DERU-4016 - Dermatology Consults

DERU-4016 - Dermatology Consults

Elective Title: Dermatology Consults
Course Number: DERU-4016
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 2
Additional Requirements: N/A
Responsible Faculty Director: Anthony Linfante, MD Periods Offered: 1-13 including holiday period 8 
Coordinator: Reynol Lopez Other Faculty: Brent Kelly, MD; Bernard Gibson, MD; Brandon Goodwin, MD
Location to Report on First Day:
4.112 McCollough Building

The student will gain greater understanding of dermatologic manifestations of systemic disease and will understand the role of the consultant in care of the patient.

1. To improve diagnostic skills in evaluating cutaneous manifestations of internal disease (including autoimmune, congenital, infections, malignancy, drug side effects/reactions, etc.)
2. To develop skills as a consultant (work with a team, communicate with primary team, follow inpatients)
3. To develop technique for "bedside" tests including Tzanck smear, KOH skin exam, mineral oil prep, etc.
4. Prepare a short (10-15 minute) presentation on a student-selected topic related to cutaneous manifestations of internal diseases.

Description of course activities
1. The student will evaluate all inpatient consults with the "consult dermatology resident". In many cases, they will be able to assess the patient initially on their own. These cases are usually more complex then the typical outpatient dermatology patient and often have cutaneous manifestations of internal diseases including autoimmune processes, malignancy, reactions/side effects to medications, infections, etc.
2. The student will also follow the inpatient consults (along with the consult team). If a biopsy was performed, they will review the findings with the dermatopathologist.
3. They will also have other clinical opportunities including seeing ambulatory patients in the dermatology clinics as well as patients undergoing surgery for cutaneous malignancies. The opportunity to spend time with a dermatopathologist reviewing biopsies is also available (if desired).

Type of students who would benefit from the course
This elective would benefit a wide variety of students. The dermatology consult service sees all hospital patients including pediatric patients, OB/GYN patients, surgical patients as well as those on the medicine wards and in the ER. Any student who wishes to improve their diagnostic skills particularly for the cutaneous manifestions of internal diseases would benefit.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 9-12 1-5
Tuesday 9-12 1-5
Wednesday 9-12 1-5
Thursday 9-12 1-5
Friday 9-12 12-5

 Average number of patients seen per week: >50
 Call Schedule: N/A

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?
    1. Daily Patient Presentations to Consult resident and faculty 2. A short (10-15 minute) presentation at the end of the rotation on a topic related to cutaneous manifestations of internal disease will be given to residents and faculty at the final journal club of the rotation (Fridays)
  B. Frequency / Duration of Presentation(s)?
    1. Daily 2. Short presentation on a topic at the end of the rotation
  C. Format - What guidelines are set for the student's presentation?
    1. Standard SOAP format 2. A powerpoint presentation
  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)?
  B. Format - What guidelines are set for the student's written work?
  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.?
  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)?
    1. Lectures from faculty to students in the other clinical dermatology courses are given throughout the month (1-2 per week). The rotating student should attend these lectures as they are designed for their level of training. 2. On Friday mornings there are conferences for the department that the student should attend: A. grand rounds at 9am B. A kodachrome conference at 10am C. Journal Club at noon

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.