DERU-4057 - Community Dermatology and Mohs Micrographic Surgery

DERU-4057 - Community Dermatology and Mohs Micrographic Surgery

Elective Title: Community Dermatology and Mohs Micrographic Surgery
Course Number: DERU-4057
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: None
Additional Requirements: N/A
Responsible Faculty Director: Paige Hoyer Williams, MD Periods Offered: 1-12 including holiday period 8 
Coordinator: Reynol Lopez Other Faculty:
Location to Report on First Day:
3703 Farm to Market Rd 2765 Suite E, El Campo, TX 77437

To attain a better understanding of rural dermatology and the benefits of serving a rural population in Texas.
Give an end of rotation presentation on a topic of the student's choice.

1. To create a differential diagnosis and treatment plan for basic dermatology conditions.
2. Learn the indications for Mohs micrographic surgery.
3. To understand the process/steps of Mohs micrographic surgery.
4. To review and learn histopathology of common dermatologic tumors treated by Mohs micrographic surgery.
5. Improve surgical skills.

Description of course activities
- Students will spend 4 days a week in clinic with me. (Monday - Mohs, Tuesday - General Dermatology, Thursday & Friday - Mohs/General Dermatologic Surgery).
- All Mohs reconstructions are performed in house. Students are exposed to a wide variety of closures, including complex flaps and grafts.
- Depending on the week, Wednesday will either be another clinic day or an academic day.
- Academic days can be utilized to prepare for the end of rotation presentation, completion of the ADD Basic Dermatology Curriculum, or research. [Specifically: compose a case report manuscript or poster to submit to a conference or journal of the student's choice (with guidance from faculty).]

Type of students who would benefit from the course
Students with an interest in: Dermatology, Plastic Surgery, ENT, Ophthalmology, Family Medicine, General Surgery

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 8AM (Follow-ups/Mohs) 5PM pending surgeries (Mohs)
Tuesday 8AM (General Dermatology) 5PM pending surgeries (General Dermatology)
Wednesday 8AM (General Dermatology/Academics); some Weds off 5PM pending surgeries (General Dermatology/Academi
Thursday 8AM (Mohs/General Dermatologic Surgery) 5PM pending surgeries (Mohs)
Friday 8AM (Mohs/General Dermatologic Surgery) 5PM pending surgeries (Mohs)
Saturday OFF OFF
Sunday OFF OFF

 Average number of patients seen per week: 50
 Call Schedule: No

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study

Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback

2.  Oral Presentation
  A. Audience - To whom does the student present?
    Faculty Director, medical staff
  B. Frequency / Duration of Presentation(s)?
    1 End of Rotation Presentation (Daily patient presentations).
  C. Format - What guidelines are set for the student's presentation?
    Will be discussed individually once the student picks a topic.
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
    Recommended 1 paper or abstract due at the end of the rotation.
  B. Format - What guidelines are set for the student's written work?
    To be discussed individually based on the type of paper/project.
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    Rotation dependent (student-selected vs faculty-guided)
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
    Oral   Written multiple choice   Written essay / short answer   OSCE

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?
    Participation in clinic, presentation at the end of the rotation, abstract/poster/paper for submission to a conference or journal.

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".

7.  Other Modes of Evaluation
  Please explain below.

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.

Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?

What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?

An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?

Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student's abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.