OHSU

Clinical Education

Clinical Education

FIRST YEAR (PGY2)

In year one, residents rotate at three-month intervals through the OHSU, VAMC, dermatologic surgery and contact dermatitis clinics. At OHSU, residents work closely with faculty members in caring for a variety of both common and uncommon dermatologic diseases. While at the VAMC, residents are exposed to a different patient population and are given more autonomy. During the dermatologic surgery rotation residents are exposed to a variety of treatment modalities such as Mohs micrographic surgery and reconstruction, liposuction and many other cosmetic procedures.

SECOND YEAR (PGY3)

In the year two, residents rotate at three-month intervals through the OHSU and VAMC clinics, pediatric dermatology, dermatopathology, and Kaiser Permanente. The Dermatopathology rotation provides an outstanding education in the histopathology of cutaneous diseases. The rotation at Kaiser exposes the resident to general dermatology in a busy "private practice" setting, in which he or she functions as the primary provider of dermatologic care.

THIRD YEAR (PGY4)

In the year three, residents rotate at three-month intervals through OHSU and VAMC clinics, hospital inpatient service, and a research block. Third-year residents build on their previous years’ experiences in clinic and patient management during the VAMC and OHSU rotations to develop accuracy and confidence in the delivery of quality skin care. The research block presents an opportunity for residents to explore their particular area of interest, which can be clinical, basic science, or epidemiological in nature. Residents can use this rotation to develop and declare a particular expertise by working with a specialist in that area. The hospital inpatient service allows the resident to act as the primary caretaker of patients with challenging dermatologic diseases. The ability to monitor these patients and their responses to treatment in this setting is invaluable. Additionally, the "hospital" resident takes inpatient consultations at both OHSU and the VAMC, while interacting closely with other hospital services.

Rotations

OHSU Medical Dermatology

The outpatient medical dermatology practice at OHSU is organized into half-day sessions (five in the morning and five in the afternoon).  As part of the OHSU resident rotation schedule, residents work eight or nine of the 10 scheduled half-day sessions with a faculty member.  Although the style of each faculty member may be different, patients are usually seen first by a resident who presents and discusses that patient with the faculty member.  A diagnosis and treatment plan are derived, and the resident actively participates in the discussion of that treatment plan and initial follow-up with the patient regarding any questions, biopsy and laboratory results, and patient care issues which arise during the clinical rotation.  On average, a resident will see 90 to 100 outpatients a week during the OHSU medical dermatology rotation.  This varies some, depending upon the stage of resident training and the attending to whom the resident is assigned.

Veterans Affairs Medical Center (VAMC)

Clinics are held four mornings per week at the VAMC, with approximately 50 patients per clinic. Patients are first evaluated by residents. The attending physician staffs all first year residents regardless of difficulty and discusses patient care with the resident. Second and third year residents may require less supervision and may simply discuss patient management or request that the attending also examine and discuss the patients. On Friday afternoon, there is a dedicated resident surgery clinic with each resident performing one or two cases, supervised by the surgical fellow. More complex surgeries are performed by senior residents.

Dermatologic Surgery

Resident education in dermatologic surgery occurs in several ways and stages during the residency.  In addition to a set of core didactic sessions that are given over a three-year period, residents rotate in the dermatologic surgery unit for a three-month block during their first year of training.  During the rotation, residents assist and/or care for greater than 95% of the surgical patients that are treated by one of the attending physicians - Dr. Swanson and Dr. Bar, or the surgical fellow.  They receive increasing levels of responsibility and independence based upon their level of training, their surgical aptitude and skill, and their desire to learn and/or perform surgery.

Residents participate in Mohs micrographic surgery and reconstruction, laser surgery, cosmetic surgery; including resurfacing by dermabrasion, laser or chemical peel, liposuction, Botox, collagen and other injectibles, tissue augmentation, sclerotherapy; the full range of cosmetic procedures.  The resident receives not only a broad experience in surgical procedures, but also an understanding of the clinical nature of cutaneous oncology, tissue movement, reconstruction, and aesthetics.

Contact Dermatitis

Each first year resident rotates for three months in the contact dermatitis clinic, run by Dr. Patricia Norris. During the rotation, residents will become familiar with contact dermatitis through direct patient care, didactic sessions, and assigned reading material. They will learn to distinguish contact dermatitis from other skin conditions, become familiar with the most common contact allergens, and be able to apply and interpret patch tests.

Dermatopathology

Dermatopathology training is an integral part of the dermatology residency at OHSU.  Each resident spends three months as a second year resident on the dermatopathology rotation.  Each afternoon the resident participates in sign-out of all dermatopathology cases from the OHSU outpatient and inpatient dermatology services, as well as cases sent in from outside physicians for consultation.  Residents examine each case and offer diagnostic possibilities.  A dermatopathology faculty member guides the resident through any necessary modification of the diagnosis and discusses any ancillary tests that may be helpful.  Each resident compiles a collection of interesting cases during the dermatopathology rotation, which is then available to all residents as a learning aid.  Residents on other clinical rotations often come to sign-out after completion of their clinical duties.  In addition, residents from the pathology department rotate on the dermatopathology service, allowing constructive interaction between dermatology and pathology residents. Dermatopathology is also integrated into the residency program through weekly histology sessions and other didactic conferences.

Pediatric Dermatology

Residents rotate through our busy pediatric dermatology service for three months during their second year in the program, which includes outpatient clinics and covering pediatric inpatient consults. OHSU is home to the only pediatric dermatologists in Portland; therefore, there is never a shortage of referrals. Upon completion of the rotation, residents will be able to define, classify and recognize the pediatric dermatoses encountered in general dermatology practice. They will understand the embryology and normal development of the skin and its appendages, and its relationship to the pathophysiology of skin diseases in newborns and children. Residents will learn to discuss the historical features; physical findings, laboratory investigations and management issues of the pediatric dermatoses encountered in general dermatology practice. Additionally, they will outline a treatment plan for each of the pediatric dermatoses encountered in general dermatology practice.

Kaiser Permanente

The Kaiser rotation exposes the resident to general dermatology in a busy private practice setting within which he or she functions as the primary provider of dermatologic care. This is a second year rotation and provides residents with the opportunity to improve their skills in all six areas of core competencies. Nine half-day dermatology clinics are scheduled for the resident in the outpatient department each week.  The resident performs a history and physical examination, and then provides a diagnosis and plan of care.  The resident acts as the primary physician, although three faculty members are available for assistance at all times.

Nail and Hair Clinics

Third year residents on the VAMC rotation spend Tuesday afternoons alternating every other week between the nail clinic at OHSU with Dr. Phoebe Rich and the private practice of Dr. Janet Roberts, who is a hair expert.  Rotations at these two clinics during a three-month block provide a valuable opportunity to diagnose and treat patients with both common and uncommon hair and nail conditions.

In the nail clinic, residents expand their knowledge of the diagnosis and treatment of nail disease. Residents take the history and perform a physical examination of patients with nail disease referred to the clinic for specialized care. Under Dr. Rich’s supervision, residents participate in diagnostic testing including nail palate removal and biopsies of nail bed and matrix. Residents appropriate surgical techniques, as well as techniques for mycological diagnosis including fungal cultures and mounts.

In the hair clinic, residents learn a systematic approach to the diagnosis and treatment of hair disease. Residents learn to take a proper history, develop a diagnosis from patients with hair loss, and learn when and how to perform a hair examination and scalp biopsy.

Community Service

All residents also have the opportunity to participate in patient care every other Thursday evening at The Wallace Medical Concern, a local free clinic that serves Portland area residents who are unable to afford traditional medical care.  Residents who volunteer at the clinic diagnose, observe, and treat patients with unusual and advanced skin problems, which they do not routinely see in their OHSU clinics.

Hospital Inpatient Service

The inpatient consult service is a three-month block in the third year of residency. The resident on this rotation sees consults at OHSU and the VAMC, and is on call for the inpatient service from 8:00 am to 5:00 pm, Monday through Friday.  The resident sees the patient on the same day the consultation is requested, performs a history and physical examination, and writes a preliminary consultation note. The attending physician will then see the patient with the resident and formulate a plan with the resident, and the resident provides follow-up recommendations. Patients with extensive psoriasis, immunobullous disease, graft versus host disease, drug reactions, and erythroderma are among more common diagnoses on the adult inpatient service.

Continuity Clinic

Each resident has one half-day clinic per month starting in their first year and continuing throughout their three years of residency. The resident acts as the provider with an attending physician present to oversee and advise, as needed. This clinic provides a unique opportunity for the resident to see continuity of skin disease over three years of residency.