General Derm Question

[deuce924]

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How much Pathology is involved in a general Dermatologist's Practice? I understand there are Dermatopathology Fellowships but how much Pathology would someone working in private practice be using pathology i.e microscopic evaluation and diagnosis.

The reason I ask is that I am a 2nd year medical student with many specialty interests (one being Derm) and I didn't hate Pathology but it wasn't my favorite course. Thanks for your help and Good luck with everyone in the Match.

 

[mohderm]

How much Pathology is involved in a general Dermatologist's Practice? I understand there are Dermatopathology Fellowships but how much Pathology would someone working in private practice be using pathology i.e microscopic evaluation and diagnosis.

The reason I ask is that I am a 2nd year medical student with many specialty interests (one being Derm) and I didn't hate Pathology but it wasn't my favorite course. Thanks for your help and Good luck with everyone in the Match.

While not a derm resident I have rotated several months this past year with both academic and privated dermatologists. As far as looking at the scope once you finish residency you don't really have too. It is important to use when diagnosing certain common problems such as fungal infections, scabies, etc... but this isn't like looking at path slides. Dermpath is however very important during your residency training. Most programs will either have one day per week or one-two months per year devoted to teaching you dermpath. In my mind it is an important component of learning the pathophysiology of dermatologic diseases. Also it is a large portion of the boards to you have to learn it.

Hope this helps.

 

[N-Surge]

I am still an intern. I am also freshly post-call. 😴

#1. I believe Dermatopathology helps to group as well as differentiate skin diseases in a way which facilitates learning. It provides yet another level of understanding that can only help to organize skin diseases in our minds as budding Dermatologists.

#2. On a practical note, you probably want to be able to read, and understand, pathology reports regarding your patients. If you understand the reports at the level of being able to visualize what the pathologist most likely saw then you should be better equipped to relay this complex information in a way that your patients can better understand.

#3. On an academic note, it can only serve to help us nerds better understand how biochemical pathways affect the skin at the cellular and gross levels. 🙂

In a nutshell, I'd say pathology is very important in the practice of Dermatology (point #2).

 

[spongioform]

Another general derm question:
How is residency structured and how are the hours (not including prelim year)? I know this varies but can someone give a general account. Thanks!

 

[sore eye asses]

Another general derm question:
How is residency structured and how are the hours (not including prelim year)? I know this varies but can someone give a general account. Thanks!

what i've heard, in general:

40-50 hrs/week in clinic/on consult service.
10-20 hrs/week studying preferred text(bolognia/fitz/andrews/weedon/wolverton/etc)
~5 hrs prepping presentations
anywhere from 6-12 weeks of call, becoming less each year after pgy2

could approach an 80 hr week depending on how hardcore you are with studying.

1st year is roughest (tons of info)
2nd is a bit more relaxed
3rd is tough due to imminent boards and more responsibility

 

[N-Surge]

Yeah, I'd up the reading/didactics to 30 to 40 hr/week, at least for PGY2. Perhaps this is only because I am a slow reader. 🙂

Also, some programs will have yearly mock boards for all their residents. So, the boards is pretty much an issue each year. Although yeah, the real thing will definitely be more of a mental beating. 🙂

Regarding structure, my program has the following components

1. County hospital clinics
2. VA hospital clinics
3. University hospital clinics
4. Peds clinics months
5. Surgical months
6. Hospital call months (I have actually been seeing my future mentors running around the hospitals! 🙂 )
7. Integrated Dermatopathology sessions
8. Grand Rounds (pimp the PGY2 sessions)
9. Weekly morning didactics (7AM, rough...), lead by either faculty or residents
10. Journal club, lead in part by residents presenting articles from selected journals, JAD, AoD, SID, BJD, and so on...

 

[kralwok]

just curious... how much reading do you actually do? i was at an interview recently and was told the first years read 4-5 hrs/weeknight and 8 hours/weekend day. that is 36 - 41 hrs/week. is that true??? i was thinking/hoping it would be more like 20 hrs/week. there is just no way i can read for 4-5 hrs/day during the week!!

 

[N-Surge]

just curious... how much reading do you actually do? i was at an interview recently and was told the first years read 4-5 hrs/weeknight and 8 hours/weekend day. that is 36 - 41 hrs/week. is that true??? i was thinking/hoping it would be more like 20 hrs/week. there is just no way i can read for 4-5 hrs/day during the week!!

My program does a Habif primer review over the first month, if I am not mistaken. That's a ton of Habif every night. I can see it being 4-5 hrs per night for a while at least. Perhaps it can be done in more like 2-3.

I kind of expected to be getting what would have otherwise been on call hours converted into reading hours. 🙂

 

[doctalaughs]

How much reading you do is highly dependent on the individual and the program. There are some programs that highly emphasize "teaching to the boards." Often, these are the ones that will be pushing you to read a lot and memorize so you score highly on the mock boards and they can brag.

Other programs do not emphasize boards much at all. Often (not always), these programs are the larger busier ones so you may trade off less reading for more patient hours (ie more on-call, more consults, later hours in the hospital).

All in all, probably varies between what the prior poster noted (4 hours a day is pretty maximum) to less then an hour a day. Also, as I said, highly individual.

Most derm residents will admit the boards have an extreme amount of useless trivia which do not make you a better practitioner. There is certainly more reading than other specialties given the thousands of dermatologic conditions that most physicians have never even heard of. However, I think given the type of person in dermatology, they have gone overboard with the useless details. And probably less reading + more patient contact means a better dermatologist overall (with a probably lower score on the boards!)

 

[youngin]

what i've heard, in general:

40-50 hrs/week in clinic/on consult service.
10-20 hrs/week studying preferred text(bolognia/fitz/andrews/weedon/wolverton/etc)
~5 hrs prepping presentations
anywhere from 6-12 weeks of call, becoming less each year after pgy2

could approach an 80 hr week depending on how hardcore you are with studying.

1st year is roughest (tons of info)
2nd is a bit more relaxed
3rd is tough due to imminent boards and more responsibility

Interesting, did not know that derm had that much work for residency, sounds more than my friend in IM especially if the reading time is more than 10 to 20.

 

[asmallchild]

Interesting, did not know that derm had that much work for residency, sounds more than my friend in IM especially if the reading time is more than 10 to 20.

Well it's a different kind of work. The actual in-clinic or in-hospital time (perhaps it's just at my program) is very benign: 40-50 hours.

But we are expected to maintain that enormous level of reading (and I believe this is true for more programs than just my program) throughout all 3 years of residency.

I'm sure I'll find a way to complain about it once I get there but I'd much rather be under the pressure of constantly having to read than to deal with night float, or overnight calls, or being sent up to the ICU during holiday blocks, or any of the other joys that came with internship.

 

[reno911]

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Most derm residents will admit the boards have an extreme amount of useless trivia which do not make you a better practitioner.

This is the "conventional wisdom" that really isn't true. I think I used to feel that way at one point when I was a resident. But as time as passed, I realized that, in general, people who do better on the boards are better dermatologists. It's probably not as much a cause-effect relationship as the writers of the boards would like, and maybe people who do better at the boards are just more intelligent and capable, so they will also happen to be better clinicians.

But I do think that the stuff you study for boards does help you be a better dermatologist at least to some extent. In studying for the boards you will learn a lot of minutiae, but these things do come up in daily practice now and then, and knowing them is what separates a good dermatologist from a great one.

More importantly though, the problem with this line of thinking (i.e., good at boards doesn't necessarily mean good dermatologist) though is that it suggests that there's a bunch of great dermatologists out there who just do really badly on board type of exams. These types of people are actually uncommon in my experience. I've never met someone who crushed the mock boards (the real board is pass/fail, so you don't know how well you do), who was a bad dermatologist and I've never met someone who got below the 20th percentile on the mock boards who I would describe as a very strong clinically.

Now, don't get me wrong. These people who fall in the lower percentiles are normally fine (after all they got into derm so they've got to be somewhat capable), but they are generally not as good as their peers who do better on the boards.

 

[N-Surge]

i'm sure i'll find a way to complain about it once i get there but i'd much rather be under the pressure of constantly having to read than to deal with night float, or overnight calls, or being sent up to the icu during holiday blocks, or any of the other joys that came with internship.

qft! 🙂