UNIVERSITY OF MINNESOTA DERMATOLOGY RESIDENCY PROGRAM

UNIVERSITY OF MINNESOTA

DERMATOLOGY RESIDENCY PROGRAM

Educational Goals and Objectives, Major Assignments and Supervisory Lines of Responsibility

Approved at 8/10/05 Dermatology Educational Faculty Meeting

TABLE OF CONTENTS Page No.

I. General Goals and Objectives of the Program .............................................................................1 II. Medical Knowledge and Clinical Practice ..................................................................................1 A. Objective ...................................................................................................................................1

1. Basic Science........................................................................................................................1 a. Educational Resources.............................................................1 b. Assessment Tools...................................................................1-2 c. Expectations ..............................................................................2

2. Medical Knowledge and Clinical Practice........................................................................2 a. Educational Resources ..................................................................................................2 b. Assessment Tools...................................................................2-3 c. Expectations ............................................................................................................... 3-4

3. Dermatopathology...............................................................................................................4 a. Educational Resources.............................................................4 b. Assessment Tools............................................................................................................4 c. Expectations ...................................................................................................................5

4. Dermatologic Surgery/Procedural Dermatology .............................................................5 a. Educational Resources .............................................................................................. 5-6 b. Assessment Tools......................................................................6 c. Expectations ............................................................................................................... 6-7

III. Program Rotations and Clinical Experience ..............................................................................7 A. Objective ....................................................................................................................................7 B. University of Minnesota Medical Center (UMMC) ..............................................................7

1. Method.................................................................................................................................7 2. Strengths.......................................................................................................................... 7-8 3. Graduated Responsibilities .................................................................................................8 4. Methods of Assessment .......................................................................................................8

C. Veterans Affairs Medical Center (VAMC)............................................................................8 1. Method.................................................................................................................................8 2. Strengths..............................................................................................................................9 3. Graduated Responsibilities .................................................................................................9 4. Methods of Assessment .......................................................................................................9

D. Hennepin County Medical Center (HCMC) .......................................................................10 1. Method...............................................................................................................................10 2. Strengths............................................................................................................................10 3. Graduated Responsibilities ...............................................................................................10 4. Methods of Assessment ............................................................................................... 10-11

E. Park Nicollet Medical Center (PNMC) ................................................................................11 1. Method...............................................................................................................................11 2. Strengths............................................................................................................................11 3. Graduated Responsibilities ...............................................................................................11

Approved at 8/10/05 Derm Educational Faculty Mtg. i

4. Methods of Assessment .....................................................................................................11 TABLE OF CONTENTS (Cont.)

Page No. IV. Resident Continuity Clinics....................................................................................................12 A. Objective .................................................................................................................................12 B. Method.....................................................................................................................................12 C. Assessment ..............................................................................................................................12 D. Expectations............................................................................................................................12 V. Elective/Away Rotations..........................................................................................................12 A. Objective ........................................................................................................................... 12-13 B. Method.....................................................................................................................................13 C. Assessment Tools....................................................................................................................13 D. Expectations............................................................................................................................13 VI. Dermatopathology Rotation....................................................................................................13 A. Objective .................................................................................................................................13 B. Method............................................................................................................................... 13-14 C. Assessment Tools....................................................................................................................14 D. Expectations............................................................................................................................14 VII. Research and Academic Development..................................................................................14 A. Objective .................................................................................................................................14 B. Educational Resources...........................................................................................................14 C. Assessment Tools....................................................................................................................15 D. Expectations............................................................................................................................15 VIII. Professionalism and Quality Assurance...............................................................................15 A. Objective .................................................................................................................................15 B. Educational Resources..................................................................................................... 15-16 C. Assessment Tools....................................................................................................................16 D. Expectations............................................................................................................................16 APPENDICES..........................................................................................................................17 Appendix A: ACGME Core Competencies ........................................................................ 18-25 Appendix B: Resident Duty Hours Policy .......................................................................... 26-27 Appendix C: .................................................................................................................................28 Table 1: Methods of Evaluation - Instruments ............................................................29 Table 2: Methods of Evaluation - Conferences ............................................................30 Appendix D: Educational Resources (Textbooks and Journals) ..................................... 31-33 Appendix E: Residency Site Directors and Administrative Offices................................. 34-35

Approved at 8/10/05 Derm Educational Faculty Mtg. ii

University of Minnesota

Dermatology Residency Educational Goals and Objectives, Major Assignments and Supervisory Lines of Responsibility

I. General Goals and Objectives of the Program The overall educational goals and objectives of the University of Minnesota Dermatology Residency program are to provide each resident with the knowledge and skills to become an expert clinical dermatologist in a professional learning environment of scholarship, friendship, cooperation, and mutual respect. The Program will provide trainees with the educational and practical experience that will allow them to be competent in care to patients with diseases of the skin, hair, nails, and mucous membranes. II. Medical Knowledge and Clinical Practice A. Objective The resident must understand the basic anatomy, physiology and molecular biology of the skin, its appendages, and related organ systems and be able to accurately diagnose and appropriately manage dermatologic conditions. Competence must be achieved in the following four major components of medical knowledge and clinical practice:

1. Basic science 2. Medical knowledge and clinical practice 3. Dermatopathology 4. Dermatologic surgery/Procedural dermatology

1. Basic Science

a. Educational Resources: • Assigned textbook reading • Journal review • Monthly didactic sessions • Courses at the annual AAD meetings • Basic science lecture series • Outside invited speakers • Patient-directed literature review • Resident presentations

b. Assessment Tools: • Monthly quizzes • Yearly ABD in-training examinations

Approved at 8/10/05 Derm Educational Faculty Mtg. 1

• Faculty observation and evaluations (E*Value) • Semi-annual evaluation with Program Director and Department Chair • Resident portfolio • Presentations at lectures, conferences, journal clubs

c. Expectations: PGY-2, PGY-3, PGY-4

• Resident attendance and participation in all lectures, conferences, and journal clubs are mandatory.

• Residents are expected to be prepared for these educational sessions by reading any assigned reading prior to attendance.

PGY-2 • By the end of the first year of dermatology training (PGY-2),

residents should have a good grasp of the assigned reading material with particular attention to structure and function of normal skin.

PGY-3

• By the end of the second year (PGY-3), residents must have an understanding and knowledge of the pathophysiology of skin diseases and how knowledge of basic science leads to the diagnosis and treatment of diseases.

PGY-4

• By the end of the third and final year (PGY-4), residents must have comprehensive knowledge of Basic Science in dermatology and must be able to teach or lecture fellow residents and medical students on the structure and function of skin and pathophysiology of skin diseases.

2. Medical Knowledge and Clinical Practice

a. Educational Resources: • Assigned textbook reading • Journal club • Regional and national conferences • Kodachrome sessions • Weekly lectures/conferences • Grand Rounds participation • Patient care-directed literature review • Faculty supervision during outpatient clinics and inpatient rounds

b. Assessment Tools: • Monthly quizzes • Attendance and participation in conferences, lectures, grand rounds • Quarterly faculty evaluations (E*Value)


• Semi-annual 360° evaluation • Faculty observation of clinical performance • Yearly ABD in-training examination • Semi-annual evaluation with Program Director and Department Chair • Resident portfolio • Grand Rounds patient/case presentation





residents should have a good grasp of the assigned reading material with particular attention to pathogenesis of skin diseases. The residents should be able to formulate an appropriate differential diagnosis and treatment plan for common dermatologic diseases (e.g. acne, psoriasis, dermatitis, dermatophytoses, urticaria, viral diseases, basal cell and squamous cell carcinomas, melanoma). They are also expected to competently perform basic clinical dermatological diagnostic procedures including skin biopsy, Wood’s lamp examination, microscopic skin preparations and cultures.

PGY-3 • By the end of the second year (PGY-3), residents must have

comprehensive knowledge of the pathophysiology of skin diseases and the methods of diagnosis and treatment. The residents must be able to formulate an appropriate differential diagnosis and treatment plan for uncommon dermatologic diseases (e.g. bullous diseases, infestations, photosensitivity syndromes, autoimmune disorders, lymphomas, cutaneous manifestations of systemic disease). They are also expected to be competent in more advanced diagnostic procedures such as dermatoscopy and laboratory mycology.

PGY-4 • By the end of the third and final year (PGY-4), residents must be

able to utilize their knowledge of clinical dermatology into clinical practice and be able to teach fellow residents and medical students. The residents must have mastered the diagnosis and management of all cutaneous disorders and be competent in consultative dermatology as well as inpatient and outpatient management of patients with serious and life-threatening dermatoses.

PGY-2, PGY-3, PGY-4

• All residents must strive to achieve the following: o Pass the yearly American Board of Dermatology In-Service.

Training Examination at the 20th percentile (overall score)


or above. o Know and apply the basic and clinical sciences appropriate

to dermatology. o Communicate effectively and demonstrate caring and

respectful behaviors when interacting with patients and their families.

o Gather essential and accurate information about their patients.

o Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment.

o Develop and carry out patient management plans. o Counsel and educate patients and their families. o Create and sustain a therapeutic and ethically sound

relationship with patients. o Use effective listening skills and elicit and provide

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

o Use information technology to support patient care decisions and patient education.

o Work in a team environment with faculty, nurses, staff, fellow residents, medical students.

3. Dermatopathology

a. Educational Resources: • Assigned textbook reading • Journal club • Regional and national conferences • Microscope unknown slide sessions • Dermatopathology sign-out sessions • Weekly lectures/conferences • Grand Rounds participation • Patient care-directed literature review

b. Assessment Tools: • Monthly quizzes • Attendance and participation in conferences, lectures, grand rounds • Quarterly faculty evaluations (E*Value) • Clinical performance • Yearly in-training examination • Semi-annual evaluation with Chair and Program Director


• Resident portfolio





residents should have a good grasp of the assigned reading material with basic knowledge of dermatopathology. The residents must be able to perform microscopic evaluation of hair mounts and of diagnostic skin preparations for organisms during clinic.

PGY-3 • By the end of the second year (PGY-3), residents must have

comprehensive knowledge of histopathology of skin diseases. The residents must also gain understanding of special stains, immuno-histochemistry, immuno-fluorescence, and electron microscopy. The residents must know the appropriate biopsy technique to attain the optimal diagnostic specimen and be capable of making a histological differential diagnosis for the most common dermatological diseases (e.g. psoriasis, dermatitis, lichen planus, molluscum, herpes virus infections, dermatophytoses, basal cell and squamous cell carcinomas, melanoma).

PGY-4 • By the end of the third and final year (PGY-4), residents must be

able to utilize their knowledge of dermatopathology into clinical practice and be able to teach fellow residents and medical students. The residents must be able to diagnose unknown slides, formulate a differential diagnosis, and establish treatment and/or further diagnostic tests. The residents must have a thorough understanding of less common laboratory methods (e.g. special tissue stains, use of fluorescent reagents, hematologic and tissue studies for lymphoma analysis, mycology cultures).

4. Dermatologic Surgery/Procedural Dermatology

a. Educational Resources:

• Assigned textbook reading • Journal review • Monthly didactic sessions


• Courses at the annual AAD meetings • Skin cancer lecture series • Outside invited speakers • Patient-directed literature review • Resident presentations • MD Live surgical lectures

b. Assessment Tools:

• Yearly ABD in-training examinations • Faculty observation and evaluations (E*Value) • Semi-annual evaluation with Program Director and Department Chair • Resident portfolio • Resident surgical/procedural log • Attendance and participation at lectures, conferences, journal clubs





residents should have a good grasp of the basics of dermatologic surgery. The residents must be able to perform simple excisions with primary layered closures, instill appropriate anesthesia, and perform other basic surgical procedures such as punch and shave skin biopsies, cryosurgery, and electrosurgery. The residents must have knowledge of Mohs surgery, cosmetic surgery, laser surgery, and reconstructive surgery (i.e. flaps and grafts).

PGY-3 • By the end of the second year (PGY-3), residents must have an

understanding and knowledge of majority of procedures in dermatologic surgery. The residents must be able to perform excisions, Mohs surgery, basic reconstruction, sclerotherapy, laser surgery, some cosmetic surgery, nail surgery.

PGY-4 • By the end of the third and final year (PGY-4), residents must have

comprehensive knowledge of procedures in dermatology and must be able to teach or lecture fellow residents and medical students in many of the procedures. The resident must achieve competence in excisions, Mohs surgery, reconstructive techniques, laser surgery, and cosmetic surgery.

PGY-2, PGY-3,

• All residents must be competent in utilizing surgical as well as medical modalities in the management of cutaneous disease. This


PGY-4 requires a thorough understanding of and adequate direct experience with all basic cutaneous surgical techniques including skin biopsy, cryosurgery, electrosurgery, nail surgery, and surgical excision with simple repair. Knowledge of anatomy, anesthesia, and wound healing are also essential. In addition, residents must have an understanding of the principles and methods involving more advanced surgical techniques including Mohs micrographic surgery, advanced soft tissue reconstruction including flaps and grafts, radiation therapy and laser therapy as well as cosmetic procedures including chemical peels, tissue augmentation, sclerotherapy, dermabrasion, hair transplant, and liposuction. Although knowledge and experience with advanced surgical and cosmetic procedures is essential for the resident to be able to counsel patients regarding appropriate indications, the extent to which each resident develops expertise in these techniques is dependent on their individual level of interest and ability.

III. Program Rotations and Clinical Experience A. Objective The residents will rotate through four institutions with each rotation ideally being done in a three-month block. The four sites are: University of Minnesota Medical Center (UMMC), Veterans Affairs Medical Center (VAMC), Hennepin County Medical Center (HCMC), and Park Nicollet Medical Center (PNMC). At each site, the residents will gain a unique experience in patient care and dermatology. Each rotation has strengths that will further the resident training and knowledge of dermatology. B. University of Minnesota Medical Center (UMMC)

4. Method: Six residents are assigned to UMMC for three months. Typically, one resident is the inpatient/consult resident and another resident may be involved in an away/elective rotation. A third resident may be on Dermatopathology rotation. The average time on the consult service per three-month rotation is two weeks. The remaining residents cover various clinics in both medical and surgical dermatology clinics. One or two residents are assigned to one attending per clinic.

5. Strengths:

The UMMC rotation has many specialty clinics as well as general dermatology clinics. These clinics include the Hair Disorder Clinic, the Consortium Clinic, the Continuity Clinic, the Cutaneous T Cell Lymphoma Clinic, the Melanoma and Pigmented Lesion Clinic, and the Pediatric Dermatology Clinic. In addition, the residents have broad


exposure to procedural dermatology. Residents work with UMMC-based dermatologic surgeons in procedural clinics performing Mohs surgery, excisional surgery, laser surgery, photodynamic therapy, and cosmetic surgery. Second and third year residents also have the opportunity to work with Dr. Brian Zelickson at the Center for Cosmetic Care and Lasers. Residents spending time with Dr. Zelickson are expected to participate in clinical research and writing of manuscripts with Dr. Zelickson.

6. Graduated Responsibilities: PGY-2 a. First year residents (PGY-2) will be given significant supervision and

guidance in all aspects of patient care. Based upon resident progress and knowledge, the resident will be given more autonomy. By the end of the first year, residents should be able to formulate a differential diagnosis and plan of treatment and/or diagnostic tests.

PGY-3 b. Second year residents (PGY-3) will be allowed to present diagnostic and

treatment plans to the attending. The residents will participate in teaching of more junior residents as well as medical students. In some rotations, the resident may serve as the senior resident in charge of clinic rotation schedules.

PGY-4 c. Third year residents (PGY-4) will often serve as the senior resident for the

rotation if a Chief Resident is not assigned or is on elective. In clinical performance, the resident will have considerable autonomy and must be able to demonstrate clinical competence and excellence. The residents must be active instructors for junior residents and medical students. The residents must show leadership skills in clinic operation and in creating and maintaining rotation schedules.

4. Methods of Assessment: • End of rotation evaluation • Clinical performance • E*Value • Resident portfolio • Resident procedure log • Resident inpatient consult log • Faculty feedback • Patient feedback • Semi-annual evaluation with Program Director and Department Chair

C. Veterans Affairs Medical Center (VAMC)

5. Method:


Six residents are assigned to VAMC for three months. All residents are present for each clinic. One resident usually serves as the consult resident but this resident typically will also be present for clinic duties. For medical dermatology clinics, there are usually one or two attendings available for clinics.

6. Strengths:

The VAMC rotation offers excellent continuity of care and hands-on surgical experiences. Each resident is assigned a clinic block to follow. This method allows for continuity of care during the three month rotation. This rotation also provides an excellent opportunity to gain autonomy in training.

7. Graduated Responsibilities: PGY-2 a. First year residents (PGY-2) will be given considerable supervision by the

faculty. Every patient seen by a first year resident will be staffed by the faculty. By the end of the first year, the residents will be given more autonomy for diagnostic and treatment plans.

PGY-3 b. Second year residents (PGY-3) will be given appropriate supervision by

the faculty. Routine follow up patients and skin checks are not always staffed by the faculty. Patients with history of melanoma, CTCL, or on oral medication requiring periodic monitoring are staffed by an attending. In some rotations, a second year resident will serve as the senior resident in charge and will be given supervisory and leadership roles.

PGY-4 c. The third year residents (PGY-4) have significant autonomy but still have

direct supervision from faculty. The residents are expected to teach junior residents, medical/dental residents, and medical students. One senior resident is responsible for schedules and supervision.

PGY-2, PGY-3, PGY-4

d. For all residents (PGY-2, PGY-3, PGY-4), surgical training is intimately tied to the demonstration of competence in increasingly complex procedures.

4. Methods of Assessment: • End of rotation evaluation • Clinical performance • E*Value • Resident portfolio • Resident procedure log • Resident inpatient consult log • Faculty feedback • Patient feedback • Semi-annual evaluation with Program Director and Department Chair


D. Hennepin County Medical Center (HCMC)

5. Method Three residents are assigned to HCMC for three months. Residents are present in all of the clinics. One resident usually serves as the consult resident but this resident is present for clinic duties. Typically, two attendings are present for each clinic.

6. Strengths

The HCMC offers the most diverse patient populations, including all skin types from many different ethnicities and all socioeconomic classes. The residents are exposed to pediatric patients at this site as well as in a weekly Pediatric-Dermatology Clinic. The HCMC site also has several specialty clinics, including a weekly Dermatology-Surgery Clinic, and a Contact Dermatitis Clinic, held three days weekly, both staffed by a faculty member and dermatology resident. Acute dermatologic conditions are seen in a weekly same-day appointment clinic. Residents attend a weekly dermatology-pathology conference with two faculty members, and two weekly “at the microscope” dermatology-pathology conferences with a dermatopathologist. A weekly conference is held at which all dermatology residents, non-dermatology residents and medical students present a 10-minute PowerPoint talk on a dermatology-related subject. A faculty member presides and directs a discussion following each talk.

7. Graduated Responsibilities PGY-2 a. First year residents (PGY-2) have considerable faculty supervision and are

given graduated autonomy as recognized by the faculty. Residents are expected to describe the histologic features of their biopsies and to begin to form differential diagnoses.

PGY-3 b. Second year residents (PGY-3) typically do not rotate at this site due to

the limitation of the schedule. If the resident is able to rotate at HCMC, he/she will be expected to present diagnostic and treatment plans to the faculty and to propose viable histopathologic differential diagnoses.

PGY-4 c. Third year residents (PGY-4) are responsible for offering leadership,

making up schedules, and teaching first-year residents and medical students. They should integrate history, examination and laboratory data to form a valid plan for treatment and/or further investigations, and are responsible for patient follow-up.

PGY-2, PGY-3, PGY-4

All patients seen by residents are staffed with HCMC dermatology faculty.


4. Methods of Assessment

• End of rotation evaluation with exit interview by chief of dermatology • Clinical performance • E*Value • Resident portfolio • Resident procedure log • Resident inpatient consult log • Faculty feedback • Patient feedback • Semi-annual evaluation with Program Director and Department Chair

E. Park Nicollet Medical Center (PNMC)

5. Method: One third year resident is assigned to PNMC for three months. The resident sees new and follow-up pediatric and adult patients under the direct supervision of one of seven different Park Nicollet dermatologists. The residents have their own clinic blocks, which allows for better continuity of care and increased autonomy. In addition, a first year resident is assigned to a four-hour Thursday AM continuity clinic at PNMC and keeps this assignment for three years.

6. Strengths:

PNMC is a large, multi-specialty group practice in a central suburb of the Minneapolis/ St. Paul area. Its facilities and electronic medical record system are state-of-the art, and all the dermatology exam rooms are equipped for both examination and minor surgery. The resident becomes part of a team of thirteen dermatologists, seven of whom teach and offer informal consultation at any given time in the large central office. A Mohs surgeon and dermatopathologist are also directly available, as they too practice in this central office. While PNMC’s patient population is very diverse, the majority of its patients reside in the suburbs and have advanced education. Most patients seen by the resident are referred to the dermatology department by PNMC primary care physicians.

7. Graduated Responsibilities: PGY-4 The main rotation is typically only for third-year residents. The residents are expected to

perform at a high level and with considerable independence.

4. Methods of Assessment:

• End of rotation evaluation • Clinical performance • E*Value • Resident portfolio • Resident procedure log


• Resident inpatient consult log • Faculty feedback • Patient feedback • Semi-annual evaluation with Program Director and Department Chair

IV. Resident Continuity Clinics A. Objective Continuity of care is an important element to medical training. All residents will be exposed to some continuity of care at their respective rotations. However, the Program has developed a resident continuity clinic for each site to enhance the experience for all residents. B. Method

1. Each resident is assigned to a weekly continuity clinic site at the beginning of residency for the duration of the three-year training period. The assignments are based upon the following: resident vacancy from graduation, new incoming resident preference, faculty preference, and residency program director preference.

2. The UMMC site has six residents and three faculty, with two residents assigned to the

same faculty member for the three years. The VAMC site has six residents and two faculty. The HCMC site has three residents and one faculty. The PNMC site has one resident and two alternating faculty.

3. The resident is the primary care-giver for the patients with faculty supervision. The level

of supervision will be graded upon resident clinical competence and the complexity of the patient.

C. Assessment

• Clinical performance • E*Value • Semi-annual 360° evaluation • QA/QI assessment • Resident portfolio • Faculty feedback • Patient feedback • Semi-annual evaluation with Program Director and Department Chair

D. Expectations

• Gain experience in continuity of care • Advancement of clinical skills • Graded autonomy and independence from faculty supervision • Enhance patient relationships


V. Elective/Away Rotations A. Objective The Department has created an elective rotation for second and third year residents. This has become an invaluable educational experience for many residents. The elective rotation is designed to gain educational experience at another ACGME-accredited institution. The residents may choose to select specific rotations that are not provided by our Program such as Pediatric Dermatology. Other residents select elective rotations based upon interest, such as dermatopathology, dermatologic surgery, and cosmetic dermatology. B. Method

1. Second and third year residents are allowed to take a 4-week elective each year. Two of the four weeks must be in pediatric dermatology with a Board-certified pediatric dermatologist. All elective rotation site and mentor must have an affiliation with an ACGME-accredited dermatology training program.

2. For each elective rotation, the resident must submit in advance an elective request form

with clearly outlined Goals and Objectives of the rotation. The request must be pre-approved with signatures from the Residency Program Director and Department Chair. The resident must provide a letter of approval/agreement from the elective rotation mentor(s).

3. Following the rotation, the resident must provide the elective rotation mentor with a blank

E*Value hard copy to be filled out and sent to the Residency Program Director. The resident also typically gives an oral presentation (15 to 60 minutes) of the elective experience to the Program upon return.

C. Assessment Tools

• E*Value evaluation from elective rotation mentor • Resident summary presentation • Semi-annual evaluation with Program Director and Department Chair

D. Expectations

• Meet the intended Goals and Objectives of the rotation(s) • Gain further knowledge and insight into an area/field of dermatology • Provide opportunity to enhance training in pediatric dermatology

VI. Dermatopathology Rotation A. Objective Dermatopathology is an essential component of resident training. All sites have a unique dermatopathology session that takes place weekly. This rotation is designed to allow the residents to spend dedicated education time to study dermatopathology at several sites. B. Method


1. Second or third year resident assigned to the UMMC rotation will spend 2 full weeks in the Dermatopathology rotation.

2. The resident will spend sign-out and educational time at one of three sites: Twin Cities Dermatopathology, Associated Skin Care, and UMMC.

3. The resident will independently review available teaching slide collections at each site.

C. Assessment Tools • E*Value evaluation from dermatopathologists • In-training examination • Semi-annual evaluation with Program Director and Department Chair

D. Expectations • Become familiar with the method of dermatopathology sign-outs • Understand the basics of histopathology and the relationship to skin diseases • Gain further knowledge and insight into an area/field of dermatopathology • Provide opportunity to enhance independent learning in dermatopathology

VII. Research and Academic Development A. Objective Residents are expected to develop and maintain habits of scholarly inquiry to ensure continued professional development. They are expected to participate in the development of new knowledge, learn to evaluate new research findings and apply them in a clinically appropriate manner. They are also expected to accept the responsibilities of teaching their knowledge to others including peers, students and patients. B. Educational Resources

• Active faculty supervision and participation in clinical discussions, rounds, journal clubs and conferences.

• Scholastic activity by faculty including active participation in ongoing clinical investigations, professional societies and publications.

• Internal departmental and institutional funding and facility support for research and other academic activities.

• Extensive institutional medical library with interlibrary loan and electronic medical database capabilities.

• On-site departmental library with 24-hour access containing major relevant texts and journals.

• 24-hour access to department computers with intranet and internet access. • Participation in Graduate Medical Educations Committee sponsored courses on research

development, statistical methods, critical analysis of the literature, and residents as teachers.

• Opportunities to teach medical students, other health care professionals and the public.


• Opportunities to work with the departmental Clinical Research Division and affiliated basic science investigators.

C. Assessment Tools

• Faculty mentoring and review of proposals and papers. • Attendance/participation log for conferences, journal clubs, lectures, rounds. • Personal portfolio containing copies of publications, grant proposals, abstracts,

presentations summaries, lecture materials, literature review summaries, etc. D. Expectations

• To demonstrate an investigatory and analytic thinking approach to clinical situations by actively participating in all department conferences and in ongoing department clinical trials.

• All residents must present at least two Grand Rounds patients per quarter. • All residents are expected to prepare assigned conferences each year. • First year residents (PGY-2) must give a 10-minute case presentation and review of

literature. • Second year residents (PGY-3) must give a one-hour presentation on a disease process. • Third year residents (PGY-4) must give a one-hour presentation on a treatment process. • All residents are expected to write quizzes and lead the discussion on assigned textbook

reading. • All residents must prepare and submit at least one paper for peer reviewed journal

submission by the end of their third year of dermatology training (PGY-4). • All residents are expected to use information technology to manage information, access

on-line medical information, and support their own education. • All residents are expected to apply knowledge of study designs and statistical methods

for the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness.

VIII. Professionalism and Quality Assurance A. Objective Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. Additionally, they must be able to investigate, evaluate, and improve their patient care practices. Residents must also develop an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. B. Educational Resources

• Faculty supervised inpatient and outpatient care with increasing levels of resident responsibility

• Opportunities to interact with other health-care professionals for patient care • Assigned textbook reading • Clinical conferences


• Live patient presentations • Journal club meetings • Patient-directed literature review • Attendance at regional and national clinical courses

C. Assessment Tools

• Daily faculty observation of clinical care activities • Faculty observation of participation in conferences and journal club • Faculty observation of resident interaction with other health care professionals • Performance on periodic quizzes • Performance on yearly national in-service examination • Semi-annual patient satisfaction survey data • Semi-annual 360° evaluation data • Yearly global evaluation by faculty • Attendance log/handouts from meetings attended (portfolio)

D. Expectations

• To locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems.

• To analyze practice experience and perform practice-based improvement activities using a systemic methodology.

• To provide health care services aimed at preventing health problems or maintaining health.

• To work with health care professionals, including those from other disciplines, to provide patient–focused care.

• To obtain and use information about their own population of patients and the larger population from which their patients are drawn.

• To demonstrate respect, compassion, and integrity. • To show a responsiveness to the needs of patients and society that supersedes self-

interest. • To demonstrate a commitment to ethical principles pertaining to provision or withholding

of clinical care, confidentiality of patient information, informed consent, and business practices.

• To demonstrate sensitivity and responsiveness to patients’ culture, age, gender, sexual orientation, and disabilities.

• To facilitate the learning of students and other health care professionals. • To work effectively and respectfully with other health care professionals. • To understand how their patient care and other professional practices affect other health

care professionals, the health care organization, and the larger society, and how these elements of the system affect their own practice.

• To know how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources.

• To practice cost-effective health care and resource allocation that does not compromise quality of care.


• To advocate for quality patient care and assist patients in dealing with health care system complexities.

• Know how to partner with health care managers and providers to assess, coordinate, and improve health care and know how these activities can affect system performance.


UNIVERSITY OF MINNESOTA

DERMATOLOGY RESIDENCY PROGRAM

APPENDICES

for

Educational Goals and Objectives, Major Assignments and Supervisory Lines of Responsibility


APPENDIX A

ACGME CORE COMPETENCIES


CLINICAL ROTATION EXPECTATIONS AND GOALS FOR DERMATOLOGY RESIDENTS, UNIVERSITY OF MINNESOTA PGY-2 PGY-2 residents should have direct one-on-one supervision available at all times. PGY-3 and PGY-4 residents will gain increasing independence for diagnosis, management and decision-making according to their knowledge level, technical skills, and expertise in the specific area. Throughout training demonstrate a kind, caring, concerned and responsible attitude and approach to patients.

• Master basic dermatologic terminology. • Master basic techniques for examination of the skin (to include microscopic exam of

skin scrapings, stains, etc.). • Become skilled in taking pertinent history, organizing data and presenting material to

staff. • Complete appropriate physical examination (focused or general) and identify primary

and secondary lesions. • Become competent with the electronic dermatology record. • Learn differential diagnosis for common, (morphological) primary skin disease

groups: i.e., macular, papular, vesicular, pustular, papulo-squamous diseases, etc. • Learn the indications for patch testing, ultraviolet light therapy, cryosurgery,

electrosurgery and referrals for Moh’s surgery. • Learn basic clinical photography techniques. • Understand the basic pathophysiology and management of the most common skin

diseases. • Develop an understanding of basic principles of topical therapy to include a general

knowledge of costs for dermatologic medications. PGY-3 and PGY-4

• Become skillful in presenting precise word descriptions of dermatological findings to colleagues.

• Be proficient and teach basic techniques for examination of the skin to junior residents and students.

• Concise history, physical findings and management plan organized and presented to staff for both simple and complex diseases.

• Develop independence in the topical and systemic management of complex disease. • Develop a clinical – histopathologic correlation of skin diseases; such that you can

generally anticipate the findings present in the biopsy specimen. • Be familiar with the appropriate laboratory examinations for evaluating patient with

cutaneous disease and for monitoring systemic therapy. • By end of PGY-4 year, demonstrate evidence of extensive reading and knowledge of

most areas of clinical dermatology.• Acquire a basic knowledge of the business management of a dermatologic practice. • Be proficient at presentation to various lay and professional groups. • Participate in clinical research studies and present paper/poster to local and national

meetings.


Core Competencies for Residents in the University of Minnesota Residency Program in Dermatology

THE AMERICAN BOARD OF DERMATOLOGY WORKING DEFINITIONS

Patient Care: Residents are expected to provide patient care that is compassionate, appropriate and effective for the promotion of health, prevention of illness, and treatment of disease.

• Provide care that is sensitive to each patient's age, gender, cultural, economic, and social circumstances.

• Gather essential and accurate information about the patient • Synthesize clinical history, physical examination findings, laboratory results and current

scientific evidence to arrive at a correct diagnosis and treatment plan • Provide a written action plan for management of acute and chronic cutaneous problems • Provide to patients and their families information that is necessary to understand illness

and treatment • Perform routine physical examination, especially the critical visual examination of the

patient's skin; perform appropriate diagnostic and therapeutic procedures • Provide information about skin cancer and melanoma, heritable, occupational and

infectious disorders and other conditions in which prophylactic measures are appropriate· Make appropriate referrals to other medical or surgical specialists

Medical Knowledge: Residents are expected to demonstrate knowledge of established and evolving biomedical, clinical and social sciences, and the application of their knowledge to patient care and the education of others.

• Actively participate in designing and implementing basic or clinical research projects; present teaching conferences

• Know, critically evaluate and use current medical information and scientific evidence for patient care

Practice-Based Learning and Improvement: Residents are expected to be able to use scientific evidence and methods to investigate, evaluate, and improve patient care practices.

• Analyze one's practice experience to recognize strengths, deficiencies, and limits in knowledge and expertise

• Locating, appraising and assimilating evidence from scientific studies related to patient's health problems

• Critically review published medical literature related to patient problems • Use information technology to manage information, access on-line medical information

and support their own education • Actively participate in the education of patients, families, students, residents and other

health professionals


Communication and Interpersonal Skills: Residents are expected to demonstrate interpersonal and communication skills that enable them to establish and maintain professional relationships with patients, families, and other members of health care teams.

• Communicate effectively with patients and families to create and sustain an appropriate professional relationship

• Enabling patients to be comfortable asking questions about their disease or treatment

Professionalism: Residents are expected to demonstrate behaviors that reflect a commitment to continuous professional development, ethical practice, an understanding and sensitivity to diversity and a responsible attitude toward their patients, their profession, and society.

• Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and society that supersedes self-interest

• Demonstrate a commitment to ethical principles pertaining to patient privacy and autonomy, the provision or withholding of clinical care, confidentiality of patient information, informed consent, conflict of interest and business practices

• Demonstrate respect for the dignity of patients and colleagues as persons including their culture, age, gender and disabilities

Systems-Based Practice: Residents are expected to demonstrate both an understanding of the contexts and systems in which health care is provided, and the ability to apply this knowledge to improve and optimize health care.

• Work effectively in various health care delivery settings and systems • Know how types of medical practice and delivery systems differ from one another,

including methods of controlling health care costs and allocating resources • Know the relative costs of procedures and treatments; ask patients how they pay for

medications • Advocate for quality patient care and assist patients in dealing with system complexities


DERMATOLOGY RESIDENCY TRAINING SPECIALTY SPECIFIC COMPETENCIES AND EVALUATION METHODS – TOOLBOX

Competency Required Skill Example Components Potential Evaluation Methods

Patient Care Caring and respectful behavior

Provide care that is sensitive to each patient's age, gender, cultural, economic, and social circumstances

Patient satisfaction questionnaires; 360 Global rating evaluations ; Checklist evaluation of live/recorded performance

Interviewing Gather essential and accurate information about the patient

Checklist evaluation of live/recorded performance; OSCE**; 360 Global rating evaluations

Informed decision-making

Synthesize clinical history, physical examination findings, laboratory results and current scientific evidence to arrive at a correct diagnosis and treatment plan

Chart stimulated recall; Checklist evaluation of live/recorded performance; OSCE*; Oral examination

Develop and carry out patient care management plans

Provide a written action plan for management of acute and chronic cutaneous problems

Chart stimulated recall; Record review; Global rating of live/recorded performances; Simulations and models; Checklist evaluation of live/recorded performance

Counsel and educate patient and families

Provide information necessary to understand illness and treatment

Patient satisfaction questionnaires; 360 Global rating evaluation; Checklist evaluation of live/recorded performance

Perform medical procedures

Perform routine physical examination, especially the critical visual examination of the patient's skin

Perform appropriate diagnostic and therapeutic procedures

Global rating of live/recorded performances; OSCE*; Checklist evaluation of live/recorded performances

Checklist evaluation of live/recorded performance; 360 Global rating evaluation; Simulations and models; Global rating of live/recorded


performances; Procedure logs

Preventative health services

Provide information about skin cancer and melanoma, heritable, occupational and infectious disorders and other conditions in which prophylactic measures are appropriate

Record review; OSCE*; Case logs

Work within a teamMake appropriate referrals to other medical or surgical specialists

360 Global rating evaluation; Portfolios; Global rating of live/recorded performances; Checklist evaluation of live/recorded performance

* OSCE = Objective Structured Clinical Examination

Competency Required Skill Example Components Evaluation Method

Medical Knowledge

Investigatory and analytic thinking

Actively participate in designing and implementing basic or clinical research projects; present teaching conferences

Chart stimulated recall; Oral examination; Simulations and models; 360 Global rating evaluation

Knowledge and application of basic sciences

Know, critically evaluate and use current medical information and scientific evidence for patient care

Multiple-choice question examination; Oral examination; Simulations and models; Record review; 360 Global rating evaluation


Competency Required Skill Example Components Evaluation Method

Practice-based Learning and Improvement

Analyze own practice for needed improvement

Analyze one's practice experience to recognize strengths, deficiencies, and limits in knowledge and expertise

Portfolios; Record review; Chart stimulated recall

Use of evidence from scientific studies

Locating, appraising and assimilating evidence from scientific studies related to patient's health problems

Record review; Chart stimulated recall; Portfolios; Multiple-choice question examination; Oral examination; OSCE*


Application of research and statistical methods

Critically review published medical literature related to patient problems

Portfolios; Chart stimulated review; Global rating of live/recorded performances; Checklist evaluation of live/recorded performance; Multiple-choice question examination

Use of information technology

Use information technology to manage information, access on-line medical information and support their own education

Multiple-choice question examination; OSCE*; Case logs

Facilitate learning of others

Actively participate in the education of patients, families, students, residents and other health professionals

Global rating of live/recorded performances; 360 Global rating evaluation; Checklist evaluation of live/recorded performance; Portfolios


Competency Required Skill Example Components Evaluation Methods

Interpersonal & Communication Skills

Creation of an appropriate professional relationship with patients

Communicate effectively with patients and families to create and sustain an appropriate professional relationship

OSCE*; Patient satisfaction questionnaires; 360 Global rating evaluation; Checklist evaluation of live/recorded performance

Listening skills

Enabling patients to be comfortable asking questions about their disease or treatment

OSCE*; Patient satisfaction questionnaires; 360 Global rating evaluation; Checklist evaluation of live/recorded performance



Professionalism Respectful, altruistic

Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and society that

Patient satisfaction questionnaires; 360 Global rating evaluation; OSCE*; Checklist


supercede self-interest evaluation of live/recorded performance

Ethically sound practice

Demonstrate a commitment to ethical principles pertaining to patient privacy and autonomy, the provision or withholding of clinical care, confidentiality of patient information, informed consent, conflict of interest and business practices

360 Global rating evaluation; Chart stimulated recall; Simulations and models; Patient satisfaction questionnaires; Portfolios

Sensitive to cultural, age, gender and disability issues

Demonstrate respect for the dignity of patients and colleagues as persons including their culture, age, gender and disabilities

OSCE*; 360 Global rating evaluation; Patient satisfaction questionnaires; Checklist evaluation of live/recorded performance; Oral examination



Systems-based Practice

Understand interaction of their practices with the larger system

Work effectively in various health care delivery settings and systems

360 Global rating evaluation; OSCE*; Portfolios

Knowledge of practice and delivery systems

Know how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources

Multiple-choice question examination; OSCE*; Portfolios; Chart stimulated recall

Practice cost-effective care

Know the relative costs of procedures and treatments; ask patients how they pay for medications

Checklist evaluation of live/recorded performance; 360 Global rating evaluation; Oral examination; Record review

Advocate for patients within the health care system

Advocate for quality patient care and assist patients in dealing with system complexities

360 Global rating evaluation; Patient satisfaction questionnaires; OSCE*; Portfolios; Oral examination



APPENDIX B

RESIDENT DUTY HOURS POLICY


From 2005-2006 Dermatology Residency Policy and Procedure Manual, p. 19

Duty Hours / Days Off

• Duty Hours are defined as all clinical and academic activities related to the training program, i.e., patient care (both inpatient and outpatient), administrative duties related to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled academic activities such as conferences. Duty hours DO NOT include at-home call, reading and preparation time spent away from the duty site.

• Duty hours are limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities.

• Residents are provided with 1 day in 7 free from all educational and clinical responsibilities, averaged over a 4-week period, inclusive of call.

• The training program provides adequate time for rest and personal activities, which consists of a 10-hour time period provided between all daily duty periods and after in-house call.

When averaged over any 4-week rotation or assignment, residents will not spend more than 80 hours per week on inpatient care duties. Residents will not be assigned on-call in-house duty more often than every third night; call has typically been every fourth night in the G2 year. Although residents are assigned to one of four sites at a given time, the Training Program sites are fully integrated and residents may be pulled from one site to cover another when the necessity arises. To facilitate such changes, all residents must be available on pager from 8:00 am to 5:30 p.m. Monday through Friday. In the event of prolonged absences (LOA, medical leave, etc.), the Chief Resident responsible for rotation schedules and the Residency Program Director will work out a coverage schedule between hospitals. Residents taking call from home should keep track of time spent in patient related activity when at home and when called into the hospital. Time out of the hospital not engaged in patient care duties does not accumulate toward the 80-hour cap.



APPENDIX C

ACGME CORE COMPETENCY PROJECT TABLE 1: METHODS OF EVALUATION – INSTRUMENTS TABLE 2: METHODS OF EVALUATION - CONFERENCES



Table 1

ACGME Core Competency Project University of Minnesota Dermatology Residency Training Program

Methods of Evaluation -- Instruments

Competency Resident ITE

Chart Review E*Value

Surgical and Inpatient Consult

Logs

360° Assessment

Resident Portfolio

Patient Care X X X X X

Medical Knowledge X X X X X X

Practice-Based Learning and Improvement X X X

Interpersonal & Communication Skills X X X

Professionalism X X

Systems-Based Practice X X



Table 2

ACGME Core Competency Project University of Minnesota Dermatology Residency Training Program

Methods of Evaluation -- Conferences

Competency Journal

Club/Book Review

Clinical Lectures

Basic Science Lectures

Surgery Lectures

Dermato- pathology

Conference

Grand Rounds

Patient Care X X X X X

Medical Knowledge X X X X X X

Practice-Based Learning and Improvement X X X X X

Interpersonal & Communication Skills X X X X

Professionalism X X X X

Systems-Based Practice X X X


APPENDIX D

EDUCATIONAL RESOURCES: TEXTBOOKS & JOURNALS

From 2005-2006 Dermatology Residency Policy and Procedure Manual, pp 17-18


Section IV. General Policies and Procedures Graduation Requirements The Accreditation Council for Graduate Medical Education’s requirements for residency training can be found on their web site at http://www.acgme.org/acWebsite/home/home.asp (select Res. Review Committees from menu at left of homepage screen, then select Dermatology at next screen, and Program Requirements from drop-down menu). Residents must read these requirements and familiarize themselves with them. A copy of the current requirements is also attached in Appendix B. Residency Schedule / Overview of Curriculum The Dermatology Residency Program consists of both clinical and didactic components. During the three years of training, residents will rotate through the following hospitals / clinics: Fairview-University Medical Center (FUMC) Veterans Affairs Medical Center (VAMC) Hennepin County Medical Center (HCMC) Park Nicollet Medical Center (PNMC) Each site has its own core of general, surgical, and subspecialty dermatology clinics and scheduled conferences. Residents take call and provide consultations for hospitalized patients. The didactic component of the program includes several conferences, which are held at FUMC on Wednesday and Friday afternoons.

Wednesday and Friday Afternoons: Journal Club – This conference consists of a rotating schedule in which articles from the Journal of the American Academy of Dermatology, Archives of Dermatology, Dermatologic Surgery, and various ancillary journals (e.g., American Journal of Contact Dermatitis, Dermatitis, Journal of Investigative Dermatology), are reviewed. Residents should be prepared to provide a review and critique of all articles. Book Review (1 each month) – Residents read assigned chapters from a textbook and are given a self-assessment examination followed by discussion of covered topics. There are three primary textbooks for the 2005-06 residency program year: 1) Bolognia JL, Jorizzo JL, Rapini RP. Dermatology. (2 vols.) St. Louis, MO: Elsevier Science,

2003; 2) Freedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith LA, Katz SI. Fitzpatrick’s

Dermatology in General Medicine, 6th Ed. Chicago, IL: McGraw-Hill Professional, 2003; 3) Odom RB, James WD, Berger TG. Andrew’s Diseases of the Skin, 9th Ed.. Philadelphia, PA:

W.B. Saunders Co., 2000. Basic Science Lectures (one afternoon per month) – These lectures are based on the Basic Science Syllabus, guest/invited speakers, and assigned articles. Surgery Lectures (1 per month) – Appropriate readings will be assigned.

From 2005-2006 Dermatology Residency Policy and Procedure Manual, pp 17-18


Kodachrome Sessions (1-2 per month)—Senior residents and faculty will lead discussion based upon unknown kodachromes or AAD kodachrome sets. Clinical Lectures (weekly) – These will be provided by the University and adjunct faculty members. Dermatopathology Conference (weekly) – Readings will be assigned from selected textbooks (e.g., Lever's Histopathology of the Skin. Elder DE, Murphy GF, Johnson BL, Elenitsas R, eds. Philadelphia, PA: 2004) as well as unknown slide review. Grand Rounds (2 per month) – Grand Rounds are scheduled to take place during the first and third Wednesday afternoons of each month. Patients are viewed in the Dermatologic Clinic on the fifth floor of the Phillips-Wangensteen Building at FUMC. Case discussions will immediately follow in the departmental library on the fourth floor. Residents will be asked to provide a clinical description, differential diagnosis, and treatment plan for each case. All attendees are expected to sign in on an attendance sheet in the patient viewing area. Residents are expected to take an active role in referring and presenting patients; residents can schedule patients for Grand Rounds by calling Diane Berube at (612) 626-4454.

The above conferences are an integral part of residency training in dermatology and are required by the standards for resident education outlined by the American Board of Dermatology. All residents are required to attend scheduled conferences. Attendance will be taken for each lecture.


APPENDIX E

RESIDENCY SITE DIRECTORS & ADMINISTRATIVE OFFICES

From 2005-2006 Dermatology Residency Policy and Procedure Manual, p. 32 (Page Updated 8/’05)

Section VI. Administration and General Information Administrative Offices Residents /fellows may direct general questions and site-specific concerns to the administrative staff at each one of the hospital sites. Fairview-University Medical Center Dermatology Office: Maria Hordinsky, MD Professor and Chair 612-625-1493 Peter Lee, MD, PhD Residency Program Director 612-625-5199 Kim Bohjanen, MD Associate Residency Program Director 612-626-0103 Gina Stauss, JD Residency Program Coordinator 612-624-9964 Diane Maki Administrative Secretary 612-625-4605 Angie Meillier Dermatology Administrative Director 612-625-4605

Hennepin County Medical Center Dermatology Office: Bruce Bart, MD Dermatology Chief 612-873-2332 Jackie Ostroum Senior Medical Secretary 612-873-2332 Veterans Affairs Medical Center Dermatology Office: Erin Warshaw, MD Dermatology Chief 612-467-2744 Kaye Williams Secretary 612-725-2236 Park Nicollet Medical Center Dermatology Office:

H. Spencer Holmes, MD Residency Site Director 952-993-3445 Nancy Reed Clinic Manager 952-993-3376


UNIVERSITY OF MINNESOTA DERMATOLOGY RESIDENCY PROGRAM

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