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Clinical Rotation Information:
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Dermatologic
Surgery |
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Resident Clinical Rotation Information Instructor:
Daniel Berg M.D. Clinic Location: UWMC Dermatology Clinic, 4225 Roosevelt Way NE, 4th Floor. |
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Rotation Description Welcome to Dermatologic Surgery. This rotation has traditionally been well liked by UW residents. Each resident has different confidence levels and skill sets entering the rotation. Each resident also may have different goals for learning. Your feedback is encouraged throughout the rotation. You are encouraged to sit down with Dr Berg in the first week to discuss your current experience, comfort level and future goals. This will help better tailor the rotation to your individual needs. You should also have a feedback session halfway through your rotation. Please work with Dr Berg to make sure this happens. Rotation Objectives
Your training in dermatologic surgery will consist of developing both a knowledge base and a skill set. The ACGME (Accreditation Council for Graduate Medical Education), has program requirements for both. For example, knowledge of lasers but not necessarily proficiency is expected. The following list of objectives is a rough guide of what you should be trying to learn. It is not all-inclusive. Hands-on experience at UWMC and the VA as well as self-study and the didactic program will all help you develop the knowledge and skills needed: -Develop or refine a rational and evidence-based approach to the diagnosis and treatment of skin cancer. -Know the cutaneous anatomy necessary for performing safe skin surgery. -Be able to use local anesthetics safely and comfortably. -Understand the indications for and technique of Mohs Micrographic Surgery. -Discuss and apply practical wound healing principles to surgical wounds of the skin. -Understand concepts and demonstrate competence in performing basic excisional surgery:
-Discuss the surgical options for dealing with acute surgical cutaneous defects:
-Understand the role of lasers in dermatology
-Understand the techniques involved in common dermatologic surgery cosmetic procedures
Schedule The following schedule is current. Monday Derm Surgery - Dermatology
Clinic 7:50am. Dr Dan Berg Derm Surgery - Dermatology
Clinic. Dr Berg Tuesday Derm Surgery - Dermatology
Clinic 7:50am. Dr Dan Berg Derm Surgery - Dermatology
Clinic. Dr Berg Wednesday Didactic Teaching: 7am to
Noon Derm Surgery - Dermatology
Clinic Dr Berg Thursday Didactic Teaching: 7am to
Noon Surgery Clinic - Dr
Berg Friday Self
Study OR Nail Surgery with Dr Fleckman
On occasion Dr Berg will not be in clinic. During these times you are still responsible for first call for any patients returning for sutures or calling with problems. You are expected to use this time for self-study, practice with pig's feet or to aid in the preparation of a dermatologic surgery didactic presentation. This is not "bonus vacation time". Didactics During Rotation Didactic Teaching is to be formally presented at Wednesday morning conferences. The didactic schedule is available on this site. Teaching during the rotation is intended to be more of a clinically-based observational and hands-on process. Nevertheless, topics of interest can be discussed informally during the day based on either your reading or questions occurring through patient care. You will be asked almost every day if there is any thing you would like to discuss. Take advantage of that time to review anything you feel uncertain of. Hands-On Teaching You are expected to gain competence in dermatologic surgery, particularly the basic skills of excisional surgery, which can be applied to more complex dermatologic surgical techniques (such as skin grafts, flaps etc.). To this end, hands-on exposure is important. Remember - The patient's comfort and safety always comes first. If a patient seems uncomfortable with your performing surgery on them, please do not. Alert me if this is the case. The following information will help you increase your hands-on exposure in an appropriate way. The prerequisites for your performing any work on a patient are the following:
Expectations for Charting & Documentation All patients require documentation of the consultation/visit as well as a procedure note for any surgery done. This is your responsibility for any patient that you see. Patient Encounter All encounters require a note in the medical record. These should be documented in the standard UW documentation sheets and increasingly directly in ORCA. In addition, all new consultations should have a letter or note copied to the referring physician, with copy to the primary care physician (if different). Follow-up visits all need a note in the record. Dictations on returning as well as new patients are often necessary especially if information relevant to a referring and/or primary physician is generated (e.g. important procedure done, followup recommendations made). Procedure Notes In most cases (but not always, so please check), any surgery more complicated than a biopsy or LN2 will be documented by the nurses using template sheets. Documentation (often brief) of the patient's visit (E and M component) including a brief mention of what was done is still necessary for you to do (see above paragraph). Expectations for Scholarship & Teaching In the past all residents on rotation have been required to prepare one 45-50 minute presentation. to be made during Wednesday morning didactic Derm Surgery sessions. This is no longer mandatory; however it is encouraged. The target audience are your fellow residents. The presentations and handouts will be useful for board preparation and will become part of the body of dermatologic surgery resident didactics. Dr Berg and/or the dermatologic surgery fellow can help guide your presentation content and may be able to provide some relevant clinical material for your talks. Residents are strongly encouraged to help in the teaching of any medical student on elective rotation. You are required to inform them of the time and location of resident didactics (Wed and Thurs) which they will be attending. Interested residents are encouraged but not required to consider a small project or case report while on rotation. On-Call Duties You are responsible for covering calls for dermatologic surgery, Monday mornings from 8am until 5pm on Friday. Please sign out calls to the on-call dermatology resident Friday afternoon until Monday morning. You will be backed up by Dr Berg or others whom he may designate. If you are leaving town or wish to sign out your pager to a fellow resident, there is no problem, but arranging coverage is your responsibility.
Resident Vacation (in years with a fellow): While you are away, the dermsurgery fellow takes first call from 8am - 5pm Mon - Friday and the on-call dermatology resident covers 5pm to 8am. When both resident and fellow are away, the attending takes first call 8am - 5pm and the on-call dermatology resident takes first call from 5pm to 8am. Resident Vacation (in years without a fellow): While you are away, the attending takes first call 8am - 5pm and the on-call dermatology resident takes first call from 5pm to 8am. Once again it is your responsibility to make sure the covering residents/fellows are signed out to and that the switchboard and Dr Berg also knows to whom you are signed out. During the week, if signing out to another resident for more than a few hours, please let Dr Berg know. Suggested Readings
There are many other excellent online resources. A page of very useful links is available via the Dermatologic Surgery Clinical Website. Optional Activities 1. You will be invited to participate in any concurrent dermatologic teaching events occurring during your rotation. 2. You are welcome to bring in pig's feet during any of the days assigned to Dr Berg. Instruments and a Workshop Manual will be provided to allow you to practice your suture techniques. Early in the rotation for junior residents, this is encouraged so that you will have basic skills to begin to apply. Suggestions for Record Keeping You should be keeping track of dermatologic surgery procedures done during your training. These kind of numbers may be important for future credentialling. As of the incoming resident class of 2005, all residents are using the online log provided by the ACGME to document procedures. |
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Last
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Contact the instructor at: danberg@u.washington.edu
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