DERMATOLOGY RESIDENCY PROGRAM

GOAL

The five-year program training in dermatology involves the development of a thorough knowledge of the skin, its appendages and mucous membranes both in health and disease, and the acquisition of clinical and technical skills in the management of all diseases related to the skin. The training will provide expertise in diagnosis, investigation and both medical and surgical management of skin diseases, while promoting aptitudes of competence in dermatological consultation, education and learning.

GENERAL OBJECTIVES

In accordance with objectives specified by the Royal College of Physicians and Surgeons of Canada and by the Collège des médecins du Québec, at completion of training, the resident will have acquired the following competencies and will function effectively as:

Medical Expert

At completion of training, a resident must have a detailed knowledge and understanding of:

  1. Clinical skills

1.1. Sciences basic to dermatology (embryology, gross and microscopic anatomy, microbiology,

biochemistry, physiology and immunology)

1.2. Clinical skills in diagnosing cutaneous disease (skin, mucous membranes andappendages) by

the use of history, physical examination and pertinent investigative procedures.

1.3.The cutaneous manifestations of systemic diseases in patients of all ages.

1.4.Dermatological therapy: percutaneous absorption, the pharmacology and side effectsof

topical and systemic medications, and the use and complications of electrosurgery,

cryotherapy and cryosurgery, immunotherapy, ultraviolet light and ionizing radiation, laser

surgery, dermatological surgery.

1.5. Dermatopathology and immunodermatopathology.

1.6. The formulation of an appropriate differential and provisional diagnosis.

1.7. The organization of appropriate laboratory investigation.

1.8. The development of an appropriate treatment plan taking into consideration the patient’s age,

general health, risk and cost of investigative procedures, risk and cost of therapeutic

interventions and epidemiology and natural history of the disease.

1.9.The dermatological literature and an analytical and critical appraisal of it.

2.Technical skills

2.1. Perform pre-surgical assessment for the most suitable therapeutic modality.

2.2. Obtain written informed consent for dermatological procedures.

2.3. Knowledge and experience involved in the use of local anesthesia, sterilization techniques,

appropriate sterile surgical techniques and suture materials.

2.4. All technical skills required for the practice of dermatology, such as skin biopsy (punch, shave,

saucerization, excisional), curettage and electrodessication, simple excision and layered

closure, cryosurgery and nail surgery.

2.5. Provide appropriate post-operative care and aid in wound healing

2.6. Acquire other diagnostic skills required for the practice of dermatology including, potassium

hydroxide preparations, scrapings for mites, Tzanck smears, Gram stain, fungal culture,

Wood’s light examination, viral immunofluorescence, hair mount, patch and photopatch

testing, epiluminescence microscopy.

2.7. Knowledge and understanding in the indications, techniques, limitations and complications of

complex dermatological surgery including Mohs micrographic surgery, flaps and grafts,

dermabrasion, laser surgery and cosmetic dermatological procedures such as chemical peels,

soft tissue augmentation, hair replacement.

Communicator

After residency training, the graduate physician will be competent to function as a consultant in Dermatology. This requires the physician to:

  1. Communicate effectively with patients, their families in clearly understood language.
  2. Be sensitive and listen effectively to the patients’ voiced concerns to better understand the patients’ psychological, occupational and social needs, taking into account the diversities of race, culture and gender.
  3. Communicate clearly, thoroughly and as frequently as needed with medical colleagues, particularly referring physicians.
  4. Deliver in a professional manner written communication that is legible.
  5. Communicate fully with those carrying out diagnostic tests (e.g. pathologists) in order to ensure the best outcome for the patient.
  6. Communicate effectively with and show respect towards nurses, paramedical and other health care personnel.

Collaborator

As part of his/her competence as a consultant, the graduate physician should be able to:

  1. Consult effectively other physicians and health care professionals.
  2. Contribute effectively to other interdisciplinary team activities.
  3. Provide instruction to medical students, house officers, other health care personnel, patients and the public at a level appropriate to their professional competence and education.

Manager

As part of his/her training, the graduate resident should:

1.Record and maintain complete and accurate medical records for every patient seen.

2.Understand and utilize information technology to optimize patient care and for life-long learning and other activities.

3.Utilize health care resources cost-effectively to balance patient care, learning needs and outside activities.

  1. Develop effective use of time based on planning and punctuality.
  2. Develop efficiency as well as accuracy in clinical skills.
  3. Reserve time for reading and keeping current with the dermatological literature.
  4. Understand the principles of practice management.

Health Advocate

The graduate resident should:

  1. Educate and be available as a resource person to counsel patients effectively on skin disorders.
  2. Counsel patients on the importance of taking responsibilities for their own well-being and of preventive medicine, specifically on issue of photoprotection and self-examination.
  3. Understand the role of national and international bodies (e.g. Canadian Dermatology Association Safety in the Sun, Skin Cancer Foundation) in the promotion of skin health and in the prevention and treatment of skin diseases.
  4. Learn about community resources and related patient support group.

Scholar

To maintain the quality of his/her competence, the graduate resident should:

  1. Develop, implement and monitor a personal continuing education strategy for life long learning.
  2. Be able to critically appraise dermatology literature as well as non-academic or alternative sources as they are related to patient diagnosis, investigation and treatment.
  3. Be able to participate in clinical or basic science studies as a member of a research team.
  4. Be able to describe the principles of good research and to judge whether a research project is properly designed.
  5. Be able to prepare a paper for publication in a peer-reviewed journal.

Professional

As a competent consultant, the graduate resident should:

  1. Deliver highest quality care with integrity, honesty, compassion and empathy.
  2. Exhibit appropriate personal and interpersonal professional behaviours.
  3. Practice medicine ethically and with sensitivity and respect for diversity, consistent with obligations of a physician.
  4. Recognize his/her own limitations with regard to skill and knowledge and seek advice when needed by appropriately consulting other physicians and paramedical personnel when caring for the patient.
  5. Demonstrate knowledge of medico-legal and bioethical issues that pertain to the practice of dermatology.

The goal and objectives of each year will be detailed in the following sections, and only objectives particular to the rotations not mentioned in the general objectives will be listed. Other objectives related to various spheres of competence when not mentioned will be the same as in the general objectives.

POSTGRADUATE YEAR 1

GOAL

The first postgraduate year consists of rotations in general internal medicine and internal medicine sub-specialties and will provide the resident with a comprehensive training in a wide range of diseases in internal medicine, with emphasis on areas of internal medicine that have particular relevance to the practice of dermatology.

CLINICAL TEACHING UNITS: ROTATION-SPECIFIC OBJECTIVES

Rotations include: CTU and/or ICU

Medical expert

  1. Acquire a solid knowledge base of basic science and clinical information related to general internal medicine diseases.
  2. Develop proficiency in the clinical diagnosis, investigation and management of a wide variety of internal medicine disorders of a serious nature.

Communicator

  1. Develop the communication skills required for the effective and sensitive interaction with patient and their families, especially when discussing serious conditions and announcing bad news.

Collaborator

  1. Function as a member of a hospital-based health team consisting of students, residents, other physicians, nurses, special therapists and technicians.

Manager

  1. Learn to coordinate in-hospital care with ambulatory and community based resources for follow-up care.

INTERNAL MEDICINE SUB-SPECIALITIES: ROTATION-SPECIFIC OBJECTIVES

INFECTIOUS DISEASES/MICROBIOLOGY

Rotations include: Infectious Diseases, Tropical Diseases, Sexually Transmitted Diseases or Mycology.

Medical Expert

  1. Acquire a broad knowledge of the basic science and clinical principles of infectious diseases
  2. Become proficient in the methods of diagnosis, investigation and management of infectious diseases in particular those relevant to cutaneous diseases.
  3. Learn appropriate laboratory techniques for the identification of specific infectious agents.

Manager

  1. Become familiar with community and public health principles in the investigation and management of infectious diseases.

HEMATOLOGY-ONCOLOGY

Medical Expert

  1. Develop a solid knowledge base of the basic science and clinical information related to neoplastic diseases.
  2. Gain a proficiency in the clinical diagnosis and investigative procedures of neoplastic disease.
  3. Learn the appropriate application of therapeutic modalities employed in the treatment of malignancies, including surgery, radiotherapy, chemotherapy and immunotherapy, especially the indications and adverse effects of each modality.

Professional

  1. Develop skills in communicating serious conditions to patients and their family with empathy and compassion.

RHEUMATOLOGY, ALLERGY AND IMMUNOLOGY

Medical Expert

  1. Develop a strong knowledge base of the basic science and clinical information related to:
  2. rheumatologic diseases and other autoimmune disorders with a significant dermatological components,
  3. allergic and immunologic diseases, particularly those with a significant cutaneous component.
  4. Develop specific diagnostic and investigative skills appropriate to the assessment of rheumatologic diseases.
  5. Become proficient in the methods of investigation utilized to identify specific allergic conditions.
  6. Gain a comprehensive knowledge of therapeutic modalities used in rheumatologic diseases.
  7. Learn the principles and practical considerations of the management of allergic/immunologic diseases

Collaborator

  1. Develop skills in participating as a collaborative member of the health-care team taking care of patients with complex rheumatological conditions and in consulting effectively other health care personnel when needed, including physical and occupational therapists, social workers and psychologists.

Manager

  1. Learn to utilize efficiently community resources and patient support groups in the care of patients with complex rheumatological and immunologic diseases.

Health Advocate

  1. Counsel patients on the importance of taking responsibilities for their own well-being and avoiding allergens and environmental exposure that may worsen their conditions.

ENDOCRINOLOGY

Medical Expert

  1. Develop a solid knowledge base of the basic science and clinical principles of endocrinologic diseases, particularly those conditions relevant to dermatology.
  2. Develop skills in clinical diagnosis of endocrinologic disorders.
  3. Gain proficiency in the appropriate methods of investigation and management of endocrinologic diseases.

POSTGRADUATE YEAR 2

GOAL

The second postgraduate year provides reinforcement of general medical knowledge acquired during the undergraduate years. The resident should become proficient in clinical examination, diagnosis and management of a broad range of medical conditions by exposure to a variety of basic clinical disciplines including Family Medicine, Pediatrics, Emergency Medicine and Plastic Surgery.

FAMILYMEDICINE: ROTATION SPECIFIC OBJECTIVES
Rotations include: Family Medicine or CLSC.

Medical Expert

  1. Reinforcement of clinical diagnostic, investigative and therapeutic skills developed during the undergraduate training period.
  2. Ability to diagnose, investigate and treat a broad range of common medical conditions.

Communicator

  1. Ability to effectively communicate with patients and family for the purposes of information gathering, investigation and explanation of the nature of illness and therapy.

Collaborator

  1. Ability to function and communicate effectively as a member of a team of health professionals, including administrative and nursing staff, special therapists, and other physicians both hospital- based and community-based.

Manager

  1. Competence in formulating comprehensive management plans for common medical problems, while recognizing the impact of socioeconomic factors on patient care and therapy.
  2. Understanding of the ambulatory approach to investigation and therapy of medical disorders including awareness of administrative aspects with respect to patient scheduling, follow-up, investigation, and data retrieval.

ADULT EMERGENCY: ROTATION-SPECIFIC OBJECTIVES

Medical Expert

1.Reinforce diagnostic and investigative skills acquired during undergraduate training.

2.Assess a wide range of acute problems of both medical and surgical natures.

3.Develop efficiency and precision in technical skills used in the diagnosis and investigation of acute illnesses, including physical examination, laboratory and radiological investigation.

Communicator

1.Develop the ability to communicate effectively with patients and families regarding the nature and management of acute diseases.

2.Develop the ability to communicate effectively with other members of the health team including students, residents, other physicians, nurses, technicians and therapists.

PEDIATRICS: ROTATION-SPECIFIC OBJECTIVES

Rotations include: Pediatric Wards, Pediatric Emergency and/or Genetics.

Medical Expert

  1. Acquire a strong knowledge base of common pediatric diseases and an overview of various genodermatoses, particularly those with important cutaneous features.
  2. Apply appropriate techniques of diagnosis, investigation and management to the pediatric patient.

Communicator

  1. Communicate effectively with patients, parents and other caregivers with respect to all aspect of pediatric patient case-history taking, examination, investigation, management and discussion of the nature of illness.

Collaborator

  1. Learn to function as memberof a health care team in the management of complex genetic conditions.

SURGERY SUB-SPECIALITIES: ROTATION-SPECIFIC OBJECTIVES

Rotations include: Plastic Surgery, Ophthalmology, Surgery-Oncologyor ENT.

Medical Expert

  1. Develop diagnostic and investigative skills in the assessment of disorders amenable to surgical treatment.
  2. Observe and become familiar with a large variety of cutaneous surgical procedures.
  3. Acquire a solid knowledge base of the basic principles and practice of surgical procedures and techniques, including surgical anatomy, pre- and post-operative care, methods of anesthesia, sterilization techniques and instrument care.
  4. Learn the role of various surgical procedures in the management of cutaneous diseases, such as biopsies, excisional and corrective procedures.

EPIDEMIOLOGY AND BIOSTATISTICS

Medical Expert

  1. Gain a solid knowledge base of the basic principles of epidemiology and biostatistics.
  2. Understand the principles of good research, including ethical responsibilities and obligations and the limitations imposed by different study designs.

Scholar

1.Be able to use the above principles to judge whether a research project is properly designed and to

critically appraise the medical literature.

2.Be able to determine the most appropriate study designs for answering a given clinical question or

problem within a given set of resources.

Collaborator

1.Learn the principles of effective team work in the setting of clinical studies or basic research.

POSTGRADUATE YEAR 3

GOAL

The third postgraduate year, consisting primarily of rotations in Dermatology clinics, should give the resident a solid grounding in basic diagnostic, investigative and therapeutic principles and techniques pertinent to a wide range of dermatological disorders, and enabling the resident to competently recognize and treat common dermatological conditions.

CLINICAL ROTATIONS AT THE MONTREAL GENERALHOSPITAL AND THE ROYALVICTORIAHOSPITAL: ROTATION-SPECIFIC OBJECTIVES

The below objectives will also apply to Clinical rotations at the end of PGY-2.

During these rotations the resident will:

as Medical Expert

1. Develop skills in the diagnosis and management of skin disorders through the supervised

examination, investigation and management of adult dermatological patients in the clinics.

2. Become proficient in simple diagnostic procedures such as microscopic examination for fungi,

scabies and viral cytology, Wood’s light examination and epiluminescence microscopy.

3. Develop proficiency in the procurement and interpretation of appropriate laboratory

investigations.

4. Acquire competence in basic office procedures, including biopsy techniques, curettage,

electrodessication, excisional techniques, cryotherapy and nail surgery.

5. Become knowledgeable of complications of dermatological therapy including emergency

procedures pertinent to the clinic setting.

6. Become proficient in the principles and practice of ultraviolet phototherapy, including UVB,

narrow-band UVB, topical and systemic PUVA phototherapy (MGH).

7. Acquire basic knowledge of laser therapy and specific skills in the assessment and laser treatment

of patients with CO2 laser, Versapulse laser and yellow/green lasers (MGH).

8. Become familiar with the indications and role of advanced surgical techniques such as Mohs

micrographic surgery, flaps and grafts and cosmetic procedures (RVH).

9. Acquire proficiency in the diagnosis and management of patients with leg ulcers including

specific investigative and therapeutic modalities required in their management, including Doppler

assessment, compressive devices and special wound care dressings (MGH).

10. Acquire proficiency in the recognition of atypical nevi and melanoma, and in the management of

patients with these diseases in the setting of a multidisciplinary clinic (RVH).

11. Develop proficiency in the assessment, investigation and management of patients with contact

dermatitis, including the screening, administration and interpretation of patch test and photopatch

testing procedures, and the reporting of results to the referring physician (RVH).

12. Develop skills in the assessment, investigation and management of organ transplant patients

with cutaneous problems (RVH).

as Communicator

1. Communicate effectively with patients and their families regarding investigation, therapy and the

nature of their illness.

2. Begin to develop consulting skills by communicating effectively both verbally and in written

reports with family physicians, other specialists and community health care personnel for the

purpose of patient management.

3. Develop proficiency in medical record notation.

as Collaborator

1. Function as an effective member of the Dermatology clinic team by interacting with elective

students/residents, dermatology staff, nursing and secretarial staff in a cooperative manner for the

purpose of optimal patient care.

as Health Advocate

1. Develop skills in disease prevention through patient counselling, and facilitating patient access to