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General Overview

The mission of the John H. Stroger Jr. Hospital of Cook County Dermatology Residency Program is to produce excellent clinical dermatologists and leaders in the field of Dermatology. This is accomplished by providing an educational and analytical environment that encourages personal growth, teamwork, effective communication, compassion, state-of-the-art clinical care, sensitivity to the individual needs of patients, professionalism, collegiality, career-long learning, clinical curiosity, scholarship, and scientific inquiry.

Within this framework, the following specific educational objectives will be emphasized:

1. Expansion of personal fund of knowledge concerning clinical, etiological, and pathophysiological aspects of all dermatological disease as reflected by successful completion of national in-training and certifying examinations.
2. Mastery of the skills of medical decision-making and judgment relevant to the comprehensive, efficient management of complex medical and procedural dermatologic disease.
3. Mastery of the technical skills relevant to the efficient diagnosis and management of general and complex dermatologic disease to the equivalent of that of a conscientious practicing general dermatologist.
4. Acquisition of proficiency in the dermatopathological diagnosis of skin disease.
5. Acquisition of proficiency in the professional communication skills necessary for effective patient care and collegial professional interaction.
6. Gain proficiency in the use of modern educational tools for maximizing the efficiency of lifelong professional learning.
7. Develop an awareness of and sensitivity to societal health care needs related to the care of skin disease.

To accomplish these goals, a faculty dedicated to patient care, teaching, scholarship, research, and intellectual curiosity will provide the infrastructure for the resident learning experience. The resident will be expected to be self-motivated, responsive to guidance, willing to invest the time and effort necessary for self-learning, and fully dedicated to patient care and career-long education.

For the sake of this discussion, the following terms relating to the different modes of dermatological practice will be employed:

General Dermatology. A designation for common, straightforward, uncomplicated skin disorders (eg, mild teenage acne vulgaris; uncomplicated verruca vulgaris, mild contact dermatitis or atopic eczema) that are treated by topical (eg, topical [corticosteroids, topical calcineurin inhibitors] or relatively safe systemic systemic drugs [eg, oral antibiotics]) or minor procedural/surgical modalities (eg, limited cryotherapy, shave excision). A key element of "general dermatology" disorders is that they are diagnostically straightforward and therapeutically uncomplicated allowing such patients to be seen safely and effectively in a high volume practice setting.

Medical Dermatology. A term that has been proposed for referring to benign or malignant cutaneous changes that are associated with systemic disease processes and to potentially-disabling or life-threatening skin diseases that are treated primarily with systemic drug therapy. Specific diseases of interest include but are not limited to: 1) autoimmune bullous disorders (pemphigus, pemphigoid), 2) cutaneous T-cell lymphoma, 3) severe drug hypersensitivity reactions (Stevens-Johnson Syndrome, toxic erythema necrolysis, the sulfone hypersensitivity syndrome), 4) widespread psoriasis, 5) neutrophilic dermatoses (eg, pyoderma gangrenosum), 6) rheumatic skin disease (eg, lupus erythematosus, dermatomyositis, scleroderma) and 7) cutaneous vasculitis (eg, Henoch-Schonlein purpura, essential mixed cryoglobulinemia resulting from hepatitis C infection).

Pediatric Dermatology. Benign or malignant general, medical, and surgical/procedural dermatologic disease occurring in individuals 18 years of age and younger.

Procedural/Surgical Dermatology. Medically-necessary benign or malignant cutaneous disorders that are managed predominantly by procedural/surgical techniques. A major example would be cutaneous malignancies that are best managed by the MOHS surgery technique.

Elective Cosmetic/Aesthetic Dermatology. Procedures triggered solely by the desire for appearance enhancement, within the purview of dermatologic therapy (e.g. Botox injection for facial wrinkles, sclerotherapy for small ectatic veins).

GOALS BY RESIDENCY YEAR AND ROTATIONS

1. Become competent in performing a dermatologic history and physical examination through one-on-one co-management of patients with teaching faculty in a dermatology clinic setting
2. Recognize and treat general dermatologic conditions (eg, acne vulgaris, cutaneous viral infections, and psoriasis) through co-management of patients with teaching faculty in a dermatology outpatient clinic setting and via regular attendance at weekly departmental teaching conferences and grand rounds.
3. Recognize and become familiar with the principles of treating complex medical dermatological disorders (eg, pemphigus, cutaneous LE, cutaneous dermatomyositis, cutaneous T-cell lymphoma)
4. Establish proficiency in basic dermatologic procedures (including but not limited to patch testing, biopsy, cryotherapy, standard excision and electrodessication and curettage)
5. Develop proficiency in performing an outpatient dermatology consultation
6. Develop a foundation in the basic science of skin biology and disease through teaching conferences and independent study
7. Develop a foundation in dermatopathology slide review and differential diagnosis

1. Perform year 1 goals with increasing expertise and responsibility
2. Develop proficiency in performing an inpatient dermatology consultation
3. Further develop a knowledge base in dermatopathology and dermatologic surgery through specialized rotations in these areas
4. Develop presentation skills and present a paper/poster at a national meeting

1. Perform year 1 and 2 goals with increasing responsibility and independence
2. Lead consult rounds
3. Teach other residents and medical students during weekly conferences and in clinics
4. Develop administrative responsibilities as a chief resident

General and Medical Dermatology

Develop expertise in the communication skills necessary for obtaining a complete dermatologic history in individuals of various socioeconomic strata and ethnic/cultural backgrounds
2. Develop expertise in performing a complete dermatological physical examination
3. Become familiar with the principles and practice of efficiently diagnosing general and medical dermatological disorders as defined above (eg, pattern recognition, discriminate use of diagnostic procedures and laboratory tests)
4. Develop expertise in performing diagnostic procedures for general and medical dermatological disorders (eg, punch and excisional skin biopsy) and how to judiciously employ them
5. Develop expertise in the principles and practices of ordering and interpreting the results of diagnostic/prognostic laboratory tests for general and medical dermatological disorders
6. Develop expertise in the principles and practices of the treatment and overall management of general and medical dermatological disorders including an appreciation of treatment cost factors directly affecting patients within different health care systems (eg, out-of-pocket medication costs)
7. Develop a full understanding of the side effect and adverse interaction profiles of pharmacological agents used to treat medical therapy for general and medical dermatological disease
8. Develop expertise in counseling patients and family members concerning the treatment, treatment side effects, and prognosis of general and medical dermatologic disease

1. Become familiar with the principles and application of histopathologic diagnosis
2. Recognize immunofluoresence patterns and their clinical significance
3. Develop a understanding of special staining (eg, PAS, immunoperoxidase) and when to employ such stains
4. Develop an understanding of the principles of modern molecular dermatopathological diagnostic techniques

1. Learn the principles and application of the Mohs' micrographic surgery technique and perform at least one Mohs' procedure under supervision
2. Develop a familiarity with the principles of performing flaps and grafts and personally perform at least one such procedure under supervision
3. Develop a working understanding of the application of laser therapy for medically-necessary skin disorders.

1. Develop an understanding of the motivation, expectations, and special needs of individuals seeking elective management of cosmetic/aesthetic skin changes. Develop an understanding of the challenges that dermatologists and other physicians face in providing such care.
2. Develop a working understanding of the principles, risks and benefits of lasers (eg, hair removal, non-ablative laser rejuvenation) and other therapeutic modalities (eg, Botox, chemical peels, sclerotherapy, fillers) for the elective management of cosmetic/aesthetic skin changes.
3. Develop a familiarity with the principles, risks and benefits of advanced cosmetic procedures (eg, liposuction, hair transplantation).
4. Become familiar with the ethical issues relating to a cosmetic/aesthetic practice (eg, marketing/advertising).

Successful achievement of these goals and objectives by Dermatology residents will be monitored in the following ways:

• Daily one-on-one performance observation/evaluation by Dermatology faculty in the clinic, at the inpatient bedside, in the surgery center, and in various weekly teaching conferences with direct feedback being given to resident at the appropriate time and place within these settings. This evaluative process includes periodic verbal "pop quizzes" by faculty in which the resident is asked to answer questions illustrating key clinical issues that are being simultaneously addressed in an actual patient care setting.
• 360 degree global rating evaluations
• Review of procedural logs
• Percentile performance level on annual American Board of Dermatology (ABD) In-Service examination.
• Semi-annual written critique of resident performance by all faculty members followed by one-on-one meetings between each resident and the Program Director to discuss the results of this faculty evaluation process.