the street from the clinic, so review of case material is possible at virtually any time, and discussion of challenging cases takes place on a daily basis.
During the PGY3 and PGY4 years, there is time available in the schedule for at least weekly attendance at routine dermatopathology sign-out, if desired.
Patients of all ages are seen in our general dermatology clinic. Additionally, a pediatric dermatologist from a local private, multispecialty group supervises pediatric dermatology clinics with our residents approximately three half-days a month.
Our residents attend a national genodermatosis review course via teleconference each year.
Didactic sessions provide an overview of common cosmetic procedures, and practical sessions are held approximately twice yearly, in which residents are able to practice these techniques on volunteers. Additionally, some attending physicians supervise cosmetic procedures for our general dermatology patients, such as botulinum toxin and filler injections, sclerotherapy, chemical peels, and laser procedures. It is noted that although we make our best effort to provide exposure to cosmetic procedures, this is not the focus of our practice.
The “basic science” of dermatology includes such topics as the normal structure and function of the skin, pharmacology, photobiology, laser science, and clinically applicable molecular biology.
In addition to coverage in the textbook reading and review sessions, residents have the opportunity to attend a basic science course at Indiana University each year. The program also supports resident attendance at the American Academy of Dermatology, which offers a “Structure and Function” course.