Dermatology Elective Advice

[Vikingwizardguy]

I'm currently an MS3 with a Dermatology elective coming up at my home institute, followed by away electives in the Summer/Fall. Wanted to ask what I should to do perform well and impress during the elective. In terms of knowledge, the suggestion is Lookingbill's which I've been glancing through, any other resources you would recommend?

I know many of you are further in the derm career...what do you like to see in Med students during electives? What do you definitely not want med students doing? How do you want med students to structure patient presentations?

Lastly, I'd like to do a case report, how do I broach that topic with an attending? Should I just let him or her know at the start that I'm looking to do one? Should I bring it up when there's an interesting case?

Thanks!

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[asmallchild]

I'm currently an MS3 with a Dermatology elective coming up at my home institute, followed by away electives in the Summer/Fall. Wanted to ask what I should to do perform well and impress during the elective. In terms of knowledge, the suggestion is Lookingbill's which I've been glancing through, any other resources you would recommend?

I know many of you are further in the derm career...what do you like to see in Med students during electives? What do you definitely not want med students doing? How do you want med students to structure patient presentations?

Lastly, I'd like to do a case report, how do I broach that topic with an attending? Should I just let him or her know at the start that I'm looking to do one? Should I bring it up when there's an interesting case?

Thanks!

Unfortunately derm electives are usually an exercise in shadowing. To impress people during your elective, do your best to make life easier for the residents (with their consent of course). That means assisting spreading the tissue on biopsies, blotting, applying pressure, reviewing wound care instructions with the patient, etc (again, with the resident's consent).

Reading through Lookingbill's and knowing it inside and out is helpful. If you have a resident interested in teaching, you may have a chance to show off that knowledge. If they allow students to participate in didactics, you may also have a chance to show off.

I've always enjoyed working with students who made my life easier. It doesn't seem like a lot but it tells me a lot about the student if they're able to watch me do a couple of biopsies and then think ahead and assist the next time. Questioning my diagnosis or asking why I treated a patient a certain way in front of them is a definite no no. Every resident is different but in general, they won't want you asking a ton of questions in the midst of a busy clinic. Hopefully the residents who are good teachers will take some time in between patients or at the end of the day to review cases and to see if you have any questions.

All the programs I rotated at did not allow students to present. But if you do get the chance, try to get a feel for how the residents do it and be as concise as possible.

Finally, with regards to the case report, I would bring it up when there's an interesting case.

 

[PatsyStone]

Unfortunately derm electives are usually an exercise in shadowing. To impress people during your elective, do your best to make life easier for the residents (with their consent of course). That means assisting spreading the tissue on biopsies, blotting, applying pressure, reviewing wound care instructions with the patient, etc (again, with the resident's consent).

Reading through Lookingbill's and knowing it inside and out is helpful. If you have a resident interested in teaching, you may have a chance to show off that knowledge. If they allow students to participate in didactics, you may also have a chance to show off.

I've always enjoyed working with students who made my life easier. It doesn't seem like a lot but it tells me a lot about the student if they're able to watch me do a couple of biopsies and then think ahead and assist the next time. Questioning my diagnosis or asking why I treated a patient a certain way in front of them is a definite no no. Every resident is different but in general, they won't want you asking a ton of questions in the midst of a busy clinic. Hopefully the residents who are good teachers will take some time in between patients or at the end of the day to review cases and to see if you have any questions.

All the programs I rotated at did not allow students to present. But if you do get the chance, try to get a feel for how the residents do it and be as concise as possible.

Finally, with regards to the case report, I would bring it up when there's an interesting case.

Again, I really, really hope that people will continue to fill out the derm interview GoogleDoc so that rising M4's can get a better sense of which programs allow students to see patients/do biopsies instead of shadow. Rotating at a program for a month that only lets you shadow, will not write you a LOR, and does not interview all rotators is a waste of time and money (programs don't owe applicants anything, but I think people should know what is and isn't possible before they set up an away rotation)

OP, the AAD has a series of online lectures and modules for med students, and I found them helpful because they cover the diagnosis and management of the most common derm disorders. I also really liked Dermatology Secrets Plus

 

[asmallchild]

Again, I really, really hope that people will continue to fill out the derm interview GoogleDoc so that rising M4's can get a better sense of which programs allow students to see patients/do biopsies instead of shadow. Rotating at a program for a month that only lets you shadow, will not write you a LOR, and does not interview all rotators is a waste of time and money (programs don't owe applicants anything, but I think people should know what is and isn't possible before they set up an away rotation)

OP, the AAD has a series of online lectures and modules for med students, and I found them helpful because they cover the diagnosis and management of the most common derm disorders. I also really liked Dermatology Secrets Plus

I definitely encourage people to use the Google Doc to share their experiences. I would caution people to not exclude a program simply because it doesn't allow students to present or be more hands on. Being more hands on is definitely more fun, it doesn't necessarily mean you'll get a better LOR out of it (and often times can mean a WORSE LOR if you overrate your own clinical abilities) and it doesn't necessarily mean the education is better at that program. I'm reminded of the contrast between my own program and another one in town that does allow students to present during their rotation.

In this case (not all cases), patient volume is significantly lower at the other program which is why they have the luxury of allowing students to work up a patient first. Just not possible at our program where we are seeing upwards of 40 patients/attending.

I agree programs that don't write you letters and don't extend courtesy interviews are programs that should be avoided if possible

I also agree the AAD online modules are outstanding (and we often craft our end of rotation quizzes based on those modules). I personally liked Derm Secrets better as well but it seems like Lookingbill is the preferred text of choice for most programs. I'm not sure how much it has been edited but at least for the old version I carried, it's very manageable (and probably recommended) to read both Derm Secrets as well as Lookingbill during your rotation.

 

[Vikingwizardguy]

This is some great advice, thanks for the responses!

Today was day 1 at the outside derm clinic. Good patient load, attendings were big on teaching and not on pimping. I'm about halfway through lookingbill and mark's and just read the top 100 of derm secrets. I have all the AAD lectures downloaded, just a matter of sitting down and getting through it all.

 

[Vikingwizardguy]

So after day 1, I'd like to pose this question: What's some bread and butter clinical dermatology diagnoses we should familiarize ourselves with? For example, today I saw about 10 patients with actinic keratoses (none of which had a chief complaint about the lesions), a few seborrheic keratoses (again, not the chief complaint), a few halo nevi on a teenager (not her chief complaint), and a wide wide array of acne (majority of the patients, ranged from mild/moderate comedones to cystic and inflammatory acne). We did end our day with a very interesting post-Humira psoriasis case. I guess along with these diagnoses, what're the sort of mainline treatments we should know about?

How about bread and butter techniques? I observed several shave biopsies and 2 bunch biopsies. No Mohs today but obviously that's coming. Assuming same goes for phototherapy. Anything outside of those? What're some of the key details within those techniques a newbie should know?

I know this is a loaded post but any help would be awesome. Thanks in advance.

 

[PatsyStone]

So after day 1, I'd like to pose this question: What's some bread and butter clinical dermatology diagnoses we should familiarize ourselves with? For example, today I saw about 10 patients with actinic keratoses (none of which had a chief complaint about the lesions), a few seborrheic keratoses (again, not the chief complaint), a few halo nevi on a teenager (not her chief complaint), and a wide wide array of acne (majority of the patients, ranged from mild/moderate comedones to cystic and inflammatory acne). We did end our day with a very interesting post-Humira psoriasis case. I guess along with these diagnoses, what're the sort of mainline treatments we should know about?

How about bread and butter techniques? I observed several shave biopsies and 2 bunch biopsies. No Mohs today but obviously that's coming. Assuming same goes for phototherapy. Anything outside of those? What're some of the key details within those techniques a newbie should know?

I know this is a loaded post but any help would be awesome. Thanks in advance.

The AAD lectures will go through the diagnosis and treatment of the bread and butter diseases. The AAD also has a module that explains the most common derm procedures

 

[asmallchild]

So after day 1, I'd like to pose this question: What's some bread and butter clinical dermatology diagnoses we should familiarize ourselves with? For example, today I saw about 10 patients with actinic keratoses (none of which had a chief complaint about the lesions), a few seborrheic keratoses (again, not the chief complaint), a few halo nevi on a teenager (not her chief complaint), and a wide wide array of acne (majority of the patients, ranged from mild/moderate comedones to cystic and inflammatory acne). We did end our day with a very interesting post-Humira psoriasis case. I guess along with these diagnoses, what're the sort of mainline treatments we should know about?

How about bread and butter techniques? I observed several shave biopsies and 2 bunch biopsies. No Mohs today but obviously that's coming. Assuming same goes for phototherapy. Anything outside of those? What're some of the key details within those techniques a newbie should know?

I know this is a loaded post but any help would be awesome. Thanks in advance.

Are you allowed to see patients on your own and present?

Either way, the answer is all the above. You'll want to know everything in Lookingbill, everything in Derm Secrets, everything in the AAD lectures and be ready to answer if asked. It does not look good to attempt to one-up the residents with a diagnosis or a treatment plan unless you are specifically asked. Certainly if you are on a rotation where you can see patients on your own and present, you'll want to make sure you are very well prepared. For students, the most impressive thing you can do is to accurately and succinctly describe the lesion or rash. If you can come up with a reasonable and broad differential, all the better. If you can narrow it down to the correct diagnosis and 1st line treatment, that is perfect. No one expects a medical student to know everything (obviously, that's what residency and beyond is for) so I would focus first on being able to describe and provide a differential. The rest will come as you continue to read, reinforce, and rotate.

Procedures are tricky. As a resident, I usually let students help with certain procedures if they've proven to me that they know the steps inside and out. Watch a couple and see where you can help without being intrusive (and if your resident allows you to assist: marking the site, labeling the site, cleaning the site, photographing the site, numbing the site, watching how the biopsy is done, providing countertraction while the biopsy is being done, assisting with hemostasis, cutting suture if necessary, assisting with bandaging, assisting with wound care instructions, etc. The more you can help with some of the ancillary stuff, the more I used to be convinced you knew the procedure inside and out and more likely I would allow you to do one while I observed. At most rotations, I would suspect a shave is as far as you'll get. But be ready to help with a punch if asked. I don't think any rotation will be allowing students to take the Mohs layers or do the closures.

 

[dermieeast]

Are you allowed to see patients on your own and present?

Either way, the answer is all the above. You'll want to know everything in Lookingbill, everything in Derm Secrets, everything in the AAD lectures and be ready to answer if asked. It does not look good to attempt to one-up the residents with a diagnosis or a treatment plan unless you are specifically asked. Certainly if you are on a rotation where you can see patients on your own and present, you'll want to make sure you are very well prepared. For students, the most impressive thing you can do is to accurately and succinctly describe the lesion or rash. If you can come up with a reasonable and broad differential, all the better. If you can narrow it down to the correct diagnosis and 1st line treatment, that is perfect. No one expects a medical student to know everything (obviously, that's what residency and beyond is for) so I would focus first on being able to describe and provide a differential. The rest will come as you continue to read, reinforce, and rotate.

Procedures are tricky. As a resident, I usually let students help with certain procedures if they've proven to me that they know the steps inside and out. Watch a couple and see where you can help without being intrusive (and if your resident allows you to assist: marking the site, labeling the site, cleaning the site, photographing the site, numbing the site, watching how the biopsy is done, providing countertraction while the biopsy is being done, assisting with hemostasis, cutting suture if necessary, assisting with bandaging, assisting with wound care instructions, etc. The more you can help with some of the ancillary stuff, the more I used to be convinced you knew the procedure inside and out and more likely I would allow you to do one while I observed. At most rotations, I would suspect a shave is as far as you'll get. But be ready to help with a punch if asked. I don't think any rotation will be allowing students to take the Mohs layers or do the closures.

I've definitely closed on excisions. Heck, by the end of my derm rotation as a med student... I did all my own biopsies (punch, shave, even diagnostic shave biopsies on the face) by myself without an attending in the room (just an MA or nurse)......This is why all programs need a VA or public hospital

 

[asmallchild]

I've definitely closed on excisions. Heck, by the end of my derm rotation as a med student... I did all my own biopsies (punch, shave, even diagnostic shave biopsies on the face) by myself without an attending in the room (just an MA or nurse)......This is why all programs need a VA or public hospital

Agreed, programs with a VA or public hospital are great for student rotators and often times, for residents as well. (Surgical volume and exposure is often significantly enhanced in programs with a VA rotation)

Closing on excisions is pretty rare. I've let students do this before but 1) I have to trust the student 2) we need to have the time available. Nonetheless, it's a good idea to brush up on those simple skills before a rotation in case you are allowed to assist with closure.

Doing biopsies unsupervised is pretty rare as well. Looks like you found a great rotation where you could really get your hands wet

 

[doctor85]

I agree that derm rotations can be very heavy on the shadowing. How you interact with the residents, faculty and staff may be the most important task you have. Play well with others. Don't be a show-off. Don't toss other rotators under the bus to get extra face time or look cool.

I think the books and resources mentioned above are enough. I found that they didn't expect me to know a whole lot. Basic derm stuff can be repetitious, so make sure you are getting the basic stuff down solid. Make sure you can describe rashes and lesions using derm terms. BE CONCISE. Derm clinics move quickly. Be ready to give a reasonable differential of 2-4 diagnoses per patient and try not to get in the way. Derm rotations are pretty painless.

 

[Vikingwizardguy]

This is some fantastic advice, thanks everyone!

For those seasoned in the field this is going to sound obvious, but one extremely helpful website is http://www.visualdx.com/ . VisualDX has an app as well which is also very handy.