Residency

Program Curriculum

Dermatology Residency Program Curriculum
University of Washington
Roy Colven, MD, Program Director

Updated January 2016

Program Goals:

  1. To provide trainees with the practical experience in a variety of clinical settings that will enable them to deliver excellent specialized care to patients with diseases of the skin, hair, nails, and mucous membranes.
  2. To provide an educational environment that fosters: a) acquisition and retention of new knowledge, b) appreciation of the limits of present knowledge, c) spirited discussion of controversies within the specialty, and d) formulation of hypotheses subject to scientific testing.
  3. To provide opportunities for mentored scholarly pursuit, including investigative dermatology.
  4. To provide mentorship and guidance to enable trainees to become future leaders in academic dermatology.

Program Curriculum
The UW Dermatology Residency Program trains selected candidates using a comprehensive curriculum that encompasses clinical practice, didactic learning, investigation, and professional development. The overall goal of this curriculum is to provide a foundation of specialty-specific scientific and medical knowledge and an interactive environment for supervised patient care with graded responsibility. For selected residents desiring experience and demonstrating an aptitude in investigative dermatology, the curriculum offers an avenue for development of mentor-guided research and a forum for feedback, as well as training in research professionalism.

I. Clinical Practice Curriculum
All residents participate in supervised patient-centered learning during one- or two-month full-time rotations at 6 different sites.  Approximately 70% of the resident’s time during these rotations will entail patient care. Residents train once-weekly in a continuity clinic at a single site that continues through all three years of training.
For qualified individuals with demonstrated experience and a high likelihood of pursuing an investigative career, support for an Investigative Track in the 3rd year is possible. These individuals are often identified after matching to our program, and begin their search for a research mentor prior to beginning residency. 

A. Clinical Rotations
Clinical rotations take place at 5 different institutions: University of Washington Medical Center (UWMC), UW Roosevelt Dermatology Center, the VA Puget Sound Health Care System—Seattle, Harborview Medical Center (HMC), and Seattle Children's Hospital (SCH). Specialized clinics at the Seattle Cancer Care Alliance occur during the UWMC inpatient consultation rotation. The UW Roosevelt Dermatology Center offers two different rotations: Roosevelt Outpatient and Dermatologic Surgery. UWMC provides two rotations: one in dermatopathology and the second leading the inpatient dermatology consultation service. The VA, HMC and SCH all offer a combined outpatient and inpatient experience, with opportunities to carry out dermatological surgery and review dermatopathology. The weekly schedule for each rotation site is found in a separate document. All residents are directed by the site medical director or section head, with oversight carried out by the Residency Program Director.

B. Continuity Clinic
Continuity clinic occurs through the entire three years of training. Continuity clinic sites are matched to the resident’s preference whenever possible. In this clinic, the resident manages patients with graded responsibility under the supervision of consistent faculty. Residents follow patients with chronic conditions over time, enabling the residents to establish a continuity relationship with their patients and to see the impact of their management decisions. The goal of continuity clinic by the end of three years of training is excellent and independent patient management. There is the expectation of test result follow up and communication, and complete documentation of all encounters with the residents’ patients.

II. Didactic Curriculum

A. Basic Science

Biology of the Skin (“The Skin”) is a  preclinical medical student organ system course that introduces skin biology, skin pathophysiology, and skin cancer to its attendees. The course is required for 1st year dermatology residents and encouraged for 2nd and 3rd year residents, if they have no clinical duty conflicts. At the end of the course, the 1st year residents take the final examination to assess their knowledge acquisition during the course. The 2nd year residents are in charge of organizing the patient-centered session that is part of this course, and both 2nd and 3rd year residents serve as small group leaders for this session and additional small groups during the course

Grand Rounds serves as a conference to allow Dermatology Division-affiliated faculty, post-doc and doctoral candidates involved in research to present current work to inform, educate and elicit feedback from attendees. In their 3rd year, residents who are conducting research present their preliminary data to educate the attendees in the background of their specific work and to gain insight into the clarity and logic of their projects.

Journal Club
frequently reviews articles covering topics in basic science.

B. Clinical Dermatology

Dermatology Division Grand Rounds (GR) is held twice monthly throughout the year and is attended by Division faculty, staff, residents, students and invited guests. Speakers for GR include residents, and division and outside of division faculty. Residents are required to complete 2 GR presentations in the 1st year, 2 in the 2nd, and an end-of-residency presentation, either presenting research or a topic of his/her choice. GR is offered for CME credit.  In the 3rd year, residents chose a topic within professionalism to present at GR. A Morbidity and Mortality session is often undertaken.

Patient Care/Morphology Conference
is held 2 or 3 times monthly alternately with GR and is attended by Division faculty, residents, and students. Medically complex or highly educational patients are invited to come to the UW Roosevelt Dermatology Center for examination by all attendees. After examining the participating patients, the attendees convene in a closed conference room to discuss the patients’ examination, history, diagnosis, differential diagnosis and suggestions for management. Depending  on the number of patients seen, 1st and sometimes 2nd year residents are asked to describe the clinical exam and generate a differential diagnosis based only on the physical exam. Feedback is given on the residents’ descriptions. Then an open exchange of ideas occurs for management next steps. Patient Care/Morphology Conference is CME accredited. A UW Health Sciences librarian attends this discussion to take note of searchable questions generated by this discussion.  Relevant articles are then posted on a blog within the Division’s intranet for later reference.

Board Review/Textbook Review
is held weekly immediately following GR or Patient Care/Morphology Conference. In this session, residents interactively review selected chapters from Wolverton’s

Comprehensive Dermatologic Drug Therapy
, Spitz’ Genodermatoses and Bolognia’s Dermatology.
Each week, individual residents create or update an existing quiz to assess residents’ synthesis from the assigned texts readings.

Interhospital Image Case Review/Teledermatology
(a.k.a. Morning Report). Digital images from patients seen at the different rotation sites are presented by the residents and reviewed with the residency group to extend the experience from Patient Care/Morphology Conference. Experience is gained in making 3 dimensional inference from 2 dimensional information, generating a differential diagnosis and fundamentals of management of these and like conditions. Again, the Program Director oversees this conference to help provide clinical experience and relevance when appropriate. Occasional teledermatology cases from regional and international networks are presented to widen the scope of exposure to skin disease outside of the usual sites of training.

Faculty-led Didactic Sessions
  A weekly session in which faculty presents a didactic and often interactive topic, either within his/her academic expertise, or relevant to the residents’ current textbook reading.  A variety of formats are used.

Dermatopathology
: (1) A Lever textbook review held at UWMC and conducted by guest faculty (Drs. Dan Lantz and Kyle Garton). Attended by dermatology residents and the dermatopathology fellow, this is a 1.5 hour slide review where the residents systematically review the Lever’s Histopathology of the Skin and examine multiple examples of all diagnoses.
(2) Selected topics in Pathology—Drs. Argenyi, George, Piepkorn: Regularly scheduled dermatopathology didactic conferences held throughout the year and attended by pathology residents and 1st year dermatology residents. Drs. Argenyi and George (UWMC) have a weekly dermpath lecture series that is organized as a review of major topic areas in dermatopathology. This conference also includes unknown slides approximately every third week.
(3)Twice monthly seminar run by Dr. Piepkorn, a guest dermatopathologist, who conducts a systematic image review of clinical diagnoses and associated pathologic findings. This session also includes discussion of subspecialty areas of pathology including melanocytic neoplasms, medical malpractice pertinent to dermatopathology, and others.

Rotation site Dermatopathology Conferences
(UWMC, HMC, VA) Weekly site-specific review of all dermatopathology generated from the clinical services at each rotation site with the exception of CHRMC. These are working conferences run by either the dermatology or pathology attendings in  which biopsies from the prior week’s clinical service are reviewed. Both interesting cases as well as cases in which further clinicopathologic correlation is needed are reviewed. Residents are active participants in these conferences. Digital images of the clinical lesions are incorporated whenever possible to enhance clinicopathologic correlation.

Dermatological surgery
- Monthly resident session presented by Dr. Kampp or the Dermatologic Surgery Fellow on fundamentals of skin surgery. This session provides a systematic review of the major topics in dermatologic surgery (i.e. anatomy, flaps and grafts, lasers, wound healing, sutures, anesthesia, etc.). Additional interactive sessions are done on average twice yearly as a “fix the defect” series where residents talk through various surgical repair options for given defects.

Contact Dermatology
- Resident session presented two or three times per year by Dr. Welch on fundamentals of contact and occupational dermatology. A combination of quizzes, case presentations, and didactic presentations are used. Additionally, handouts are given to facilitate board review of relevant contact dermatitis material.

Journal Club
– An every other week review of the medical and scientific literature pertinent to dermatology led by dermatology residents, interested students, and faculty and open to all division-affiliated faculty, staff, residents and students. Articles for review are selected by the week’s presenter and distributed in advance of the conference. The article is reviewed and an interactive discussion ensues. Basic sciences, clinical trials, clinical reviews, medical education and professionalism are all topics covered by the articles reviewed in this session. Half of the session is devoted to rapid-fire reviews of highly relevant articles from the most current dermatology literature.  Once a year, each resident presents an article centered on professionalism.
Other departmental conferences offered by rotation sites
HMC: Medicine Noon Conference, Chief of Medicine Rounds, HMC Dermatopathology Conference,  HIV Clinical Conference, Infectious Disease Conference, Chest Conference
UWMC: Medicine Noon Conference, Medicine Grand Rounds, UWMC Dermatopathology Conference
VA: Medicine Noon Conference, VA Dermatopathology Conference, Chief of Service Conference
SCH: Pediatric Grand Rounds

III. Research Curriculum (*applicable to residents in investigative track)

Quality Improvement. Each year every resident, paired with a faculty member, will design and carry out a quality improvement project, with the aim of impacting clinical practice for the improvement of the patient experience, minimization of medical error, and/or reducing health care cost. Project ideas will be reviewed by the second quarter of the academic year, reviewed as Works in Progress by mid-year, and then be presented as part of Wednesday morning GR in the late spring. The goal of these projects is to be practical, reiterative, and impactive.

Journal Club – see above

*UW Survival Skills for the Research Year
is a 2 day seminar specifically developed for post-doc trainees in UW labs.

*UW Bio-Medical Research Integrity Series 
Ethics in Research and Human Subjects training

IV. Professional Development & Professionalism

American Academy of Dermatology Annual Meeting - Attended by all 2nd and 3rd year residents.

Society for Investigative Dermatology (SID) Annual Meeting
- Attended by 3rd year residents in the investigative track.

SID Resident Retreat for Future Academicians
- Attended by 2nd year residents late in the year who are embarking on an academic career path.

Pacific Northwest Dermatological Society Annual Meeting
-  One third year resident selected to present and attend the annual conference.

Seattle Dermatological Society (SDS) Monthly Meetings
- Monthly meeting and patient care conference of the SDS. Didactic lectures are prepared by members of the clinical or full-time academic faculty, or by invited guests. Following this, there is a patient care conference in which patients with challenging diagnostic or management issues are viewed and subsequently discussed. When available, pathology is also reviewed. Residents view all patients and are encouraged to participate in the discussion.

Journal Club
– see above

UW Dermatology Division Retreat
- Once yearly retreat to discuss, educate and brainstorm issues related to the mission (hyperlink to http://depts.washington.edu/dermatol/about.html)  of the Dermatology Division. Attended by all faculty, residents and administrative staff.

Billing/coding & Compliance Conferences
- Periodically held conferences conducted by coding and
UW compliance specialists attended by all Division faculty and residents.

Practice Management
– (1) The AAD Annual Meeting-associated Practice Management Course is taken by most 3rd year residents in conjunction with the American Academy of Dermatology Annual Meeting. (2) UW GME office offers Financial Management Series on contacts, debts, and other items requested by house staff.

Human Resources
– Sexual harassment training provided periodically by the University of Washington GME and HR departments.

Teaching Development

  1. Teaching Scholars Program.  Available to qualified 3rd year residents who are committed to medical education and moving toward a Clinician-Educator career track. This one year course requires successful application, commitment of Division funds, and a half-day per week commitment of the selected resident. Sponsored by the UW Department of Medical Education and Bioinformatics.  http://www.meded.washington.edu/teaching-scholars
  2. The Skin course small groups – see above
  3. Medicine 678 (Dermatology 4th year elective clerkship) lecture Weekly clinical lectures given to the 4th year medical students rotating on the Dermatology elective.
  4. Grand Rounds presentation – see above
  5. Other outside-division presentations.  For example, accepted presentations at the AAD, Pacific Northwest Dermatological Society, and Society for Investigative Dermatology meetings. Occasionally residents are asked to speak at Medicine Department Noon Conferences, Family Medicine Dept Teaching Conferences, and other departmental grand rounds.

Impairment awareness –UW GME sessions on the following topics are provided as e-learning modules or are under development: fatigue/sleep deprivation, substance abuse, work/family balance, impairment self-awareness.

Curriculum Activities by ACGME Core Competency

  1. Patient Care: Assigned rotations, continuity clinics, Patient Care Conference, Grand Rounds, textbook review, image case review, pathology conferences at training sites, kodachrome session, systematic dermatopathology review, dermatopathology unknowns, dermatological surgery didactic, contact dermatology didactic, journal club, mycology course.
  2. Medical Knowledge: All of the above activities under Patient Care plus HuBio 567 The Skin course, Works in Progress
  3. Practice-based learning and improvement: Journal Club, textbook review, assigned rotations, continuity clinics, Patient Care Conference, Grand Rounds, Quality Improvement project
  4. Interpersonal and Communications Skills: Assigned rotations, continuity clinics, Patient Care Conference, Grand Rounds, image case review, kodachrome session, pathology conferences at training sites, journal club, AAD and outside of division presentations
  5. Professionalism: Assigned rotations, continuity clinics, Patient Care Conference, image case review, journal club, Human resources sessions, M & M conference
  6. Systems-based practice: Assigned rotations, continuity clinics, Patient Care Conference, Billing and coding sessions, Dermatology Division retreat, Practice Management Course (AAD), Quality Improvement project 

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