DERU-4003 - Dermatologic Surgery and Cutaneous Oncology

DERU-4003 - Dermatologic Surgery and Cutaneous Oncology

Elective Title: Dermatologic Surgery and Cutaneous Oncology
Course Number: DERU-4003
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 2
Additional Requirements: N/A
Responsible Faculty Director: Richard F. Wagner, MD Periods Offered: 1-13 including holiday period 8 
Coordinator: Reynol Lopez Other Faculty: Dr. Frank T. Winsett
Location to Report on First Day:
contact course director by email one week prior to beginning elective

An introduction to the dermatologic subspecialty of dermatologic surgery and cutaneous oncology, including Mohs micrographic surgery, is provided. The student will learn general approaches to the clinical problems encountered in cutaneous oncology.

At the completion of a four-week elective, the student should be able to understand the approach of the dermatologic surgeon and cutaneous oncologist to specific clinical situations such as the indications and techniques on Mohs micrographic surgery, cutaneous examination of skin cancer, pre-operative evaluation and postoperative management of the dermatologic surgery patient, and approaches to the management of benign and malignant skin tumors.

Description of course activities
1. The student will work closely with Dr. Wagner, the Mohs fellow and the rotating Dermatology resident during the dermatologic surgery clinics on Tuesday, Wednesday and Thursday from 9:00 am until completion. The student will function as an integral part of the dermatologic surgery team.
2. A dermatologic journal club is held every Friday, and the student will participate by presenting a pre-selected article about dermatologic surgery or dermatologic oncology to the group (medical students, dermatology residents and dermatology faculty) at each meeting.
3. There is no evening call for the rotating medical student.
4. Discussion of reading assignments will be with Dr. Wagner or the rotating dermatology resident.
5. Individual research interests or student involvement with ongoing research projects are strongly encouraged. If the formal preparation of such research for publication is desired by the student, the student may desire to take the dermatology research elective (DERU-4015) or dermatology Selective (DERU-4004) with Dr. Wagner.
6. Mondays are reading periods for the student to prepare for the journal club presentation each Friday. Students rotating on dermatologic surgery and cutaneous oncology have the option of attending all dermatology departmental conferences and clinics throughout the week.

Type of students who would benefit from the course
This course is particularly valuable for students who are interested in a career in dermatologic surgery and cutaneous oncology or a related specialty such as medical oncology, family medicine, plastic surgery, radiation therapy, otolaryngology, anatomic pathology, dermatopathology, ophthalmology, dermatology or surgical oncology.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday reading/departmental conferences/clinics reading/departmental conferences/clinics
Tuesday 9-noon 1:00-until finished
Wednesday 9-noon 1:00-until finished
Thursday 9-noon 1:00-until finished
Friday Departmental conferences Departmental conferences
Saturday none none
Sunday none none

 Average number of patients seen per week: 25
 Call Schedule: None

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time 20 hours of contact each week with Dr. Wagner
Self-Directed Study 5-16

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?
    Daily interactions with faculty and residents.
  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?
    Dermatology Journal Clubs are attended by dermatology faculty, dermatology residents and rotating medical students.
  B. Frequency / Duration of Presentation(s)?
    Presentation during each Friday journal club during the 4-week rotation.
  C. Format - What guidelines are set for the student's presentation?
    Standard dermatology journal presentation (summary/discussion for 5 minutes or less with questions from participants).
  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)?
    No written assignments required.
  B. Format - What guidelines are set for the student's written work?
    No written assignments required.
  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?
    No written assignments required.
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    No written assignments required.
  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)?
    Attendance at all clinical sessions and 4 required journal club presentations. Students completing this elective are requested to provide anonymous feedback through completion of the end of rotation course evaluation.

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.
    No additional forms of student evalulation are used in this clinical elective.

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.