Credits: 4.00 CREDITS (Clinical Elective)
Sites: BIDMC, BWH, CHMC, LAH, MGH, BVHS-WR
Directors: Haynes, Harley Anderson
Prerequisites: HMS Principal Clinical Experience (Core Clinical Clerkships) or equivalent
Offered: Full time every month. Open to Int'l Dec-Apr ONLY.
Open to Exclerks: Yes (may be restricted for international students)
The course provides concentrated experience in: 1) the diagnosis and treatment of diseases that primarily affect the skin; and 2) the recognition of skin changes that reflect multisystem disease. The Department of Dermatology has ambulatory and inpatient facilities in the BIDMC, BWH, CH, MGH, and VAMC (West Roxbury), and is affiliated with the Lahey Clinic. Each student will be assigned primarily to one of these units on the first morning of the course at a meeting with the chief resident. The students will do their clinics and consultations at the assigned sites and will participate in joint teaching activities at MGH and the Longwood Area hospitals. Under the supervision of faculty members of the Department of Dermatology, students will actively participate as clinical clerks in the diagnosis and therapy of patients with dermatologic problems at one or more of the hospitals listed above; the majority of patients will be ambulatory. Competency in performing several of the diagnostic and therapeutic procedures will be attained by the students. Students will also participate in clinical-pathological conferences, consultation and departmental rounds, and weekly diagnostic conferences. Student-specific teaching activities include a weekly didactic lecture and a seminar with the chief resident for which each student presents a talk.
Achieve fluency in description of lesions and eruptions.
Generate a basic differential diagnosis in approach to dermatologic disease.
Understand pathophysiology of basic skin diseases and relate gross pathology to microscopic pathology.
Develop an approach to treatment for basic dermatologic diagnoses, relying on the underlying science.
Incorporation of Basic Science Content and Evidence-Based Medicine:
1. Evidence-based medicine sessions presented monthly as part of Journal Club.
2. Basic science article review sessions presented monthly as part of Journal Club.
3. Literature review pertaining to clinical cases seen.
1. Medical students will be evaluated on their performance as part of the inpatient consult service and in the outpatient clinic: evaluating patients independently when appropriate, writing assessment notes, presenting to the resident/attending, engaging and sharing patient-related self-directed learning, and functioning as a member of a team.
2. Medical students will prepare a 15 minute presentation for the last week of the rotation on a subject of their choice, relating to a dermatologic disease, a patient presentation, or a dermatology-related basic science investigation.
3. A final exam will be given, evaluating students on basic pathology, basic dermatologic disease findings, and related pathophysiology.
4. Participation in Wednesday resident-led didactic sessions for medical students.
Displays most or all of the following qualities:
- Observation on rotation: Consistently complete, accurate, and efficient history and physical exam, even on the most complicated patients. Consistently excellent morphologic descriptions and excellent visual diagnosis skills. Knowledge base is superior in both breadth and depth. Consistently able to apply sophisticated understanding of pathophysiology to clinical context. Consistently models highest level of skill in procedural techniques. Differential diagnosis reflects highly sophisticated reasoning process. Understands use of tests/procedures with comprehensive treatment plans. Consistently models superior communication skills, and written and verbal presentations are consistently cogent, efficient and sophisticated. Behavior models the highest standards of integrity, reliability, and collegiality.
- Exceptional end-of-rotation student presentation.
- Exceptional performance on the final exam.
Displays some or most of the following:
- Observation on rotation: Most often gathers complete and accurate history, and performs a thorough physical exam. Very good morphologic descriptions and visual diagnosis skills. Knowledge base very good. Solid understanding of pathophysiology and disease mechanisms. Shows a high level of mastery in performing procedures. Differential and treatment plan reflects solid clinical reasoning. Consistently demonstrates empathy and collegiality and communicates effectively. Often seeks out and accepts added responsibility. Often engages in independent self-improvement activities. Comfortable with generating a list of morphologic differential diagnoses or, at a minimum, able to correctly recall and associate morphologies.
- Very good end-of-rotation student presentation.
- Very good performance on the final exam.
Displays some or all of the following:
- Observation on rotation: Generally accurate and complete enough to identify key problems although may miss less critical information. Exam is generally appropriate. Generally satisfactory morphologic descriptions and visual diagnosis skills. Adequate knowledge base. Adequate knowledge of basic pathophysiology of disease. Procedural skills and differential are generally appropriate. Adequate communication and presentations; able to establish rapport and demonstrate empathy. Shows interest in improvement and takes initiative in activities that enhance knowledge and skills.
- Adequate quality end-of-rotation presentation.
- Adequate performance on final exam.
Displays some or all of the following qualities:
- Observation on rotation: Consistently misses essential findings on history and physical examination and often does not make appropriate connection between history and physical. Often inaccurate morphologic descriptions and visual diagnoses. In procedures, often uses faulty or inappropriate technique. Knowledge base is inadequate or has significant deficits. Has consistent difficulty relating basic science principles and clinical information to patients' problems. Differential is often incomplete or incorrect. Written and/or verbal presentations frequently lack clarity, organization or thoroughness. Acts in ways that raise significant concerns about ability to establish rapport, communicate effectively, and behave with integrity, reliability and responsibility, and/or ability to work with others.
- Poor quality end-of-rotation presentation.
- Poor performance on final exam.