Dermatology Residency Training
The following are trained at WHASC Dermatology:
- Residency training in Dermatology in the PG-2 through PG-4 training years.
- Continuing medical education for staff dermatologists and other interested credentialed providers.
- Familiarization with Dermatology for residents from other programs. These are primarily PG-3 Internal Medicine residents but may include other disciplines (Pediatrics, Flexible Rotating Internships, Oral Surgery).
- Familiarization with Dermatology for medical students. These are primarily HPSP and USUHS 3rd and 4th year students but may include students from UTHSCSA-SA or other schools with which SAUSHEC has a memorandum of understanding.
- Enlisted technician training from Academy of Health Sciences.
Currently, all residents train together at WHASC. Staff physicians provide continuous and complete supervision. All surgical procedures are staffed on a one-on-one basis. Conferences occur on a regular published schedule Monday through Friday.
The second year and third year residents rotate at SAMMC. A two-month rotation as the resident physician on the inpatient dermatology service occurs in the third year. As the inpatient physician, the resident along with the chief resident and supervising staff physician, provides full dermatologic care. The outpatient experience continues much as it did the first year. With additional experience residents achieve greater autonomy - though always in conjunction with supervising physicians. Further, more advanced surgical skills are developed during this time.
Dermatology residents begin their training in the clinic, first by observing, and then by following their own patients under close supervision of the more senior residents and attending staff. A staff physician is present in the clinic at all times and immediately available for consultation. At all times every resident is encouraged to seek consultation and to show interesting patients to others, if only for interest or discussion. As residents assume more senior status, they acquire additional teaching obligations.
In addition, all interesting cases, including inpatients, are presented for examination and discussion during the weekly teaching conferences. Some military patients, when fully fit for duty, receive distant assignments on discharge and may thus be lost to follow-up. The vast majority of patients, however, are local active duty or retired military personnel or their dependents who are followed in the clinic. Every effort is made for each patient to be seen by the same physician on each visit. The greatest number of inpatients are seen on consultation from other services, and these, too, are followed in the clinic during hospitalization and after discharge from the hospital. Bedfast patients are, of course, visited on the wards. Bedside consultations for patients on other services are performed by a second year resident in conjunction with staff.
As part of the residency program, it is expected that every resident will complete one paper suitable for publication. At the conclusion of three years of training the resident is awarded a certificate of completion and becomes eligible to take the examination for certification by the American Board of Dermatology.
Dermatologic in-patient care is performed by a resident and attending staff. No assigned dermatology ward is utilized and beds are made available on an "as needed" basis on various wards. SAMMC provides in-patient dermatologic support to the WHASC branch of the program.
Several "off-site" locations are utilized to provide outreach dermatologic care and enhanced learning opportunities. These include but are not limited to:
- University of Texas Southwestern Medical Center, Dallas, Texas
- Christus Santa Rosa Medical Center, San Antonio, Texas
- Texas Diabetes Institute, San Antonio, Texas
- South Texas Dermatopathology Laboratory, PA , San Antonio, Texas
- Medical support on Southern Command Humanitarian Missions (Staff, 2nd year or 3rd year residents as missions become available)
- Monthly Southern Regional Medical Command assistance mission to Fort Polk, LA (Staff and Chief Resident)
Since dermatology is primarily an outpatient health care delivery system, most of the resident's clinical experience is gained in the clinic. Emphasis is placed on developing the acumen to distinguish benign cutaneous conditions from those with more serious implications, i.e., those indicative of cutaneous malignancies, and to recognize cutaneous signs of systemic disease, genetic syndromes, drug reactions, and diseases that, while not life threatening, have the potential to affect the individual's well being. It is expected that each resident will formulate appropriate differential diagnoses based on the history and physical findings by drawing on information obtained from regular conferences and from the experience of senior residents and staff. The physician is then to select and interpret - including a degree of proficiency in "reading" histopathologic specimens and lab data - and arrive at the correct diagnosis. Then, in a supervised setting, the resident is to be able to develop treatment plans which involve being able to deal with the various modalities in dermatology - topical and oral medications, surgical management, and use of radiation (ultraviolet or x-ray).
The inpatient component is relatively small and thus managed by one resident at a time in conjunction with the staff attending and chief resident. The hospitalized patients are those who are too sick to be diagnosed and cared for at home, or those whose therapy is too complicated to be effectively completed within an outpatient setting. Through daily contact with patients and personally overseeing the therapy, the resident develops greater skill in managing the more complex and serious diagnostic dilemmas and in dealing with the nuances of dermatologic therapy. The experience of the ward physician is passed to the rest of the physicians during weekly patient management conferences.