procedural dermatology/mohs fellowship
The primary goal of the University of Washington Procedural Dermatology fellowship is to provide comprehensive training for the fellow in the areas of cutaneous oncology, Mohs micrographic surgery, reconstructive, and cosmetic surgery.
The knowledge and skill is gained through a program of progressive and comprehensive learning designed to add to the base of knowledge and skill acquired during prerequisite dermatology residency.
General Program Goals
To provide the fellow with the practical hands-on experience in a variety of clinical settings that will enable them to deliver excellent cutaneous procedural care to patients in the areas of cutaneous oncologic surgery, cutaneous reconstructive surgery and cutaneous cosmetic surgery.
To provide an environment where faculty and all members of the medical team model care delivered in the patient’s best interest and with adherence to ethical practice at all times.
To provide an educational environment that fosters scholarly activity, namely: a) pursuit and acquisition of new knowledge, b) appreciation of the limits of present knowledge, and c) spirited discussion of controversies within the subspecialty.
To provide opportunities to increase the fellow’s skills as an educator and communicator through teaching in clinical and didactic settings.
To provide mentorship and guidance to develop the fellow’s skills to allow them to become future contributors in the field of procedural dermatology.
I. Clinical Practice Curriculum
The training program provides a hands-on learning experience for a high-level adult learner who has successfully completed an ACGME- accredited Dermatology residency program. The 12 month training is a time of surgical concentration and dedication for the trainee.
The fellow participates in supervised patient-centered learning in at least three different sites. The primary site is the University of Washington Dermatology Center, directed by Dan Berg, MD. This site provides the primary training experience in current aspects of procedural dermatology, including basic science, anatomy, anesthesia, pre- and post-operative case management, surgical technique, hair transplantation, nail surgery, laser surgery, wound healing, laboratory technique and cutaneous reconstruction of surgical defects.
The second site is the Skin Surgery Center with locations in Seattle and Bellevue. Peter Odland, MD, and Annalisa Gorman, MD are the supervising physicians for the fellow at this site. The fellow trains between three and six weeks at this site. At the Skin Surgery Center, the fellow experiences the practice of Mohs surgery in an out-patient, single provider private practice setting. This also includes learning practice management skills required for this setting such as managing patient records and personnel. A primary benefit of this site is the opportunity to train with additional experienced surgeons with his/her own unique approaches to cutaneous surgery and reconstruction.
The third site is Pacific Dermatology and Cosmetic Center, located in Seattle. Jennifer Reichel, MD, is the supervising physician at this site. The fellow trains up to ten days at this site to experience the practice of cosmetic dermatology in an out-patient, single provider private practice setting. Training at this site includes cutaneous soft tissue augmentation with injectable filler material, small-volume tumescent liposuction and fat transplantation, skin resurfacing techniques, including chemical peels, sclerotherapy and cosmetic laser procedures.
The Veteran Affairs - Puget Sound Medical Center is developing a Mohs Surgery Center and will be a training site in the future.
All fellows are supervised by the site physicians, with oversight carried out by the Fellowship Program Director.
II. Didactic Curriculum
The first didactics for the fellow are the online learning modules from teh university's Leaning Gateway system. The modules include training in Infection Control, Bloodborne Pathogens, Respiratory Protection, Patient Safety, Fatigue and Sleep Deprivation, and Teaching Skills. These modules must be completed within the first 30 days of training.
B. Basic Science
Human Biology of the Skin Course (HuBio 567 – The Skin) is a 2nd year medical student organ system course offered annually in the Spring by the Dermatology Division that introduces skin biology, skin pathophysiology, and skin cancer to its attendees. The course is required for 1st year dermatology residents, encouraged for 2nd and 3rd year residents, and select lectures can be attended by the procedural dermatology fellow to supplement gaps identified in the Individual Learning Plan. Faculty in the Procedural Dermatology Fellowship lecture on Biology of Skin Cancer. There is an opportunity for the fellow to teach medical students as a small group leader.
C. Clinical Dermatology
Dermatology Division Grand Rounds is held twice monthly throughout the year and is attended by Division faculty, staff, residents, students and invited guests. Speakers for Grand Rounds include residents, and divisional and outside of division faculty. The fellow is encouraged to attend Grand Rounds when the clinical schedule permits. Grand Rounds is offered to the Seattle dermatology community for CME credit.
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. Then an open exchange of ideas occurs for management next steps. Patients requiring input regarding procedural issues are often presented and the opinions of the derm surgery faculty and fellow are solicited. Patient Care/Morphology Conference is CME accredited.
Seattle Dermatologic Surgery Journal Club is a meeting of 4-5 dermatologic surgeons from a variety of practices,(including but not limited to faculty from the fellowship). Articles from recent Derm Surgery Journals are reviewed, including those areas of active investigation by the attendees. Meets quarterly.
Dermatopathology ClinicoPathologic Conference is a weekly conference is attended by dermatology and procedural dermatology faculty. Interesting cases from both medical and procedural dermatology are presented along with the pathology with general discussion on knowledge related to the case, diagnosis, treatment plan and practice improvement, systems and ethical issues raised by the cases.
Textbook Review is held on a regular basis with direct dialogue between Dr Berg, Dr Chang and the fellow to ensure that key topics in dermatologic surgery are covered. The fellow selects and reads specific chapters in the assigned books (Bolognia, Robinson, Alam) and discusses questions with the attending. This discussion occurs weekly. The selection of topics is based on the Individualized Learning Plan developed early in the training year.
Dermatological Surgery Didactic Lecture Series - Monthly resident session presented by Dr. Berg, Dr. Chang 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.).
Otolaryngology Conferences are weekly sessions are made available for the procedural dermatology fellow. While most sessions are not of interest, the fellow is notified of the schedule and attends the topics which are germane to procedural dermatology (e.g. anatomy).
Mohs Laboratory Training is informal one-on-one training occurs throughout the year. The fellow is expected to review the Mohs Surgery Laboratory Manual as well as the Manual of Mohs Histology provided by the American College of Mohs Surgery and housed in the laboratory.
In addition the fellow receives at least two formal ½ day training sessions with the chief Mohs histotechnologist, Norma Anderson, in which most aspects of running a Mohs laboratory and processing tissue specimens are reviewed.
D. Procedural Skills
Il Duomo Teaching Heads (High Fidelity Surgical Training Model). This realistic facial model is used early in the year to demonstrate hands on techniques and throughout the year to demonstrate reconstructive concepts (e.g. z-plasty, flaps). In addition skin replica foam pads are made available to the fellow early in the year to practice key suture techniques.
Hands On Cosmetic Training with dermatology residents four times per year at Pacific Cosmetic and Dermatology Center with an emphasis on neurotoxins, fillers, and sclerotherapy.
Annual Anatomy for Facial Plastic Surgery Course is a two-day course attended by ENT, plastic surgery and ophthalmology residents from UW and around the country features morning lectures and afternoon cadaver demonstrations and dissections. Prominent surgeons from several specialties from around the country make up the faculty. The fellow interacts directly with dermatology and surgical faculty and is able to try and demonstrate surgical technique for reconstructions. The fellow is invited to participate as both learner as well as lab teacher for the senior dermatology residents who attend.
Head Neck and Skin Lecture Series (Radiation Oncology) Annual
Every two years a series of core lectures in Radiation Oncology are presented to the radiation oncology residents. We are on the invitation list and these are attended by the Procedural Dermatology fellow.
III. Scholarly Activity
An average of a half-day per week is free from clinical responsibilities in the fellow’s schedule to pursue scholarly interests. The Program Director assists in mentoring or matching the fellow with a mentor or other resources as needed. The fellow is expected to submit a paper or make a major presentation within the training year or within a few months of completing the training year.
UW Bio-Medical Research Integrity Series A four-part lecture series and small groups covering ethics in research and human subjects available to the fellow as appropriate.
IV. Professional Development & Professionalism
Seattle Dermatological Society Monthly Meetings - Monthly seminar, meeting, and patient care conference of the Seattle Derm Society. 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. These cases include both medical and surgical issues. When available, pathology is also reviewed. The fellow can view all patients and is encouraged to participate in the discussion.
UW and Statewide Dermatology Association Meetings - Two times per year the University co-sponsors a state-wide meeting of dermatologists. Each meeting includes a patient conference, a current presentation topic by a national/regional speaker, opportunity for professional networking.
UW Dermatology Division Retreat - Once yearly retreat to discuss, educate and brainstorm issues related to the mission of the Dermatology Division. Attended by all faculty, residents, fellows and administrative staff.
Annual meeting of the American College of Mohs Surgery
Fellow is strongly encouraged to attend and their salary will be covered while away. Multiple lectures on all aspects of clinical care, laboratory skills, biology and practice management are available to the fellow.
Billing/coding & Compliance Conferences – Basic training is covered in the annual UWMC orientation provided by the GME office. In addition the administrative staff responsible for coding compliance reviews basic coding and documentation requirements. Dr. Berg regularly reviews coding and billing issues with the fellow.
Activities: Assigned rotations, Patient Care Conference, Grand Rounds, textbook chapter review, dermatopathology conference, dermatological surgery didactic series, journal club, review of unknown reconstructive cases with Dr Berg (kodachromes), hands-on cosmetic sessions with Dr Reichel.
Activities: All of the above activities under Patient Care plus HuBio 567 The Skin course, histology training.
Practice-based learning and improvement
Activities: Journal Club, textbook review, assigned rotations, Patient Care Conference, Grand Rounds
Interpersonal and Communications Skills
Activities: Assigned rotations, Patient Care Conference, Grand Rounds, image case review, pathology conferences at UWMC training site, journal club, ASDS Annual Meeting and outside of division presentations.
Activities: Assigned rotations, Patient Care Conference, image case review, journal club, Human resources sessions, M & M conference
Activities: Assigned rotations, Patient Care Conference, Billing and coding sessions, Dermatology Division retreat
(1) HuBio 567 Small groups – see above
(2) Grand Rounds presentation – see above
(3) Bedside teaching to residents: Dermatology residents rotate through procedural dermatology 2.5 days per week and the fellow interacts with them and is expected to perform bedside and blackboard teaching. Plastic surgery residents and elective residents rotate through procedural dermatology at least 6 weeks per year and also interact closely with the fellow.
(4) Surgery Didactics Series to Residents. Monthly lectures are presented to the Dermatology Residents and the Fellow covering key topics in procedural dermatology. The fellow is both an attendee and a teacher, preparing up to 1/3 of the presentations. Procedural Dermatology faculty are typically present to both assess the level of knowledge and teaching and to help in the teaching themselves.
Curriculum Activities by ACGME Core Competency