Dermatology Core Competency Curriculum

Program: Internal Medicine, Sinai-Grace

Detroit Medical Center/Wayne State University

Program Director: Mohamed S. Siddique M.D.

Specialty / Course: Dermatology PGY 1, 2, & 3

Curriculum Coordinators: Geetha Krishnamoorthy, M.D.

Marc Feldman, MD, FACP

Date: February 5, 2009

Competency	Objectives Specific	Educational Experiences Knowledge/ Skills Integration/Application	Assessment Tools
Patient Care That is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health	1. To be able to identify and manage or refer appropriately, the common dermatological conditions seen in the office and inpatient setting.	Series of Dermatology lectures based on photographs of patients with dermatological conditions that include pure skin diseases as well as various Internal Medicine disorders that have skin manifestations. Morning report PERKS (Promoting Excellence in Resident’s Knowledge and Skills) – OSCE Optional dermatology rotation at the VA Hospital dermatology Clinic	Ability of residents to identify skin lesions appropriately in in-patient and out-patient settings. PERKS – Evaluated at the end of each session - OSCE 3. Dermatology picture based quiz during noon conference
Medical Knowledge About established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care	Learn patho-physiology, clinical presentation, lab & radiographic evaluation and management of important dermatological problems Commitment to continuous learning	Dermatology picture based lecture series. Board review course for PGY-II and IIIs	Monthly exam for all house staff Dermatology quiz. Monthly PERKS program - OSCE In-Training exam
Interpersonal and Communication Skills That result in effective information exchange and teaming with patients, their families, and other health professionals	Learn to identify common dermatological conditions and explain to patient about the etiology of the condition and how to manage it e.g., dry skin, pruritis, acne, drug reaction, decubitus ulcer etc.	Case discussions with attending. PERKS program - OSCE	Rounders evaluation through direct observation and feedback by patients. PERKS program – OSCE
Professionalism As manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population	Always be honest with patients e.g., skin rash due to prescribed antibiotic. Always maintain patients’ confidentiality	Dermatological problems which are seen in the general medical clinic and on inpatient medical services.	Rounders evaluation thruogh direct observation and feedback by patients.
Practice-Based Learning and Improvement That involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care	Self directed learning to keep up with new developments. Use information technology to manage information Facilitate learning of others	Taught throughout training as explained in other curricula. Learners are made aware of web based teaching sites to use for self study.	Poster/Oral presentation at scientific meetings i.e. ACP-MI Chapter, National Meetings, annual Sinai-Grace Hospital research day Quarterly evaluation with the advisor
Systems-Based Practice As manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system for health care and the ability to effectively call on system resources to provide care that is of optimal value	Practice cost-effective care Learn to minimize patient care errors Understand various types of health insurances and how it impacts patient care in both in-patient/out-patient settings i.e. LOS, UR and prescriptions Advocate for patients within the health care system	MDM course Net learning course Faculty lectures/discussions on how utilize dermatologic services for various types of insurance systems	Quarterly evaluation with the advisor

Specific educational experience expected during cardiology rotation: All Residents may not be exposed to all skills due to limited time of rotation (2 weeks)

1. Diagnostic

A. Ability to classify skin lesions by their morphology and appropriately use the following terms.

1. Macule

2. Papule

3. Ulcer

4. Crust

5. Erosions

6. Plaque

7. Vesicle

8. Bullae

9. Module

10. Atrophy

11. Petechiae

12. Purpura

13. Ecchymosis

14. Avscess

15. Sinus

16. Scale

17. Lichenifacation

18. Excoriation

2. Procedure Skills

A. Application of chemical destructive agents for skin lesions e.g.: warts and molluscum, condyloma

B. Incision, drainage, and aspiration of fluctuant lesions for diagnosis or therapy

C. Scraping of skin (for potassium hydroxide, mite examination)

D. Skin biopsy (punch)

E. Cryotherapy

3. Primary interpretation of tests

A. Microscopic examination for scabies, nits, etc.

B. Zinc smear

4. Ordering and understanding tests

A. Dark-field microscopy

B. Fungal culture

C. Skin biopsy

5. Common dermatologic conditions which the resident should understand in terms of clinical presentation, pathophysiology, differential diagnosis, evaluation and management:

A. Abscess

B. Cellulitis

C. Condyloma

D. Cyst

E. Eczematous reaction pattern

1. Acute contact dermatitis

2. Atopic dermatitis

3. Stasis dermatitis

4. Dyshidrotic eczema

5. Nummular eczema

6. Follicular disease

a. Acne

b. Rosacea

7. Malignancy and premalignancy

a. Actinic keratosis

b. Basal cell carcinoma

c. Melamona

d. Squamous cell carcinoma

8. Papulosquamous reaction pattern

a. Fungal, yeast infections

b. Seborrheic dermatitis

c. Syphilis

d. Lichen planus

e. Psoriasis

9. Paronychia, folliculitis

10. Erythema nodosum

11. Pityriasis rosea

12. Skin Ulcers

13. Skin signs of systemic disease

a. Diabetes mellitus

b. kaposi’s sarcoma

c. Liver disease

d. Lupus erythematosus

e. Sepsis

f. Thyroid disease

g. Dermatomyositis

h. Gastrointestinal polyposis

i. Inflammatory bowel disease

j. Internal malignancy

k. Rheumatoid arthritis

l. Scleroderma

m. Thrombocytopenia

14. Vascular reaction pattern

a. Drug hypersensitivity

b. Urticaria

c. Viral exanthems

d. Erythema multiforme

e. Toxic epidermal necrolysis

f. Vasculitis

15. Vesiculobullous reaction pattern

a. Herpes simplex infection

b. Herpes zoster infection

c. Variccella

d. Bullous pemphigoid

e. Pemphigus vulgaris

16. Warts

17. Molluscum contagiosum

18. Scabies

19. Develop an awareness that skin lesions may be an indication of systemic diseases. The resident should recognize the disease association of the following skin lesions:

a. Acanthosis nigricans

b. Erythema multiforme

c. Angioedema

d. Café-au-liat spots

e. Pyoderma gangrenosum

f. Raynaud’s phenomenon

g. Stomatitis

h. Telangiectasis

i. Urticaria

j. Vitiligo

k. Eruptive xathoma

l. Xanthelassma

m. tuberous xanthoma

n. Erythema nodosum

o. Digital clubbing

This list is not inclusive but merely representative of the type of knowledge to be acquired.

I. PROCEDURAL:

A. Punch biopsy

B. Excisional biopsy

C. Tzanck preparation

D. Woods lamp

E. Fungal scrapping and KOH preparation

F. Liquid nitrogen freezing for warts

G. Podophyllum topical application for genital warts

H. Use of topical and injection steroids

I. Understand the use of ultraviolet light (PUVA, UVA, UVP)

Resource Materials

Recommended Reading and review:

1. Harrison’s textbook of Internal Medicine

2. MKSAP 14

3. Color Atlas in Dermatology - Fitzpatrick