MSDO Program Description
Throughout their fellowship, fellows are exposed to clinical care in a variety of practice settings as noted above. Outpatient clinics and surgery compose 90% or more of fellowship time, and the clinical curriculum integrates the following ACGME competencies into the curriculum: Patient Care, Medical Knowledge, Practice-based Learning and Improvement, Interpersonal and Communication Skills, Professionalism, and a System-based Practice. Clinical training in cutaneous oncology incorporates medical, surgical, and dermatopathology knowledge of cutaneous neoplasms, and extensive instruction and practice in Mohs micrographic surgery. Cutaneous reconstructive surgery includes the repair of skin defects that result from the surgical removal of tumors or other skin disease, scar revision, and is based upon knowledge of cutaneous anatomy, wound healing, and cutaneous repair techniques. Cutaneous cosmetic surgery incorporates medical, surgical, and dermatopathology knowledge of cutaneous disorders and aging of the skin. It focuses on the study and performance of minimally invasive procedures to improve the appearance of the skin. Hair transplantation and liposuction is also part of the curriculum. In addition, specialty clinics include the High Risk Skin Cancer clinic, devoted to the investigation and care of patients at risk for skin cancer due to solid organ transplant and other iatrogenic immunosuppression, HIV infection, and genetic conditions predisposing to cutaneous malignancy. A monthly multidisciplinary tumor board is held, designed to provide comprehensive consultative care for patients with complicated, advanced, recurrent, or unusual cutaneous tumors. This monthly conference brings together experts from dermatologic surgery, dermatopathology, otolaryngology and head and neck surgical oncology, radiation oncology, medical oncology, facial plastics, plastic surgery, and oculoplastic surgery to evaluate patients and devise management recommendations. From these multidisciplinary relationships, fellows have been invited to observe reconstructive procedures with other surgical subspecialties to broaden their surgical exposure. Research experience is part of Micrographic Surgery and Dermatologic Oncology fellowship. Fellows are expected to embark on scholarly research which may include case series, retrospective case reports, review articles, and clinical or basic science research. All division faculty are responsible for oversight of this. The Arron Lab is a dedicated cutaneous oncology research lab, with focus on the genomics of squamous cell carcinoma in organ transplant recipients. The dermatologic surgery division also collaborates with additional research facilities, including the labs of Boris Bastian, Wilson Liao, Raymond Cho, and Dennis Oh. Fellows are expected to review journal articles in consultation with faculty members.
Fellows are all boarded in dermatology and as such are expected in some manner to function on the level of a first year faculty member or individual in their first year of practice in dermatology. The focus of the fellowship is to begin to give them incrementally greater skills in the specifics in procedural dermatology. They are expected to formulate differential diagnoses, plan diagnostic strategies, confirm diagnoses and offer therapeutic recommendations for patient encounters. They are given a greater degree of autonomy than residents, however always with the supervision of an attending physician for the sake of quality assurance and patient care. They are involved in bedside teaching during clinics including teaching dermatology and residents as well as medical students and serve in a capacity intermediate between resident and attending physician.
Fellows care for patients in an environment that maximizes effective communication, including the opportunity to work as a member of an inter-professional team. Fellows plan integral parts of patient referrals, diagnostic workups, treatment decisions, measurement of treatment outcomes, and communication and coordination of activities with clinic management, receptionist, nursing staff, and referring sources. All fellows are also actively involved in telephone and email inquiries from patients and other physicians.
The minimum requirements as outlined by the Accreditation Council for Graduate Medical Education are at least 1000 dermatologic surgical procedures per fellow over the duration of the fellowship, 650 of which must be Mohs micrographic surgery procedures. As demonstrated by our graduate fellows’ procedure logs, we have consistently exceeded this requirement. Over the last 5 academic years, the mean procedure number (based on surgical logs) is over 1600 procedures for each fellow. Out of that total, each fellow averages 872 Mohs surgery cases.
The didactic curriculum includes a weekly lecture series dedicated specifically to Micrographic Surgery and Dermatologic Oncology, a reading curriculum, and journal club. The didactic lecture series topics include, but are not limited to, peri-operative assessment and management, anesthesia, surgical anatomy, surgery techniques, suture materials, antibiotics, Mohs surgery, reconstructive surgery, cutaneous oncology, high risk skin cancer, laser theory and practice, nail surgery, cosmetic consultation, chemodenervation, sclerotherapy/phlebology, and chemical peels. The reading curriculum parallels the didactic lectures, and in addition covers wound healing, adjuvant treatment modalities, and laboratory techniques. Journal club, run by the fellows, augments the clinical curriculum. Fellows are also responsible for delivering a didactic lecture and Grand Rounds presentation each year.
The division of Micrographic Surgery and Dermatologic Oncology is fully staffed with appropriate administrative support. This includes the clinical–based staff (dedicated registered nurses, licensed vocational nurses, and medical assistants) and office–based staff (dedicated administrative assistant, as well as business office) to help with research applications, clinical research and other aspects of care. Digital photography is utilized within the division and an archival database is updated on a shared server and fellows have access to this for preparation of their own talks as well as for relevant patient care. This is kept in secured HIPAA compliant, password protected computers. Fellows have access to specialty specific and other appropriate reference material in print or electronic format. Electronic medical literature databases with search capabilities are available.
The fellows are formally evaluated at least twice a year by 360 degree evaluations based on multiple evaluators (faculty, peers, patients, self, and other professional staff).
The faculty make objective, documented assessments on professional competencies (patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems based practice), record keeping, and number and types of procedures accomplished. The Program Director provides a summative evaluation for each fellow upon completion of the program. The fellows also evaluate faculty performance as it relates to the educational program, including a review of the faculty’s clinical teaching abilities, commitment to the educational program, clinical knowledge, professionalism, and scholarly activities.