Download DUBAI RESIDENCY TRAINING PROGRAMME Continuing Education Department

DUBAI RESIDENCY TRAINING PROGRAMME
SPECIALIST TRAINING PROGRAMME IN
DERMATOLOGY
Four Year Residency Training Program
Continuing Education Department
Dubai Department of Health and Medical Services
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Programme Administrators
Dr Humaid Ghanim
Dr Alia Al Mualla
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TABLE OF CONTENTS
Page
Contents
1. Mission
2. Goals and Objectives
3. Educational Objectives
4. Administrative Structure
5. Programme Director
6. Programme Site Co-Director
7. Residency Programme Committee
8. Entry Requirements
9. Number of Posts
10. Duration of Training
11. Accreditation
12. Certification
13. Programme Structure and Rotations
14. Evaluation of Residents Performance
15. Evaluation of Programme
16. The Certificate
17. References
18. Syllabus
19. Arab Board LogBook
20. TextBooks
21. Policy on Supervision
22. LogBooks
23. Evaluation of Rotation Form
24. Evaluation of Teaching Faculty Form
25. Evaluation of Residents Form
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I.
Mission Statement
The mission of the programme is to train specialists in Dermatology who are capable of
independent practice. An dermatologist is a specialist trained in the diagnosis and treatment
of a broad range of diseases involving the skin and its derivatives and is especially skilled in
the management of patients who have genitourinary disease processes. A dermatologist cares
for hospitalised and ambulatory patients and may play a major role in teaching or research.
The residency programme in Dermatology at DOHMS is designed in accordance with the
requirements of the Arab Boards of Dermatology. The residency programme has been
created by the Dermatology Department with close collaboration with the Department of
Continuing Medical Education. Its curriculum provides a rigorous training in the basic
sciences and a large emphasis on the understanding of pathology and pathophysiology of
diseases.
II.
Goals and Objectives
Upon completion of training, a resident in Dermatology is expected to be a competent
specialist in Dermatology, capable of independent practice in the specialty.
The goals and objectives may be summarized as follows. The resident must:
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III.
acquire a working knowledge of the theoretical basis of the specialty, including its
foundations in the basic medical sciences and research.
acquire the knowledge, attitudes, and skills common to dermatology practice.
demonstrate knowledge of the pathophysiology, presentation of historical and clinical
features, and appropriate investigation and medical management of acute and chronic
dermatological conditions.
demonstrate the knowledge, skills and attitudes relating to gender, culture and ethnicity
pertinent to Dermatology.
demonstrate an ability to incorporate gender, cultural and ethnic perspectives in research
methodology, data presentation and analysis.
contribute to research
have self-evaluation and learning skills in the areas of problem-solving, evidence based
medicine, and critical appraisal at a level to ensure that they remain effective clinicians,
teachers and investigators throughout their careers
Educational Objectives:
At the completion of training, the resident will have acquired the following competencies and
will function effectively as a:
1. Medical Expert/Clinical Decision-Maker
Specialists possess a defined body of knowledge and procedural skills, which are used to
collect and interpret data, make appropriate clinical decisions, and carry out diagnostic and
therapeutic procedures within the boundaries of their discipline and expertise. Their care is
characterized by up-to-date, ethical, and cost-effective clinical practice and effective
communication in partnership with patients, other health care providers, and the community.
The role of medical expert/clinical decision-maker is central to the function of specialist
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physicians, and draws on the competencies included in the roles of scholar, communicator,
health advocate, manager, collaborator, and professional.
General Requirements
• Demonstrate diagnostic and therapeutic skills for ethical and effective patient care using
the best available medical practices.
• Access and apply relevant information to clinical practice.
• Demonstrate effective consultation services with respect to patient care and education.
• Demonstrate an understanding of medico-legal issues as they apply to Dermatology.
Specific Requirements
• Elicit, present, and document a history that is relevant, concise, accurate and appropriate
to the patient's problem(s).
• Perform, interpret the findings of, present and document a physical examination that is
relevant and appropriate.
• Select medically appropriate investigative tools, interpret the results of common
diagnostic tests and demonstrate an understanding of their cost effectiveness, limitations
and complications.
• Formulate a comprehensive patient problem list, synthesize an effective diagnostic and
therapeutic plan and establish appropriate follow up.
• Demonstrate effective consultation skills in presenting well-documented assessments and
recommendations in written and/or verbal form.
• Be able to assess, diagnose, and manage patients with common and uncommon diseases
in the appropriate setting (emergency, in-patient and ambulatory). Also, to demonstrate an
understanding of the epidemiology of such conditions.
• Retrieve, critically appraise and apply relevant information to clinical practice.
• Demonstrate an understanding of basic pharmacology and its application to clinical
practice.
2. Communicator
To provide humane, high-quality care, specialists establish effective relationships with
patients, other physicians, and other health professionals. Communication skills are essential
for the functioning of a specialist, and are necessary for obtaining information from, and
conveying information to patients and their families. Furthermore, these abilities are critical
in eliciting patients' beliefs, concerns, and expectations about their illnesses, and for assessing
key factors impacting on patients' health.
General Requirements
• Establish therapeutic relationships with patients/families.
• Obtain and synthesize relevant history from patients/families/communities.
• Listen effectively.
• Discuss appropriate information with patients/families and the health care team.
Specific Requirements
• Recognize that being a good communicator is an essential function of a physician, and
understand that effective patient-physician communication can foster patient satisfaction
and compliance as well as influence the manifestations and outcome of a patient's illness.
• Establish relationships with the patient characterized by understanding, trust, respect,
empathy and confidentiality.
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Demonstrate the ability to communicate professionally and compassionately, while
considering the influence of factors such as the patient's age, gender, sexuality, and ethnic
cultural and socio-economic background.
Demonstrate skills in:
o providing clear, concise and timely verbal and written communication as applied
to consultation notes, sign over of patient care and discharge planning;
o communication with patients and families regarding informed consent, the
medical condition, plan of treatment, prognosis, primary and secondary
prevention, adverse events, medical uncertainty, medical errors, end of life
wishes, autopsy and organ donation; and
o communication with other health care professionals regarding all aspects of
patient care.
3. Collaborator
Specialists work in partnership with others who are appropriately involved in the care of
individuals or specific groups of patients. It is therefore essential for specialists to be able to
collaborate effectively with patients and a multidisciplinary team of expert health
professionals for provision of optimal patient care, education, and research.
General Requirements
• Consult effectively with other physicians and health care professionals.
• Contribute effectively to other interdisciplinary team activities.
Specific Requirements
• Identify and describe the role, expertise and limitations of all members of an
interdisciplinary team required to optimally achieve a goal related to patient care, a
research problem, an educational task, or an administrative responsibility.
• Develop a care plan for a patient they have assessed, including investigation, treatment
and continuity of care, in collaboration with members of the interdisciplinary team, the
patient and the family.
• Participate in an inter-physician or an interdisciplinary team meeting, demonstrating the
ability to accept, consider and respect the opinions of other team members, while
contributing specialty-specific expertise.
4. Manager
Specialists function as managers when they make everyday practice decisions involving
resources, co-workers, tasks, policies, and their personal lives. They do this in the settings of
individual patient care, practice organizations, and in the broader context of the health care
system. Thus, specialists require the abilities to prioritize and effectively execute tasks
through teamwork with colleagues, and make systematic decisions when allocating finite
health care resources. As managers, specialists take on positions of leadership within the
context of professional organizations and the Dubai health care system.
General Requirements
• Utilise resources effectively to balance patient care, learning needs, and outside activities.
• Allocate finite health care resources wisely.
• Work effectively and efficiently in a health care organization.
• Utilise information technology to optimize patient care, life-long learning and other
activities.
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Specific Requirements
• Utilise appropriate time management for effective patient care, administrative duties and
scholarly activities.
• Recognise the business and financial skills needed for a successful medical practice
and/or academic career.
• Implement patient care practices considering available health care resources.
• Have an understanding of population-based approaches to health care services and
recognise their implication for medical practice.
• Demonstrate conflict resolution skills.
5. Health Advocate
Specialists recognize the importance of advocacy activities in responding to the challenges
represented by those social, environmental, and biological factors that determine the health of
patients and society. They recognize advocacy as an essential and fundamental component of
health promotion that occurs at the level of the individual patient, the practice population, and
the broader community. Health advocacy is appropriately expressed both by the individual
and collective responses of specialist physicians in influencing public health and policy.
General Requirements
• Identify the important determinants of health affecting patients.
• Contribute effectively to improved health of patients and communities.
• Recognize and respond to those issues where advocacy is appropriate.
Specific Requirements
• Educate patients and families about and promote the importance of long-term healthy
behaviours and preventive health care (e.g. avoiding prolonged exposure to direct
sunlight, using medically unproven creams).
• Respect and empower patient autonomy.
• Promote equitable health care.
• Apply the principles of quality improvement and quality assurance.
• Appreciate the existence of global health advocacy and initiatives for elimination of
poverty and disease, (e.g. tuberculosis, malaria, Obesity, Acquired Immune Deficiency
Syndrome).
6. Scholar
Specialists engage in a lifelong pursuit of mastery of their domain of professional expertise.
They recognize the need to be continually learning and model this for others. Through their
scholarly activities, they contribute to the appraisal, collection, and understanding of health
care knowledge, and facilitate the education of their students, patients, and others.
General Requirements
• Develop, implement and monitor a personal continuing education strategy.
• Critically appraise sources of medical information.
• Facilitate learning of patients, house staff/students and other health professionals.
• Contribute to development of new knowledge.
Specific Requirements
• Understand the principles of scientific research and how these principles apply to the
development and implementation of a research proposal.
• Understand how to search and critically appraise the medical literature.
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Demonstrate the ability to teach medical students, residents, patients, colleagues and other
health care professionals.
Develop lifelong learning skills.
7. Professional
Specialists, as professionals, have a unique societal role with a distinct body of knowledge,
skills, and attitudes dedicated to improving the health and well being of others. Specialists are
committed to the highest standards of excellence in clinical care and ethical conduct, and to
continually perfecting mastery of their discipline.
General Requirements
• Deliver highest quality care with integrity, honesty and compassion.
• Exhibit appropriate personal and interpersonal professional behaviours.
• Practise medicine ethically consistent with obligations of a physician.
Specific Requirements
• Discipline-based objectives:
o Display attitudes commonly accepted as essential to professionalism.
o Evaluate one's abilities, knowledge and skills, recognize one's limitations and use
appropriate strategies to maintain and advance professional competence.
• Personal/Professional Boundary Objectives:
o Strive to heighten personal and professional awareness and explore and resolve
interpersonal difficulties in professional relationships.
o Strive to balance personal and professional roles and responsibilities.
o Demonstrate ways of attempting to resolve conflict and role strain.
• Objectives related to Ethics and Professional Bodies:
o Know and understand the professional, legal and ethical codes to which
physicians are bound.
o Recognize, analyze and attempt to resolve in clinical practice ethical issues such
as truth telling, consent, advanced directives, confidentiality, end-of-life care,
conflict of interest, resource allocation, research ethics, interactions with the
pharmaceutical industry.
o Understand and apply relevant legislation that relates to the health care system in
order to guide one's clinical practice.
o Recognize and know how to deal with unprofessional behaviours in clinical
practice, taking into account local and provincial regulations.
IV.
Administrative Structure
1.
Programme Director
The program director is senior physician for the overall conduct of the Residency
Program. The Residency Program Director is responsible to the Chair of the Department
of Dermatology and to the Postgraduate Dean and is a member of the Postgraduate
Education Committee.
2.
Programme Site Co-Director
The Program Site Co-directors are responsible for the day-to-day functioning of the
Residency Program at each institution participating in the Program. The Program Site Codirectors are responsible to the Program Director. There must be active liaison between
the Program Director and the Program Co-Directors.
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3.
Residency Programme Committee
The Residency Program Committee assists the Program Director in the planning,
organization, and supervision of the Program. The Residency Program Committee
must meet regularly, at least quarterly, and keep minutes. The Programme Director
who is its executive officer chairs it.
This committee includes
• A representative from each participating institution,
• the Program Site Co-Directors
• A representative of each major component of the program: Internal Medicine,
Paediatrics, Plastic surgery, Histopathology, Rheumatology, Haematology,
Gastroenterology, Emergency Medicine, and Infectious Disease, PHC
• Representatives of Residents in the Program nominated and elected by their
peers in the program. Where numbers permit this representation should consist
of at least one each from Dubai Hospital and Rashid Hospital.
4.
Responsibilities of the Programme Director
The responsibilities of the Program Director, assisted by the Residency Program
Committee include:
• Development and operation of the Programme such that it meets the standards of
accreditation for a specialty program in Dermatology.
• Selection of candidates for admission to the program
• Evaluation and promotion of residents in the program in accordance with policies
approved by the Postgraduate Medical Education Committee.
• Maintenance of an appeal mechanism. (see Residents Rules and Regulations)
• Establishment of mechanisms to provide career planning and counseling for
residents and to deal with problems such as those related to stress in collaboration
with the Residents Affairs
• An ongoing review of the Programme to assess the quality of the educational
experience and to review the resources available in order to ensure that maximal
benefit is being derived from the integration of the components of the program.
This review must include:
o An assessment of each component of the Programme to ensure that the
educational objectives are being met
o An assessment of resource allocation to ensure that resources and facilities are
being utilized with optimal effectiveness
o An assessment of the teachers in the Programme
Further to those responsibilities listed above, the Programme Director must function as a
resident advocate and aid in the organization of other educational opportunities. The
Programme Director is responsible for assigning residents their rotation and service
schedules. The Programme Director is responsible to the residents to train them well in a
humane atmosphere.
The Programme Director reports to the Postgraduate Dean.
5.
Programme Sites
The Residency Program in Dermatology will utilize the following sites:
• Rashid Hospital, Dubai Hospital
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• Other hospitals or institutions recognized for training by the Accreditation Committee of
the Postgraduate Medical Education Committee
6.
Entry Requirements
Prospective candidates:
• Should have successfully completed basic medical training leading to MBBS, MD, or MB
Ch from a recognized institution.
• Must have completed a one year internship programme that included at least three months
of Internal Medicine.
• Must be fully registered by the competent Authority, to practice Medicine in the United
Arab Emirates.
• Must be successful at an Evaluation Examination which may include an oral and/or
written examination and oral interview. The Office of Postgraduate Education in
collaboration with the Admission Committee will supervise the Evaluation. Applications
will be submitted on line in response to advertisement.
7.
Number of Posts and Duration of Programme
The number of posts in the Internal Medicine Residency Programme is 4. This number
reflects the available resources at the programme sites and the need within the community.
The duration of the Programme is four years of formal supervised training. The resident
would have successfully challenged the Arab Board and the British membership
examinations by the end of the fourth year. Residents may start applying for overseas
fellowship at this time.
8.
Accreditation
The training program fulfills the requirements for training as stated by the Arab Board of
Dermatology. The Dermatology training program is a waiting for accreditation from the
residency review committee (DOHMS) and The Arab Board of Medical Specializations.
V. Program Structure
Residents will enter the program having received a broad foundation in several aspects of
general medicine and surgery during their internship year.
1. Core Rotations:
The program consists of four-year training period
First Year Residency:
Dermatology Department
3 months
General Medicine
6 months
Gastroenterology – 1 month
Endocrinology
- 1 month
Haematology
- 1 month
Infectious diseases – 45 days
Rheumatology
- 45 days
Pathology Department
2 month
Annual leave
1 month
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Second Year Residency:
Psychiatry
Plastic Surgery
Paediatric Methods in Research (PHC)
Dermatology Department
Annual leave
7.3
1 month
3 month
3 months
1 month
3 months
1 month
Third and fourth Year Residency:
Dermatology Department
1 month/year
Annual leave
Dermatology Residency program
Rotation-Outline
Sep
1st year
Nov
Dec
Dermatology
Sep
2nd
year
Oct
Psych
Jan
Feb
March
April
General Medicine
Oct
Nov
Paediatrics
Dec
Jan
Feb
May
June
July
Plastic Surgery
March
Primary Health Care
April
Patho
May
June
Leave
July
Dermatology
Part I Exam
3rd year
Dermatology Department
4th year
Dermatology Department
Part II Exam
2. Elective:
The resident will be given the opportunity for additional experience in an area of interest that
may be outside of the prescribed selective experiences. This 8 week elective period will be in
an area to be chosen by the resident in consultation with the Program Director.
3. Academic Half Day:
One half-day per week will be designated as protected academic time. This period will be
utilized to bring all residents in the program together in order to undertake lectures,
workshops and other learning experiences that are best delivered in this format. These
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Aug
Aug
Leave
sessions are meant to compliment and augment learning that is taking place in the clinical
setting.
4. Research Blocks:
A block of 4 weeks that is left unscheduled for clinical training in each of the years 2-4 is for
resident research into a chosen topic. The Programme Director will identify the Research
supervisor at the beginning of the residency.
5. Vacation and Conference Leave:
Each year will include four weeks of vacation and one week of conference leave that may be
taken at any time in the program with the approval of the Programme Director and the
supervisor of the affected rotation. An effort will be made to avoid significantly impacting
the educational experience on any single rotation that might occur should a prolonged leave
take place within a single rotation.
7. Absences from training
Residents are statutorily entitled to short breaks as per contract and the Resident Rules and
Regulations
VI.
Evaluation of Resident Performance
1. Format
The ultimate responsibility for compiling the Final In-Training Evaluation of the resident lies
with the Programme Director. During each rotation of the program the resident will be
supervised and evaluated by the rotation supervisor directly or by the members of the
rotations teaching faculty as co-coordinated by the rotation supervisor. Evaluations will
reflect the goals and objectives for the rotation as set out in this document. At the beginning
of each rotation the goals and objectives for the rotation will be reviewed by the rotation
supervisor with the resident and these will be reviewed periodically during the rotation to
ensure that progress is being made towards their attainment.
Evaluation will be ongoing throughout the rotation and be composed of several components
and will include a formal written exam, oral exam as well as by direct observation of resident
performance in clinical situations. This evaluation will be at the end of each rotation.
Clinical and operative skills will be assessed by direct observation by the rotation's teaching
staff. Communication skills will be assessed by direct observation of resident interaction with
patients and families as well as by examining written communications to patients and
colleagues. Resident's interpersonal skills will be assessed by observing collaborations with
all members of the patient care team and their wise use of consultations with other specialties,
subspecialties and non-medical disciplines. Teaching skills will be assessed by written
student evaluation and by direct observation of the resident in seminars, lectures and case
presentations. Attitudes will be assessed by observation and by using feedback from peers,
supervisors, allied health personnel, and patients and their families.
Periodic in-training evaluation of trainees should be carried out to insure that the trainee is
making satisfactory progress. The rotator will be evaluated based on their performance in
clinic, interaction with patients and staff, their oral presentation and examination scores. Both
formal examinations and performance ratings by the faculty can be utilized and the trainee
should be personally appraised of his or her strengths and weaknesses at appropriate
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intervals. Completion by the program director of resident yearly report forms, such as those
requested by the Arab Board of Dermatology, is an important part of this evaluation process.
2. Feedback:
Honest and constructive feedback will be provided to the resident in a timely fashion. Formal
feedback sessions will take place at the midpoint of each rotation and at the end of the
rotation following the evaluation process. There should also be regular feedback to residents
on an informal basis. As well, a case log will be maintained by the resident and signed by the
senior clinician involved with the particular case. The Programme Director will inspect this
periodically by the rotation supervisor and discussion around the cases will occur to ensure
progress in the area of patient management. Examples of a case log page may be found in the
appendix.
3. Standards
The residents and the Programme Director are ultimately responsible for the candidates’
successful progress through and completion of the Programme. The Programme Director will
review each rotation evaluation and any concerns will be reviewed with the resident. As well,
rotation supervisors and site co-coordinators will be encouraged to make any concerns about
the resident known at the earliest opportunity in order that any deficiencies may be addressed
in a timely and effective manner. A clear plan for addressing any deficiencies will be
developed by the involved parties.
If two consecutive evaluation reports are either "Borderline" or "Poor", or the resident is
absent from the Program for two months in any one year, the resident will be invited for
counseling by the Programme Director and the resident's progress reviewed. Such a resident
is allowed to continue with the Programme at the discretion of the Postgraduate Dean and
based on the recommendation of the Programme Director and the Residency Programme
Committee. It is expected that inputs from the tutors and the involved rotation and
supervisors will weigh heavily in these considerations.
Any period of absence in excess of two months will result in the addition of a make-up
period. The duration, timing and composition of this period will be at the discretion of
Programme Director after consultation with the Residency Program Committee and the
involved resident.
The resident must pass the Part 1 and 2 examinations of either the Arab Board for
Specialization at stages indicated on the schedule.
At the end of year 4 the residents will be assigned by an examination with the following
components; a comprehensive written examination, a clinical examination and OSCE. This is
a requirement for completion of the program.
If a resident fails to successfully complete the Final Examination, a re-sit examination will be
arranged within one month of the first attempt. If the resident fails to pass the re-sit
examination, a review with the Programme Director will be undertaken. The resident will be
required to complete another year in the Programme prior to attempting the examination
again. Only one additional year may be spent in the Program and a resident cannot be
certified as having successfully completed the program if they do not pass the Final
Examination even if they pass the Part 2 of either the Arab Board for Specialization
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Should a resident be dissatisfied with their assessment at any point in the program they are
encouraged to review the issues with the involved rotation supervisor or the Programme
Director. If satisfactory resolution cannot be obtained the resident has the right to lodge a
formal complaint with the Programme Director, the Residency Program Committee or the
Postgraduate Dean. The complaint will then undergo the process as outlined in the guidelines
for appeal.
VII.
Evaluation of the Programme
1. Residency Programme Committee
The Residency Programme Committee under the leadership of the Programme Director will
be responsible for the ongoing evaluation of the programme. This will include an assessment
of the strengths and weaknesses of the programme and recommendation of improvements. As
well, all residency training sites, including elective experiences will be assessed and
evaluated. Formal evaluation of all of the teaching staff affiliated with the program.
Discussion regarding the program will occur at all residency program committee meetings
and a formal evaluation of the program accompanied by a report should occur on a yearly
basis.
2. Internal Review
The internal review is intended as a mechanism to assist the sponsor in maintaining the
quality of Residency Programme and providing the Programme Administrators with
information about the strengths and weaknesses of the Programme, so that necessary
corrective measures may be taken.
The Postgraduate Dean should initiate the internal review and the team should include: a
Programme Director from another Programme, a staff member from another discipline who is
experienced in postgraduate medical education, and a resident from another discipline. The
review team should have available all documentation regarding the Programme. A series of
interviews should take place with the Programme Director, teaching staff, members of the
resident group, and with the Residency Programme Committee.
Visits to individual sites should occur when indicated. The internal review team should
review all residency education sites and elective experiences. There should be a careful
assessment of the quality of the program and the degree to which it fulfills its Goals and
Objectives.
The written report of the internal review should include the strengths and weaknesses of the
Programme and specific recommendations for continued development and improvements.
This report should be submitted to the Postgraduate Dean, and made available to the Chair of
the department, the Programme Director, and members of the Residency Programme
Committee.
Internal Review should take place every two years
3. External Review
The Programme should undergo an external review every 5 to 6 years. The process of the
external review is similar to that of the internal review with the exception of the make up of
the review committee. The external review is initiated by the Postgraduate Dean and the team
should include: a representative of an accrediting body in Dermatology, a Programme
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Director from another Dermatology Programme accredited by the aforementioned body, a
faculty member from another discipline who is experienced in postgraduate medical
education, and a resident from an accredited external program.
The external review committee would generate a report that should include the strengths and
weaknesses of the program and specific recommendations for continued development and
improvements. This report should be submitted to the Postgraduate Dean and made available
to the Chair of the Department, the Programme Director, and members of the Residency
Programme Committee.
VIII. THE CERTIFICATE:
Certification
Upon completion of the residency, the trainee will be eligible to take the Arab Board of
Dermatology examination.
On satisfactory completion of the entire program of specialist training, the Programme
Director will notify the Postgraduate Dean and a certificate of completion of training will be
issued. The authorized signatories on the certificate will be the Programme Director, Director
General/Assistant Director General (MA) and Postgraduate Dean
IX.
References
•
The "Rookie Book" - A Guide for New Program Directors, S.L. Moffatt,
Royal College of Physicians and Surgeons of Canada, June 2001
General Information Concerning Accreditation of Residency Programs, Royal
College of Physicians and Surgeons of Canada, September 2006
Frank JR. The CanMEDS 2005 Physician Competency Framework, 2005
•
•
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APPENDIX 1
Syllabus
1.1.
GENERAL MEDICINE:
Dermatology residency training program will start with six month rotation in the Internal
Medicine department at Rashid and Dubai hospitals. A rotation in the medical units exposes
residents to the dermatologic manifestations that can be associated with a wide range of
internal disorders.
1.1.1
Endocrine and Metabolic Diseases:
Hypothalamus and pituitary gland:
• Anatomy and physiology
• Diagnosis and Disordered pituitary function
• Tumors of pituitary gland
• Syndromes due to anterior pituitary hypersection
• Syndromes due to anterior pituitary hyposecretion
• Diabetes Insipidus
Thyroid gland:
Anatomy and physiology
Hyperthyroidism
Hypothyroidism
Goiter
Parathyroid gland
Anatomy and physiology
Hyperparathyroidism
Hypothyroidism
Tetany
Adrenal glands:
Anatomy and physiology
Hyperfunction of the Adrenal gland
Insufficiency of the adrenal cortex
Corticosteroids And ACTH in the treatment of the disease
The danger of the corticosteroid therapy
Phaeochromocytoma
Gonads
Anatomy and physiology of the reproductive systems
Nutritional factors in disease
Diabetes Mellitus, Hypoglycemia
Lipid disorders
Obesity
Metabolic bone disease: Rickets, Osteomalacia and Osteoporosis
1.1.2 Haematology:
Disorders of the red blood cells
Disorders of white blood cells and the reticulo-endothelial system
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Haemorrhagic disorders
1.1.3. Rheumatology:
Arthritis
Autoimmune connective tissue diseases, aetiology and pathophysiology
1.1.4. Gastroenterolog:
Liver cirrhosis
Jaundice
Hepatomegally
Liver failure
Hepatitis
Liver functions tests
Haemochromatosis and Wilson's disease
Inflammatory bowel disease
Malabsorption
Intestinal tumours: Carcinoid tumours and intestinal Polyps
Glucagonoma
Acute and Chronic pancreatitis
Peptic ulcers
1.1.5. Infectious Diseases:
Source and spread of infections
Defaces of the Human Host
The prevention of infections
Diagnostic features of exanthems (such as Measles, German Measles, Chiken pox, Small pox,
Scarlet fever, Exanthem subitum, Erythema infectious mononucleosis, Enterovirus infection,
Kawasaki's disease)
Syphilis
Malaria
Tuberculosis
Intestinal infestations
Infections in the immunodeficient patients
Fever of undetermined origin
Bacteraemia, septicemia and septic shock
Chemotherapy of infection
1.1.6. Medical Emergencies and Abnormalities in fluid and electrolyte balance
Serial lectures of the above subjects will be delivered to the resident during their attachment
to the dermatology department in their second year of residency.
1.2.
PEDIATRIC DERMATOLOGY
The residents will spend a three months devoted to pediatric department. The residents rotate
through an active pediatric department clinic at Al-Wasal and Dubai Hospitals. Hospitalized
infants and children are seen in consultation with the pediatric inpatient service. Teaching
sessions are held within the framework of the CME schedule to familiarize trainees with the
full spectrum of the developing area of pediatric dermatology.
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During the course of their training residents develop expertise in the diagnosis and
management of common and unusual skin diseases of infants, children and adolescents that
should includes the following topics:
1.
2.
3.
4.
5.
1.3.
Prenatal Diagnosis
Care of the normal new born
Growth & Development
Child abuse and neglect
Bronchial asthma
PRIMARY HEALTH MEDICINE
During three months residency rotation in the primary health care the residence will gain the
knowledge of the following Subjects:
Epidemiology
Biostatistics
Principles of Health Policy and Management
Environmental and Occupational Health
Evidence based medicine
Research training
1.4.
DERMATOLOGIC SURGERY
A broad education in dermatologic surgery focuses on proper biopsy technique, surgical
excision, wound repair with linear closure, flap repair, and graft repair. Dedicated three
months of plastic surgery rotation at the plastic surgery department should be completed in
the first year of residency. The resident also receives instruction and hands on experience in
the performance of vascular lesion laser, pigmented lesion laser, and hair removal laser.
Residents learn to inject Collagen and BOTOX and to perform basic sclerotherapy.
A. Surgical Anatomy of the skin and male and female genetalia
B. Basic Surgical Principles:
− Identifying and sterilization of instruments related to skin surgery
− Surgical preparation
− Anesthesia
− Patient evaluation for dermatologic survey
− Preoperative psychological evaluation
− Emergencies in skin surgery
− Suture materials
− Wound healing and wound dressing
C.
18
Standard Dermatologic Surgical Procedures:
− Skin biopsy
− Excision
− Scissor Surgery
− Sutures and Suturing Techniques
− Electrocautery
− Cryo Surgery
D.
Advanced Dermatologic Surgical Procedures:
− Flaps
− Skin Grafts
− Tissue Expansion
E.
Regional Dermatologic Surgery
− The ear
− The hand
− The nose
− The lips and oral cavity
− The eyelids
− The nails
− The male and female genitalia
5.5.
HISTOPATHOLOGY
1. Introduction
• Technique for Biopsy
a. Histopathology specimens
b. Biopsy techniques and indications
c. Specimen preparation
• Limitations of Histologic Diagnosis
2. Embryology of the skin
• The Epidermis
• The Epidermal Appendages
• The Dermis
3. Histology of the skin
• Keratinocytes of the Epidermis
• Dendritic cells of the Epidermis
• Nerves of the Epidermis
• Eccrine Glands
• Apocrine Glands
• Sebaceous Glands
• Hair
• Nail
• Connective Tissue of the Dermis
• Blood Vessels and Lymph Vessels
4. Laboratory Methods
• Fixation, Processing and Dermis
• Histochemical Staining
• Polariscopic Examination
5. Morphology of the Cells in the Dermal Infiltrate
• Granulocytic Group
• Lymphocytic Group
19
• Plasma Cell
• Monocytic or Macrophagic Group
• Mast Cell
6. General Pathology
7. Inflammation
8. Terms in Dermatopathology (Grossary in Histopathology)
1.6.
DERMATOLOGY DEPARTMENT
Dermatology department is committed to providing excellent patient care while educating
resident physicians in the clinical and basic science aspects of dermatology. The educational
focus is to train physicians to be experts in the diagnosis and treatment of diseases of the skin,
hair, nails and mucous membranes, the program emphasizes mastering core competencies in
patient care, medical knowledge, practice-based learning and improvement, interpersonal and
communication skills, professionalism
The knowledge acquired through clinical practice is augmented through the didactic portion
of the residents’ learning experience. The didactic experience includes several regularly
scheduled lectures and conferences. As one part of this didactic experience, the program has
designated every Monday morning as protected academic time. Residents are free from all
clinical and administrative duties during this 4 to 5 hour session. The didactic lecture series
integrates clinical dermatology, basic science, pharmacology and therapeutics, surgery and
dermatopathology. Both faculty and residents participate in the development and teaching of
didactic sessions.
Basic Science:
Embryology, Histology, Biochemistry, Physiology and Anatomy of the skin and
mucous membranes.
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.
o.
p.
Structure and development of skin and skin appendage
Control of skin development; cell and tissue interactions
Epidermal cell kinetics
Biosynthesis and structure of epidermal hair root and nail proteins
Eccrine sweat glands
Appocrine sweat glands
Lipids of the skin
Hair follicles
Biology of the melanin pigmentary system
Biology of the dermis: Basement membranes, mucopolysaccharide of ground
substance, collagen and elastic fibres.
Immunogenetics
The effector systems of inflammation
Non immunologic effector systems: Postaflandins and the Hageman factor –
dependent pathways of plasma
Mechanism of temperature regulation in the skin
Neurophysiologic reactions of the skin: Pathophysiology or pruritis.
Percutaneous absorption.
Basic Genetics
20
2.
3.
4.
5.
6.
7.
8.
9.
Normal cell division
The human chromosomes
The transfer of genetic information
Modes of inheritances
a. Autosomal
b. Sex linked
c. Varations in expression of expression of genes
d. Multifactorial inheritance
Chromosomal abnormalities
Autosomal aberrations
The sex chromosomes and sex abnormalities
The sex chromatin
Basic Immunology
1. Introduction to immunology
2. Immunogenicity antigen specificity and humoral immunity
3. Cell mediated immunity
4. The role of phagocytic cells – neutrophils and macrophage line
5. Complement system abnormalities and immundeficiencies
6. Human histocompatibility HLA system
7. Mediators of inflammation
8. Immune reactions
9. Laboratory evaluation of immune function
Dermatopathology
Dermatopathology plays an intricate role in the overall practice of dermatology. The
dermatopathology weekly sessions offers a strong foundation in histology and clinical
correlation, and allows residents to gain experience in interpreting cutaneous biopsies. This
experience enhances the resident’s ability to generate comprehensive differential diagnoses
based on histological features.
21
•
•
•
•
•
•
•
Normal Histology
Morphology of individual inflammatory cells
Histological definitions
Artefacts etc associated with tissue processing
Congenital and inherited diseases
Bullous Diseases
Inflammatory disorders
o Spongiotic
o Psoriasiform
o Lichenoid
o Connective tissue disorders
o Dermal inflammation and perforating disorders
•
•
Histochemistry in dermatopathology
Immunocytochemistry in dermatopathology
•
•
Follicular disorders and alopecia
Infections and infestations
o
o
o
o
o
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Viral infections
Non-granulomatous cutaneous bacterial infections
Superficial fungal infection
Arthropod infestations
Helminth infestations
Granulomatous inflammation
Panniculitis
Vasculopathies
Metabolic diseases
Disorders of pigmenttion
Cysts and sinuses
Tumours of the epidermis
Benign
Premalignant and malignant
Adnexal tumours
o Hair follicle derived tumours
o Sebaceous tumours
o Lesions of the sweat apparatus
o Malignancy in adnexal tumours
Melanocytic lesions
Mesenchymal lesions
o Tumours and proliferations of "fibrous tissue" - a heterogenous group
o Tumours of adipose tissue
Vascular proliferations and tumours
o Benign and malignant lymphoid infiltrates
o T-cell lymphoma
o B-cell lymphoma
o 'Reactive' lymphocytic infiltrates
Histocytic proliferations
Cutaneous metastases
Differential diagnosis in dermatopathology
o Differential diagnosis of skin disease
Microbiology: Bacteriology, Virology, Mycology, Entemology and Parasitology
of the skin.
Bacteriology and Microbiology: A series of didactic lectures on the bacteria and fungi that
cause dermatologic disease is presented. In addition residents have a rotation in Microbiology
in order to learn how to plate and grow organisms that commonly cause dermatologic
disease. A rotation in infectious disease exposes residents to the dermatologic manifestations
of Hepatitis C and HIV disease as well as to a wide variety of exotic diseases from abroad.
Pharmacology
Basic pharmacologic principles
Pharmacokinetics-major components (relate to oral, parenteral, administered drugs).
22
•
•
•
•
•
Absorption
Distribution
Bioavailability
Metabolism
Excretion
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
General principles of topical dermatologic therapy and their various modalities
Vehicles for solution, lotion, ointments and creams
Cleansing agents
Emulsifying agents
Antiseptics
Antipruritic
Antiseborrhoeic
Preservatives
Keratolytics
Keratoplastics drugs
Antiparasitic agents
Photosensitizers and agents for pigmentation
Photoprotection
Depigmenting agents
Antiperspirants
Anaesthetics (local)
General pharmacology and pharmacokinetic.
Drugs for systemic and/or topical use and their mode of actions:
• Corticosteroids
•
•
•
•
•
23
Antibiotics
o Antibacterial agents
o Penicillin, cephalosporins, new Beta-Lactam antibiotic/Beta-Lactamase
inhibitor combinations
o Carbapenems and Monobactams
o Macrolides
o Fluoroquinolones
o Tetracyclines
o Rifamycins
o Trimethoprim-sulfamethoxazole
o Clindamycin
Antifungal agents
Antiviral agents
o Acyclovir
o Valacyclolovir
o Famciclovir
o Antiviral agents
Antihistamines, drugs used in hyposensitization and allergic emergencies
Analgesic and NSAID
•
Antipatasitics
•
Systemic Immunomodulators and antiprolifrative agents
o Methotrexate
o Azathioprine
o Cyclosporine
o Dapsone
o Antimalarial drugs
o Retinoids
o Psoralens
o Interferons
•
Cytotoxic agents
Cyclophosphamide
Chlorambucil
Hydroxyurea
Mycophenolate mofetil
Fluorouracil
Melphalan
•
Miscellaneous
o Vitamins
o Hormones: Estrogen, Progesterone, and Androgen
o Antiandrogens
o Tranquilizers
o Hypnotics
o Anticonvulsants
o Toxicology and antidodes
o Fluids and electrolyte
GENITOURINARY MEDICINE (GUM)
Genitourinary Medicine involves the investigation and management of sexually transmitted
infections and HIV. GUM is primarily outpatient based that deal with sexually transmitted
infections diseases for example, syphilis, chlamydia trachomatis, gonorrhoea, genital herpes,
hepatitis B/C, genital warts and HIV infection and many other genital and sexual problems.
Clinical attachment to the Dermatology clinic is needed for practical training and experience
in the GUM. The residence expected to be learning the principle of taking the general and
sexual history of the patient, performing the physical examination and should be trained in
collection of specimens, immediate staining, and microscopy of samples.
Sexually transmitted diseases
24
•
Genital infection in males
o Urethral discharge
o Genital ulcer
o Inguinal and femoral lymph nodes (lymphogranuloma venereum)
o Scrotal swelling (epididym-orchitis) gonorrhoea, and/or chlamydial
•
Genital infection in females
o
o
o
o
•
Vaginal discharge
Genital ulcer
Vulvovaginitis
Pelvic inflammatory disease
Syndromal approach
Specific sexual transmitted bacterial infections
• Syphilis
• Clinical presentation: primary, secondary, tertiary
• Syphilis serology
• Treatment of syphilis
• Post-treatment evaluation of syphilis
• Gonorrhea
• Chlamydia trachomatis
• Lymphogranuloma venereum
• Chancroid
• Granuloma inguinale
Sexually transmitted viral infections
• Genital herpes simplex infections
• Molluscum contagiosum
• Acquired immunodeficiency syndrome
o Cutaneous manifestations
• Genital warts
25
Rotation-Specific Objectives
26
Internal Medicine Rotations
Haematology Unit
Subject matter
There are 2 main areas of subject matter included within the curriculum
1. Rotation in the haematology unit the trainees would be expected to acknowledge the
following clinical problems:• Anaemia
o Macrocytic, microcytic, and disorders of iron synthesis
• Acute leukaemia in adults
• Chronic leukaemia
• Myeloma and lymphoma
• Acquired bleeding disorders
• Haemoglobinopathies
• Bone marrow failure syndromes
• Myeloproliferative disorders
• Congenital coagulation disorders
• Thrombophilia
• Anticoagulation
• Platelet disorders
2. Laboratory aspects of haematology.
Knowledge the basic haematological tests the ability to interpret test results.
Knowledge
Use of automated blood counters
Making and staining of peripheral
blood films
Use of different stains
Basic Blood Transfusion techniques
Techniques for coagulation testing
including automation of coagulation
tests
Basic Thrombophilia testing
Lymph node histology and
classification of lymphomas
Interpretation of CSF cytology
27
Skills
Explain the principles behind automated counters
Interpret results generated
Report blood films and differential white cell
count
Recognize malignant haematological disorders,
red cell abnormalities (sickle cell, spherocytes,
microangiopathic schistocytes & malarial
parasites)
Interpret:• Blood grouping
• Cross matching
• Direct antiglobulin test
• Recognise clinically significant
antibodies
Perform and interpret PT, INR, APPT, Thrombin
time, Fibrinogen assay.
Interpret thrombophilia testing results
Basic knowledge of lymph node histology
Be familiar with classification of Hodgkin and
non Hodgkin lymphomas particularly the REAL
classification
Recognize presence of malignant cells in CSF
Endocrinology Unit
Endocrinology & Diabetes Mellitus
Skin manifestation of the following diseases:
• Diabetes mellitus
• Thyroid disease
• Diabetes Insipidus.
• Metabolic bone disease
• Adrenal disorders
• Dyslipidemias
Diabetes mellitus
Subject matter related to diabetes and skin
Certain cutaneous disorders occur in diabetic patients specifically in relation to
hyperglycemia and hyperlipidemia and are reversible when these abnormalities are corrected
• Xanthomatosis
• Xanthomas
• Tuberous xanthomas
• Xanthelasma
•
•
•
•
•
•
•
•
•
Diabetic Dermopathy
Erythema and Necrosis
Bullous Lesions
Thickened Skin, Stiff Joints, and Scleredema Adultorum
Necrobiosis Lipoidica
Granuloma Annulare
Vitiligo
Acanthosis Nigricans
Perforating disorders
Subject matter related to endocrine disease
Glucagonoma Syndrome
An unusual and striking cutaneous disease is found in patients with glucagon-secreting islet
cell tumors. Although there is hyperglycemia as a consequence of excess glucagon secretion,
the cutaneous findings are not a manifestation of diabetes.
Disorders of the thyroid gland
Subject matter
•
•
•
•
•
28
Patients with thyroid disease, both hypo- and hyperthyroidism, can affect hair, nails,
and skin.
Explain disease states in terms of disorders of the physiology and biochemistry of
thyroid hormone
Interpret thyroid function test results to diagnose disease
Use of antithyroid drugs
Use and/or refer for the use of radioisotopes to diagnose and treat thyroid disorders
•
Diagnose and manage primary and secondary hypothyroidism
Disorders of the Adrenals
•
•
•
•
•
Perform and interpret tests of adrenal function
Investigate and provide first-line management of Cushing’s syndrome
Investigate suspected endocrine hypertension and provide first-line management for
phaeochromocytoma and adrenocortical hypertension
Diagnose and manage non-classical congenital adrenal hyperplasia and provide firstline management for classical CAH in adolescence and adulthood
Investigate with suspected adrenal tumours
Disorders of the gonads
•
•
•
•
•
Perform and interpret tests of the hypothalamo-pituitary-gonadal axis
Investigate primary and secondary gonadal failure
Assess, investigate and manage women with hirsutism/virilism
Assess, investigate and manage women with menstrual disturbance
Manage polycystic ovary syndrome
Disorders of parathyroid glands, calcium metabolism and bone
•
•
•
•
•
•
Diagnose and manage hypercalcaemia
Diagnose and manage hyperparathyroidism
Investigate and manage hypocalcaemia
Diagnose and manage vitamin D deficiency states
Provide preventive care against osteoporosis
Make appropriate referrals for bone densitometry and understand its value and
limitations
Gastroenterology Unit
•
•
•
•
•
•
Skin manifestations of inflammatory bowel disease:
o Ulcerative colitis
o Crohn's disease
Celiac disease; Most patients with dermatitis herpetiformis have a gluten-sensitive
enteropathy
Hepatitis C infection
Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome
Peutz-Jeghers syndrome
Pseudoporphyria.
Skin conditions commonly associated with GI diseases include:
•
•
•
29
Pyoderma gangrenosum, which occurs in patients with inflammatory bowel disease
Lichen planus and porphyria cutanea tarda, which are associated with hepatitis C
infection
Diffuse hyperpigmentation, or “bronze diabetes,” which occurs in hemochromatosis
•
Erythema nodosum may accompany inflammatory bowel disease, sarcoidosis, and
various infections. Eruptive xanthomas may result from elevated serum triglycerides
Infectious Disease Unit
During the rotation, the resident must be able to demonstrate understanding of standard
evaluation and management of common infections including:
• Community Acquired and Nosocomial
• Pneumonia
• Meningitis
• Tuberculosis
• Bacteraemia, septicemia and septic shock
• Human immunodeficiency syndrome; the resident should understand methods of
recognition of HIV diseases, initial evaluation and management of HIV diseases,
symptoms/signs of common opportunistic events, and management of opportunistic
events.
• Chemotherapy of infection; residents will reflect satisfactory understanding of the use
of antimicrobial agents including commonly used antibiotics and antifungal
medications. Residents will reflect understanding of the spectrum of antimicrobial
drugs, their clinical indications, and their side effects.
By the end of the rotation, the resident must demonstrate ability to complete a detailed
physical examination and recognize and interpret physical findings seen in infectious diseases
including
• Skin lesions
• Lymphangitis,
• Wound infections signs
• Animal bites
• Lymphadenopathy
• Pharyngitis and mucosal abnormalities
• Neck stiffness and neurologic abnormalities
• Adventitious pulmonary sounds
• New or changing heart murmurs or rub
• Abdominal or flank tenderness, organomegaly
• Joint or limb swelling, tenderness
The resident will be able to interpret Gram stains, fungal stains, acid-fast stains, KOH preps,
serologic antigen and antibody testing for viral, bacterial and fungal diseases, antibiotic
sensitivity testing, anaerobic and aerobic culture results and their relevance in the appropriate
clinical setting.
Rheumatology Unit
Subject matter
•
30
Recognition and management of patients with both rheumatological and cutaneous
manifestations of:
• Psoriatic arthritis
•
•
•
•
•
Rheumatoid arthritis
Vasculitis
Lupus Erythematosus
Dermatomyositis
Systemic Sclerosis (Scleroderma)
Interpretation of laboratory evaluation of connective tissue disease .
o Serologic tests for diagnosis and follow-up evaluation of Systemic Rheumatic
Diseases and Connective Tissue Diseases
1. Autoantibody tests
Rheumatoid factor
Antinuclear antibody
Antibodies to extractable nuclear antigens:
Sm, RNP, SS-A (Ro), and SS-B (La).
Anti-DNA antibody
Antihistone antibodies
Antineutrophil cytoplasmic antibody:
cytoplasmic ANCA (c-ANCA) and perinuclear ANCA (p-ANCA)
2. General tests of inflammation
Erythrocyte sedimentation rate
C-reactive protein
Complement component levels of either the C3 or C4 proteins
Plastic Surgery Rotation
Subject matter
Knowledge
31
•
•
•
•
•
•
•
•
•
Surgical Anatomy of the skin and male and female genetalia
Identifying and sterilization of instruments related to skin surgery
Surgical preparation
Anaesthesia
Learn appropriate judgment in planning surgical therapies
Preoperative psychological evaluation
Emergencies in skin surgery
Suture materials
Wound healing and wound dressing
•
•
•
•
•
•
Standard Dermatologic Surgical Procedures Punch biopsy,
Shave excision
Simple excision and closure
Cryosurgery
Electrodessication
Curettage
•
•
•
•
Skin Grafts
Tissue Expansion
Sclerotherapy of veins
Advanced Dermatologic Surgical Procedures
Flaps
•
•
Blepharoplasty
Liposuction
Regional Surgery
•
•
•
•
•
•
•
The ear
The hand
The nose
The lips and oral cavity
The eyelids
The nails
The male and female genitalia
Cosmetic procedures
•
•
•
Chemical and Mechanical Skin Resurfacing
Botulinum toxin ("Botox")
Soft Tissue Augementation (fillers (collagen and hyaluronic acid)
Laser therapy
•
•
•
•
Vascular lesion laser
Pigmented lesion laser
Tattoo removal
Hair removal laser
Psychiatry Rotation
Disorders that are more commonly encountered in a dermatology practice:
•
•
•
•
•
•
•
•
delusions of parasitosis
body dysmorphic disorder
dermatitis artefacta
prurigo nodularis
lichen simplex chronicus
trichotillomania
acne excoriée
neurotic excoriations
Subject matter should be knowledge
Dysmorphic Delusions and Hallucinations:
Delusions of Parasitosis
Body Dysmorphic Disorder
Factitious Syndromes
Dermatitis artefacta, factitious dermatitis: responsibility for lesions is uniformly
denied by the patient, whether the lesions are created consciously or unconsciously.
Cutaneous compulsions: lesions that result from conscious and repetitive actions, e.g.,
neurotic excoriations, trichotillomania.
Malingering: lesions produced consciously and deceitfully for secondary gain.
Obsessive-compulsive disorders
These includes: trichotillomania,
onychotillomania, neurotic excoriations, and acne excoriée
32
Signs and symptoms of obsessive-compulsive disorder Presence of obsession Obsession is a recurrent, intrusive, ego-dystonic (i.e. feeling foreign to oneself) idea.
Presence of compulsion - Compulsion is a behavioral response to obsession. If
suppressed, compulsive urge may build up.
Obsession and compulsion need not both be present: the presence of one or the other is
sufficient to make the diagnosis.
Presence of varying degrees of insight (in contrast to psychosis, where, by definition, there is
no insight).
Signs and symptoms of generalized anxiety disorder
Excessive anxiety and worry
Restlessness or feeling 'keyed up' or 'on edge'
Difficulty concentrating or mind going blank
Irritability
Muscle tension
Stress
Sleep disturbance (difficulty falling or staying asleep; or restless, unsatisfying sleep)
Dizziness
Sweating
Palpitations
Abdominal complaints
Frequent urination
Signs and symptoms of major depression
Very depressed mood
Anhedonia (i.e. markedly diminished interest or pleasure in activities)
Significant weight loss when not dieting, weight gain, or decrease or increase in appetite
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue, lack of energy
Helplessness, hopelessness, worthlessness
Excessive guilt
Difficulty with concentration, memory loss
Suicidal ideation/plan
Crying spells (i.e. finding oneself tearful for no reason or with minimal provocation)
Somatization (i.e. preoccupation with vague, non-specific, or exaggerated physical concerns
but not of delusional intensity)
Making a Psychiatric Referral
Patients who present to the dermatologist are often not emotionally ready for psychiatric
referral and must be prepared for that step, so that referral is not experienced as rejection or
stigma. In some of the dermatological conditions examples for patients with psoriasis or
eczema are often more than willing to speak of how emotional stress adversely affects their
condition. However, patients afflicted with delusions of parasitosis are typically resistant to
any discussion of their situation in psychological terms because, by definition of psychosis,
they have no insight into their disease. If a successful communication between the
dermatologist and his/her patient is established, the patient can be helped gradually to
recognize the need for further help and, by verbalizing it, make that recognition a part of
33
his/her own experience. The patient can then acknowledges the failure of dermatologic
measures, recognize the ways that symptoms interfere with activities and relationships, and
own up to the expense, disappointment, frustration, and emotional suffering that have been
endured. It will then be self-evident to the patient that psychiatric consultation is the logical
next step.
Pediatric Rotation
Each resident and student is expected to gain background knowledge of the special
interpersonal and communication skills required for successfully interacting with parents and
children with disease. Inpatient pediatric training aims to teach residents to assess the
newborn, ill infant or child comprehensively and to diagnose and manage most common
pediatric conditions. Residents attend daily attending rounds
Subject matter
General knowledge
1. To gain exposure to the full range of skin disease in children.
2. To generate age-appropriate differential diagnoses and treatment plans
3. To learn skin manifestations of genetic disease, and the need for a multidisciplinary
approach
4. To learn and observe the course and therapies for hemangiomas, and to understand
surgical and multidisciplinary referral for selected hemangioma patients
5. Psychological Aspects of Skin Disease in Children
6. Child abuse and neglect
Disorders
Disorders of Pigmentation
1. Mongolian Spot
2. Nevus of Ota
3. Navus of Ito
4. Mosaic Hypopigemtation
5. Vitiligo
6. Albinisms
7. Piebaldism
Vascular disorders
1. Blueberry Mufin Baby
2. Acute Hemorrhagic Edema of Infancy
3. Henoch-Schonlein Purpura
4. Nevus Anemicus
5. Congenital Hemangiomas
1. Infections Molluscum Contagiosum
2. Eczema Herpeticum
3. Staphylococcal Scalded Skin Sundrome
Dermatoses
1. Seborrheic dermatitis (Cradle Cap)
2. Gianntti-Crosti Syndrme (papular Acrodermatitis of Childhood)
34
3. Acropustulosis of Infancy (Infentile Acropustulosis)
4. Transient Neonatal Pustular Melanosis
5. Erythema Toxicum Neonatorum
6. Lichen Striatus
7. Atopic Dermatitis
8. Other Types of Dermatitis
9. Nutritional Disorders
10. Bites, Stings and Infestations (Scabies)
11. Urticaria and the Erythemas
12. Acne
13. Psoriasis and Other Papulosquamous
14. Blistering Disorders
15. Photosensitivity
16. The Histocytoses
17. Hair and Nails
18. Genitourinary Problems in Children
19. Treatment, Reactions to Drugs and Poisoning
Cutaneous neoplasm and Malformation
1. Epstein’s Pearls (Bohn’s Nodules)
2. Pseudoverrucous Papules and Nodules
3. Perianal Pyramidal Protrusion
4. Nevus Sebaceous of Jadassohn
5. Schimmelppenning’s Syndrome
6. Linear Epidermal Nevus
7. Aplasia Cutis Congenita
8. Melanocytic Naevus
Genetic Disorders
Disorders of Subcutaneous Tissue
• Cerebrotendenous xanthomatosis
• Familial multiple lipomatosis
• Familial Fibrodysplasis ossificans progresiva
• Lipogranulomatosis
• Partial lipodystrophy
Disorders of Connective Tissue
• Ehler’s-Danlos Syndrome
• Osteogenesis Imperfecta
• Marfan’s Syndrome
• Cutis Laxa
• Pseudoxanthoma Elasticum
• Tuberous Sclerosis
• Buschke-Ollendorf Syndrome
• Focal Dermal Hypoplasia
• Aplasia Cutis Congenita
• Epidermal Naevi/Epidermal Naevus
• Syndromes/Proteus Syndrome
35
Vascular Related Disorders
• Von Hippel-Lindau Syndrome
• Ataxia-Telangiectasia
• Osler-Weber-Rendu Syndrome (Hereditary Hemorraghic Telangiectasia)
Disorder with chromosome abnormalities
• Down’s Syndrome’Turner Syndrome
• Noonan Syndrome
• Klinefelter Syndrome
Metabolic disease
• Porphyrias
• Mucopolysaccharidoses; Hunter syndrome
• Acrodermatitis enteropathica
• Alkaptonuria
• Familiar cutaneous amyloidosis
Others:
• Neurofibromatosis
• Xeroderma Pigmentosa
• Ectodermal dysplasia Syndromes
• Syndromic disorders
• Ichthyoses
• Epidermolysis Bullosa
• Acrokeratodermas
• Erythrodermas
Pathology rotation
Subject matter
Knowledge of Skin Histology
•
Embryology of the skin
•
36
Normal Histology of The Skin
•
o
o
o
o
o
o
o
o
o
Epidermis & Mucosal epithelium
Stratum basalis (basal cell layer)
Stratum spinosum (squamous cell layer)
Stratum granulosum (granular cell layer)
Stratum corneum (horny cell layer)
Stratum lucidum
Keratinization
Melanocytes
Langerhans cells
Merkel cells
•
Basement membrane zone
•
Dermis
o
o
o
o
o
o
Collagen fibers
Elastic fibers
Ground substance
Blood vessels
Lymphatics
Glomus bodies
•
o
o
o
Nerves and sensory receptors
Pacinian corpuscles
Meissner corpuscles
Mucocutaneous end organs
•
Subcutaneous fat
•
o
o
o
o
Adnexal structures
Hair follicle
Sebaceous gland
Apocrine gland
Eccrine gland
•
Nail (nail plate, nail folds, cuticle, lunula, nail matrix, nail bed, hyponychium)
•
o
o
Muscle
Smooth muscle
Skeletal muscle
•
Regional variation
•
o
o
o
o
o
o
o
o
Inflammatory cells
Neutrophils
Eosinophils
Lymphocytes
Plasma cells
Histiocytes
Mast cells
Fibroblasts
Dendrocyte
•
Limitations of Histologic Diagnosis
•
General Pathology
Laboratory Methods
•
•
•
•
Histopathology specimens
Biopsy techniques and indications
Specimen preparation Fixation, Processing Histochemical Staining
Polariscopic Examination
• Histochemical stains
o Crystal violet
o Congo red
37
Amyloid
o Thioflavine T
•
Calcium
o Von Kossa
o Alizarin red S
•
Carbohydrates
o Periodic acid-Schiff (PAS)
o Alcian blue
o Colloidal iron
o Mucicarmine
•
Collagen
o Masson trichrome
•
Elastic fibers
o Acid Orcein
o Verhoeff-van Gieson
o Gomori's aldehyde fuchsin
•
Iron
o Fontana-Masson
o Perls' Prussian blue
•
Melanin
o Fontana-Masson
•
Lipids
o Sudan black B
o Oil red O
•
Mast cells
o Giemsa
o Leder
o Toluidine blue
•
Microorganisms Gram
o Ziehl-Neelsen
o Fite
o Gomori's methenamine silver nitrate
o Warthin-Starry
•
Reticulum and nerves
o Bodian (Gomori's silver)
•
Routine stain
o Hematoxylin and eosin (H&E)
38
Glossary in Dermatopathology
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39
Abscess
Acantholysis
Acanthosis
Anaplasia
Apoptosis
Ballooning degeneration
Birefringence
Blister
Cartwheel pattern
Cholesterol clefts
Civatte bodies
Cleft
Colloid bodies
Cornoid lamella
Corps ronds
Crust
Decapitation secretion
Degeneration
Dermal edema
Diffuse infiltrates
Dyskeratosis
Epidermal atrophy
Eosinophilic spongiosis
Epidermolytic hyperkeratosis
Epidermotropism
Exocytosis
Fibrinoid degenerationFlame figures
Foam cells
Giant cells
Grains
Granular degeneration of epidermis
Granulation tissue
Granuloma
Grenz zone
Hydropic (liquefactive) degeneration
Hypergranulosis
Hypogranulosis
HyperkeratosisHyperplasia:
Incontinence of pigment
Interface dermatitis
Karyolysis
Karyorrhexis
Leukocytoclasis
Lichenoid dermatitis
Lichenoid reaction
•
•
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•
•
•
•
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•
•
•
•
•
•
•
•
Liquefactive degeneration
Metachromasia
Metaplasia
Munro microabscess
Necrobiosis
Necrosis
Orthokeratosis
PapillomatosisParakeratosis
Pautrier microabscess
Perivascular infiltrates
PleomorphismPustulePyknosis
Reticular degeneration
Scale crustSpongiosis
Squamous eddies
Telangiectasia
Ulcer
Vacuolar alteration
Dermatology Rotation
Dermatopathology
Dermatopathology plays an intricate role in the overall practice of dermatology. The
dermatopathology weekly sessions offers a strong foundation in histology and clinical
correlation, and allows residents to gain experience in interpreting cutaneous biopsies. This
experience enhances the resident’s ability to generate comprehensive differential diagnoses
based on histological features.
Dermatopathology Textbook Review
Each resident must read, assimilate, and be prepared to discuss in condensed form the
assigned reading from the text. The chapter will be reviewed in a resident teaching session,
each resident will have reviewed selected slides pertinent to the chapter assigned.
Subject matter
•
•
•
•
•
•
•
•
•
•
•
•
•
•
40
Introduction to Dermatopathology
Biopsy Techniques
Normal histology of the skin
Laboratory methods
Approach to interpretations of skin biopsies
Algorithmic Classification of skin disease for differential diagnosis
Congenital diseases (Genodermatosis)
Noninfectious Erythematous Papular and Squamous disease
Vascular diseases
Non infectious Vesiculobullous and Vesiculopustular diseases
Connective Tissue Diseases
Cutaneous Toxicities of Drugs
The Photosensitivity Disorders
Disorders associated with Physical Agents: Heat, Cold, Radiation, and Trauma
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Noninfectious Granulomas
Degenerative Diseases and Perforating Disorders
Cutaneous Manifestations of t Nutritional Deficiency States and Gastrointestinal
Disease
Metabolic Diseases of the Skin
Inflammatory Diseases of Hair Follicles, Sweat Glands, and Cartilage
Inflammatory Diseases of the Nail
Inflammatory Diseases of the Subcutaneous
Bacterial Diseases
Treponemal Diseases
Fungal Diseases
Protozoan Diseases and Parasitic Infestations
Diseases Caused by Viruses
The Histiocytoses
Pigmentary Disorders of the Skin
Benign Pigmented Lesions and Malignant Melanoma
Tumors and Cysts of the Epidermis
Tumors of the Epidermal Appendages
Cutaneous Lymphomas and Leukemias
Tumors of Fibrous Tissue Involving the Skin
Vascular Tumors: Tumors and Tumor-like Conditions of Blood Vessels and
Lymphatics
Tumors With Fatty, Muscular, Osseous, and Cartilaginous Differentiation
Tumors of Neural Tissue
Metastatic Carcinoma of the Skin: Incidence and Dissemination
Tissue reaction patterns Vocabulary:
o Superficial perivascular dermatitis
o Spongiotic
o Lichenoid
o Vacuolar interface
o Psoriasiform
Textbook
1. Pathology of the Skin, 3rd edition... McKee H Phillip. January 2005.
2. Textbook of Dermatopathology, 2nd ed. Mc-. Graw-Hill, 2004;. Weeden D.
3. Lever’s Histopathology of the Skin. Ninth Edition. E. David. Elenitsas R. Johnson, Jr.
BL. Murphy, GF. 2005.
41
Clinical Dermatology Rotation
The general goal of the residency-training program in Dermatology is to provide
comprehensive practical and theoretical training in clinical and investigative cutaneous
medicine. The residency comprises 30 months training in the dermatology Department. Over
this time, the residents maintain a continuity clinic and broad exposure to dermatopathology,
dermatologic surgery, pediatric dermatology, mycology, and all other topics mandated by the
Arab Board of Dermatology. Weekly CME activities and didactic lectures series,
dermatopathology unknown slides, journal review, grand rounds, and: book review sessions.
Purpose: The purpose of the program is to define goals, objectives, and requirements of
specific clinical rotations in the Dermatology Department.
Implementation: Implementation of the program is the responsibility of the Program
Director, Attending Faculty, and Residents
Procedure: All Faculty and Residents will be made aware of the program policy during
orientation or when the policy is changed or updated. (It can be viewed at anytime in the
resident handbook, or on the DOHMS Website)
Policy: Dermatology Resident Clinics
Rotation Dermatology Resident Clinics
Director:
Rotation Goals: To provide an educational experience in the evaluation and management of
dermatology patients in a department-based outpatient and inpatient setting.
Rotation Objectives for the second year resident
Patient Care
Medical knowledge
42
1. To develop expertise in the diagnosis and management of a
range of dermatologic conditions.
2. To develop the ability to formulate a differential diagnosis
and treatment options with attending dermatologists.
3. To learn to provide patient care and to develop the ability to
educate the patient in the relevant areas of disease
prevention, detection, progression, and therapy to promote
skin health.
1. By the end of the year, a resident should be able to
accurately describe cutaneous eruptions.
2. To develop an understanding of the pathophysiology of
common skin diseases.
3. To develop a knowledge base in the epidemiology of
common skin pathology.
4. To learn to evaluate evidence-based medicine for treating
dermatologic diseases.
5. To learn the management of dermatologic emergencies and
medication side effects.
6. To learn how to correctly perform and interpret microscopy
for dermatologic conditions, including KOH prep, hair
mount, Tzanck smear.
7. To learn diagnostic and therapeutic dermatologic
procedures, including punch biopsy, shave excision,
cryosurgery, electrodessication and curettage.
Additional
objectives
1. To evaluate phototherapy patients, and to understand the
operation of UVA, UVB, and hand/foot light therapy
Inpatient Consults
1. To learn to perform inpatient consults on complicated
medical and surgical patients.
2. To learn to review inpatient hospital records efficiently and
effectively to retrieve pertinent history pertaining to the
patients admission.
3. To learn to perform diagnostic procedures at bedside and
appropriately document findings.
4. To learn to interact with the primary team to facilitate care
of the patient with skin manifestations.
Dermatopathology
1. To recognize the basic histopathology of skin disease.
2. To appreciate the importance of providing adequate history
in the interpretation of cutaneous biopsies.
3. To generate a basic differential diagnosis.
4. To understand use of ancillary tests, including: common
5. histochemical stains, immunohistochemistry, and genotypic
analysis of lymphoid infiltrates.
6. To understand the mechanics of specimen accessioning and
processing including familiarity with the proper grossing of
skin biopsies, and to understand limitations of these
techniques when interpreting the final result.
Practice-based
learning and
improvement
1. To review, analyze and utilize scientific evidence from the
dermatologic literature in the management of dermatologic
patients.
2. To learn from dermatologic patients the most effective
therapeutic modalities.
3. To learn from the clinic operating procedure and patient
interactions the best practice patterns to facilitate care of the
patient with skin manifestations.
Interpersonal and
Communication Skills
1. To learn to communicate effectively with staff, peers,
attending dermatologists, referring physicians and
consultants.
2. To learn to listen patiently and attentively to patient history
and concerns.
3. To learn to effectively discuss with the patient and/or
family: diagnosis, treatment plans including side effects, and
answer questions from the patient and/or family.
43
4. To become a teacher of dermatology to other residents,
medical students, and other healthcare professionals.
Professionalism
1. To perform all expected professional responsibilities.
2. To practice ethical principles in relation to patient care and
confidentiality.
3. To practice ethical interactions with pharmaceutical
representatives and be unbiased in prescribing habits.
4. To be sensitive to cultural, age, gender and disability issues
Rotation Objectives for the 3rd & 4th year resident
Patient Care
1. To further develop expertise in the diagnosis and
management of all dermatologic conditions.
2. To formulate an extended differential diagnosis and to
systematically evaluate more advanced treatment options in
order to develop a treatment plan with attending
dermatologists.
3. To provide patient care that is safe and compassionate, to
further develop the ability to clearly educate the patient in
the relevant areas of disease prevention, detection,
progression, and therapy to promote skin health.
Medical knowledge
1. To extend the understanding of the pathophysiology of
common and uncommon skin diseases.
2. To further develop a knowledge base in the epidemiology of
dermatologic diseases including common and uncommon
skin pathology.
3. To learn the most up-to-date evidence-based medicine for
treating dermatologic diseases.
4. To master the management of dermatologic emergencies
and medication side effects.
5. To correctly perform and interpret microscopy for
dermatologic conditions, including KOH prep, hair mount,
Tzanck smear.
6. To perform diagnostic and therapeutic dermatologic
procedures, including punch biopsy, shave excision,
cryosurgery, electrodessication and curettage.
Additional
objectives
1. To monitor and learn the evolution of disease in specific
patients.
2. To evaluate treatment modalities and learn to manage
treatment side effects and failure.
3. To establish an ongoing rapport with individual
patients/families.
4. To demonstrate knowledge and competency in the
performance of procedures in allergy and immunology to
include appropriate patch testing, RAST testing.
44
5. To evaluate and formulate a treatment plan for phototherapy
patients, and to safely and appropriately operate the UVA,
UVB, and hand/foot light apparatus; and to appropriately
manage side effects of psoralens and light therapy.
Inpatient Consults
1. To perform inpatient consults on complicated medical and
surgical patients.
2. To review inpatient hospital records efficiently and
effectively to retrieve pertinent history pertaining to the
patients admission.
3. To perform diagnostic procedures at bedside and
appropriately document findings.
4. To interact with the primary team to facilitate care of the
patient with skin manifestations.
Practice-based
learning and
improvement
1. To review, analyze and utilize scientific evidence from the
dermatologic literature in the management of dermatologic
patients.
2. To learn from the dermatologic patient the most effective
therapeutic modalities.
3. To practice standard clinic operating procedure and develop
the best practice patterns to facilitate care of the patient with
skin manifestations.
Interpersonal and
Communication Skills
1. To communicate effectively with staff, peers, attending
dermatologists, referring physicians and consultants.
2. To listen patiently and attentively to patient history and
concerns.
3. To effectively discuss with the patient and/or family:
diagnosis, treatment plans including side effects, and answer
questions from the patient and/or family.
4. To become a teacher of dermatology to junior residents,
medical students, and other healthcare professionals.
Professionalism
1. To perform all expected professional responsibilities.
2. To practice ethical principles in relation to patient care and
confidentiality.
3. To practice ethical interactions with pharmaceutical
representatives and be unbiased in prescribing habits.
4. To be sensitive to cultural, age, gender and disability issues.
Dermatopathology
1. To recognize the full range of histopathology of skin
disease.
2. To appreciate the importance of providing adequate history
in the interpretation of cutaneous biopsies.
3. To generate an advanced differential diagnoses and
accurately establish diagnosis.
4. To appropriately use of ancillary tests, including: common
histochemical stains, immunohistochemistry, and genotypic
45
analysis of lymphoid infiltrates.
5. To understand the mechanics of specimen accessioning and
processing including familiarity with the proper grossing of
skin biopsies, and to understand limitations of these
techniques when interpreting the final result.
6. To review microscopic sections and understand common
inflammatory dermatoses and cutaneous tumors.
Sexually transmitted
diseases
Genital infection in males
o Urethral discharge
o Genital ulcer
o Inguinal and femoral lymph nodes (lymphogranuloma
venereum)
o Scrotal swelling (epididym-orchitis) gonorrhoea, and/or
chlamydial
Genital infection in females
o Vaginal discharge
o Genital ulcer
o Vulvovaginitis
o Pelvic inflammatory disease
Sexually transmitted viral infections
o Genital herpes simplex infections
o Molluscum contagiosum
o Cutaneous manifestations of acquired immunodeficiency
syndrome
o Genital warts
Procedure Logs
Documentation of procedures performed is kept by each resident in a logbook. This recording
of information usually consists of ID number, procedure performed (i.e., punch biopsy, shave
ED&C, culture, etc.), and differential diagnosis. Later, when the histological diagnoses are
available, the earlier records provide an organized system to ensure adequate follow-up, as
well as a useful learning tool. Upon completion of residency, the documentation is used in
many instances as proof of experience to obtain hospital privileges
46
Arab Board Logbook:
1 Clerking of case histories: - 100 cases (40 male cases, 30 female cases and 30 Pediatric
cases)
2. Minor surgical procedures
• Biopsies : - a minimum of 50 cases
• Electro cauterization : - a minimum of 50 cases
• Cryosurgery: - a minimum of 50 cases
3. Special procedures
• PUVA/NB – UVB: a minimum of 50 cases
• Patch test: - a minimum of 50 cases
• Fungal scraping: - a minimum of 50 cases.
4. Minor procedures
• Wood's lamp a minimum of 50 cases
• Epilations: - a minimum of 50 cases
• Skin grafting: - a minimum of 10 cases
5
Serving scientific activity: - a minimum of 30 activities
6
Histopathology: - discussion of 50 slides
7
Journal club presentation: - a minimum of 20 presentation
8
Case presentation: - a minim of 50 presentation
Textbooks:
1. Rook's Textbook of Dermatology. Seventh Edition.
2. Fitzpatrick's Dermatology in General Medicine. 6th ed. New York, N.Y.: McGrawHill.
3. Dermatology (Jean Bologna, 2003).
4. Andrews' Diseases of the Skin, 10th ed.,.. Philadelphia, W.B. Saunders Co 2006.
5. Textbook of Dermatopathology. 2nd ed. Mc-. Graw-Hill, 2004;. Weeden D.
6. Lever’s Histopathology of the Skin. Ninth Edition. E. David. Elenitsas R. Johnson, Jr.
BL. Murphy, GF. 2005.
7. Pathology of the Skin, 3rd edition.. McKee H Phillip. January 2005.
8. Pediatrics: Clinical Pediatric Dermatology, 2nd edition. Author: Sidney Hurwitz
9 Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology by Klauss Wolff, Fifth
Edition 2005.
10 Hurwitz Clinical Pediatric Dermatology: A Textbook of Skin Disorders of Childhood
and Adolescence. Third edition. Paller Amy S. Mancini AJ.
11 Clinical Dermatology: A Color Guide to Diagnosis and Therapy, 4th edition. Author:
Thomas P. Habif.
47
SUPERVISION OF THE RESIDENTS
Policy:
1. Clinical Teaching staff are essential and important to the successful implementation
of the Dubai residency training Programme.
2. Clinical Teaching staff are expected to be familiar with the goals and objectives of the
programme as well as of the rotation for which they have responsibility.
3. Clinical Teaching staff are expected provide a direct and appropriate level of clinical
supervision to all residents during clinical rotations.
4. Clinical Teaching staff are expected to foster an effective learning environment by
ensuring that the (a) residents share responsibility for decision-making in patient care
under supervision, (b) residents have constructive feedback from the concerning
clinical skills at diagnosis and management (c) participation of residents in patient
care adds to the effectiveness, appropriateness and quality of care.
Procedures:
1.
Clinical responsibilities must be assigned to the residents in a carefully supervised and
graduated manner, so that the resident assumes progressively increasing responsibility
in accordance with their level of education, ability, and experience.
2.
Teaching staff supervision must include timely and appropriate feedback to the
residents.
3.
The resident’s clinical involvement must be in fulfillment of the programme’s written
educational curriculum.
4.
Teaching staff must demonstrate concern for each resident’s well-being and
professional development.
5.
Teaching staff who supervise the residents have overall responsibility for patient care
and are the ultimate authority for final decision.
6.
Teaching staff schedules must be structured to ensure continuous supervision of
residents and availability of consultation.
7.
All decisions regarding diagnostic tests and therapeutics, initiated by the residents will
be reviewed with the responsible Consultants during patient care rounds.
8.
Patients will be seen by the team of residents, interns and medical student and their
care will be reviewed with the Consultant at appropriate intervals.
9.
The residents are required to promptly notify the patient’s Consultant physician in the
event of any controversy regarding patient care or any serious change in the patient’s
condition.
10.
In clinics and consultation services, the Consultant or supervising physician must
review overall patient care rendered by residents.
11.
In the operating theatres, the Consultant or supervising physicians are responsible for
the supervision of all operative cases. Consultants supervising physicians must be
present in the operating room with residents during critical parts of the procedure. For
less critical parts of the procedure, the Consultant or supervising physician must be
immediately available for direct participation.
48
LOG BOOK
TRAINING PROGRAM FOR ARAB BOARD OF
DERMATOLOGY AND VENEREOLOGY
Trainee name:
49
Clerking of case histories: - 100 cases (40 male cases, 30
female cases and 30 Pediatric cases)
50
CLERKING OF CASE HISTORIES
100 CASES: 40 MALE CASES, 30 FEMALE CASES AND 30 PEDIATRIC CASES
SR.
NO.
DATE
DIAGNOSIS
I.P.NO.
REMARKS
SIGNATURE OF
SUPERVISOR
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
•
•
51
Minimum of 100 case histories are to be clerked before appearing for the final
examination.
s far as possible avoid including similar cases. Maximum of 2 or 3 similar cases are
accepted.
SR.
NO.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
52
DATE
DIAGNOSIS
I.P.NO.
REMARKS
SIGNATURE OF
SUPERVISOR
SR.
NO.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
62.
63.
64.
65.
66.
67.
68.
69.
70.
71.
72.
73.
74.
53
DATE
DIAGNOSIS
I.P.NO.
REMARKS
SIGNATURE OF
SUPERVISOR
SR.
NO.
75.
76.
77.
78.
79.
80.
81.
82.
83.
84.
85.
86.
87.
88.
89.
90.
91.
92.
93.
94.
95.
96.
97.
98.
99.
100.
54
DATE
DIAGNOSIS
I.P.NO.
REMARKS
SIGNATURE OF
SUPERVISOR
MINOR SURGICAL PROCEDURES
BIOPSIES
55
MINOR SURGICAL PROCEDURES
BIOPSIES
SR.
NO.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
56
DATE
DIAGNOSIS
REMARKS
SIGNATURE OF SUPERVISOR
BIOPSIES
SR.
NO.
26.
DATE
DIAGNOSIS
REMARKS
SIGNATURE OF SUPERVISOR
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
•
57
Minimum of 50 surgical procedures in each category mandatory prior to qualificate of
final.
MINOR SURGICAL PROCEDURES
ELECTRO CAUTERIZATION
58
MINOR SURGICAL PROCEDURES
ELECTRO CAUTERIZATION
SR.
NO.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
59
DATE
DIAGNOSIS
REMARKS
SIGNATURE OF SUPERVISOR
SR.
NO.
26.
DATE
ELECTRO CAUTERIZATION
DIAGNOSIS
REMARKS
SIGNATURE OF SUPERVISOR
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
•
60
Minimum of 50 surgical procedures in each category mandatory prior to qualificate of
final.
MINOR SURGICAL PROCEDURES
CRYOSURGERY
61
MINOR SURGICAL PROCEDURES
CRYOSURGERY
SR.
NO.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
62
DATE
DIAGNOSIS
REMARKS
SIGNATURE OF SUPERVISOR
CRYOSURGERY
SR.
NO.
26.
DATE
DIAGNOSIS
REMARKS
SIGNATURE OF SUPERVISOR
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
•
63
Minimum of 50 above special procedures are to be prior to appearing of exams.
SPECIAL PROCEDURES
PUVA
64
SPECIAL PROCEDURES
PUVA
SR.
NO.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
65
DATE
DIAGNOSIS
REMARKS
SIGNATURE OF SUPERVISOR
PUVA
SR.
NO.
26.
DATE
DIAGNOSIS
REMARKS
SIGNATURE OF SUPERVISOR
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
•
66
Minimum of 50 surgical procedures in each category mandatory prior to qualificate of
final.
SPECIAL PROCEDURES
PATCH TEST
67
SPECIAL PROCEDURES
PATCH TEST
R.
NO.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
68
DATE
DIAGNOSIS
REMARKS
SIGNATURE OF SUPERVISOR
PATCH TEST
SR.
NO.
26.
DATE
DIAGNOSIS
REMARKS
SIGNATURE OF SUPERVISOR
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
•
69
Minimum of 50 above special procedures are to be prior to appearing of exams.
SPECIAL PROCEDURES
FUNGAL SCRAPING
70
SPECIAL PROCEDURES
FUNGAL SCRAPING
SR.
NO.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
71
DATE
DIAGNOSIS
REMARKS
SIGNATURE OF SUPERVISOR
FUNGAL SCRAPING
SR.
NO.
26.
DATE
DIAGNOSIS
REMARKS
SIGNATURE OF SUPERVISOR
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
•
72
Minimum of 50 above special procedures are to be prior to appearing of exams.
MINOR PROCEDURES
EPILATIONS
73
MINOR PROCEDURES
EPILATIONS
SR.
NO.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
74
DATE
DIAGNOSIS
SIGNATURE OF SUPERVISOR
MINOR PROCEDURES
SKIN GRAFTING
75
MINOR PROCEDURES
SKIN GRAFTING
SR.
NO.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
76
DATE
DIAGNOSIS
SIGNATURE OF SUPERVISOR
SERVING SCIENTIFIC ACTIVITY
77
SERVING SCIENTIFIC ACTIVITY
SR. NO.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
78
DATE
TOPIC
SIGNATURE OF SUPERVISOR
HISTOPATHOLOGY
79
HISTOPATHOLOGY
SR.
NO.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
80
DATE
TOPIC
REMARKS
SIGNATURE OF SUPERVISOR
SR.
NO.
26.
DATE
HISTOPATHOLOGY
DIAGNOSIS
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
•
81
50 slide discussions is mandatory prior to examination.
REMARKS
SIGNATURE OF SUPERVISOR
JOURNAL CLUB PRESENTATION
82
JOURNAL CLUB PRESENTATION
SR.
NO.
DATE
TOPIC
REMARKS
SIGNATURE OF
SUPERVISOR
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
•
83
A minimum of 20 presentations is mandatory prior to examination.
CASE PRESENTATION
84
CASE PRESENTATION
SR.
NO.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
85
DATE
TOPIC
REMARKS
SIGNATURE OF SUPERVISOR
CASE PRESENTATION
SR.
NO.
26.
DATE
DIAGNOSIS
REMARKS
SIGNATURE OF SUPERVISOR
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
•
86
A minimum of 50 presentations is mandatory prior to examination.
DOHMS Internal Medicine Residency Program
Clinical ROTATION Evaluation
Resident Name: (optional)__________________Rotation__________________________
This Form is designed to provide resident feedback to Programme Administrators concerning strengths and areas to improve in the variety
and organisation of clinical exposures provided in the different clinical rotations of the Internal Medicine Programme. The forms will be
given to the rotation supervisor of each rotation at the end of the rotation. Please feel free to be candid and objective. All comments will not
be traceable to the resident completing the form by the immediate supervisor.
Rank the following statements on a scale of 1 to 7 on whether you agree or disagree with them as they
pertain to this rotation (1= strongly disagree; 7 = strongly agree)
Evaluation Scale:
Organization of the Rotation
The overall workload of the rotation was appropriate
(please make a comment in comments section as to if
workload was too light or too heavy)
Patient Rounds were run in an efficient manner
balancing teaching with patient care needs
The amount of scut in the Rotation was appropriate
Could
not
Judge
Strongly
Disagree
Strongly
Agree
0
1
2
3
4
5
6
7
0
1
2
3
4
5
6
7
0
1
2
3
4
5
6
7
0
1
2
3
4
5
6
7
0
1
2
3
4
5
6
7
0
1
2
3
4
5
6
7
There was adequate access to internet resources and
books if I needed to look something up
The bedside teaching was very good
0
1
2
3
4
5
6
7
0
1
2
3
4
5
6
7
I received my evaluation before the rotation ended
0
1
2
3
4
5
6
7
0
1
2
3
4
5
6
7
0
1
2
3
4
5
6
7
0
1
2
3
4
5
6
7
0
1
2
3
4
5
6
7
0
1
2
3
4
5
6
7
0
1
2
3
4
5
6
7
0
1
2
3
4
5
6
7
The clinical material I saw provided a good exposure
to the field of practice of the rotation
I was given clinical responsibilities appropriate for
my level of training (please make a comment in
comments section as to whether too much or too little
was expected of you)
Teaching
The academic activities of the division provided
good learning opportunities
I received feedback about my performance
throughout the rotation
Organisation
There was adequate space for me to complete my
work
The supervising staff were available for back up and
consultation if needed
The rotation was arranged in such a way that I was
able to attend other Teaching Activities
Resident – Faculty Interactions
I felt that my contributions to the department’s
clinical activities were valued
My opinions were respected and I felt like a member
of the team.
Overall
Overall this rotation allowed me to meet most of the
rotation specific educational objectives
87
Comments:
Adapted from McGill Paediatric Residency Forms
88
DOHMS Internal Medicine Residency Program
Clinical Rotation FACULTY Teaching Evaluation
Resident Name: (optional)__________________Rotation__________________________
This Form is designed to provide resident feedback to Programme Administrators concerning strengths and
areas to improve in the quality of training by providing an assessment of teaching staff in the Internal Medicine
Programme. The forms will be given to the resident at the end of each rotation. Please feel free to be candid
and objective. All comments will not be traceable by the faculty in question to the resident completing the form.
Rank the following statements on a scale of 1 to 7 on whether you agree or disagree with them as they pertain to
this rotation (1= strongly disagree; 7 = strongly agree) Please Rate the Faculty Member’s teaching style and
capacity to function as a role model.
Clinical Teaching Faculty: _______________
_______________
Rotation:
(Note: Use a separate sheet for each supervising Faculty Member)
Could Strongly

not
Disagree
Judge
Medical Expert
Up–to-date in area of practice, scientific and
clinical knowledge
Strongly
Agree
0
1
2
3
4
5
6
7
0
1
2
3
4
5
6
7
0
1
2
3
4
5
6
7
0
1
2
3
4
5
6
7
0
1
2
3
4
5
6
7
0
1
2
3
4
5
6
7
0
1
2
3
4
5
6
7
0
1
2
3
4
5
6
7
0
1
2
3
4
5
6
7
0
1
2
3
4
5
6
7
0
1
2
3
4
5
6
7
0
1
2
3
4
5
6
7
0
1
2
3
4
5
6
7
The highest levels of integrity and honesty
Sensitivity to and respect for diversity
Compassion and Empathy
0
1
2
3
4
5
6
7
0
1
2
3
4
5
6
7
0
1
2
3
4
5
6
7
Recognition of own limitations
Application of the principles of medical ethics
to clinical situations
0
1
2
3
4
5
6
7
0
1
2
3
4
5
6
7
Promotes development of trainee’s judgement
and decision making
Supervised the teaching of procedural skills
Communicator
Role model for effective & compassionate
communication with patients & families
Clear written communications documentation
Collaborator
Role model for care in interdisciplinary setting
Respectful interaction with trainees/ other
colleagues in clinical situations
Provided appropriate graded responsibility
to the resident during the rotation
Manager
Role modeled the use of health care resources
cost effectively
Organization of work and time management
Health Advocate
Role-modeled just advocacy for his/her
individual patients
Scholar
Promoted critical appraisal skills in teaching
and clinical work
Enthusiasm for and effectiveness at teaching
Professional Role modelled and promoted the
values of:
89
Comments:
Adapted from McGill Paediatric Residency Forms
90
DOHMS INTERNAL MEDICINE RESIDENCY PROGRAM
ROTATION IN-TRAINING ASSESSMENT (RESIDENT)
Name:
Period of Training
Resident: I
Rotation:
II
FROM:
III
IV
TO:
V VI
MEDICAL EXPERT
Basic scientific knowledge
Basic clinical knowledge
History & physical examination
Interpretation & use of information
Clinical judgment & decision making
Technical skills
COMMUNICATOR
Communication with other allied health
professionals
Communication with patients & families
Written communication & documentation
COLLABORATOR
Consults effectively with all health
professionals
Delegates effectively
MANAGER
Understands & uses IT
Uses resources cost-effectively
Organises work & manages time well
HEALTH ADVOCATE
Advocates for the patient
Advocates for the community
SCHOLAR
Motivated to acquire knowledge
Critically appraises medical literature
Teaching skills
Completion of research/project
PROFESSIONAL
Integrity & honesty
Sensitivity & respect for diversity
Responsibility and self-discipline
Professional relationships with physicians
Recognition of own limitations, seeking
advice when needed
Understands and applies principles of
ethics clinical situations
GLOBAL EVALUATION OF
COMPETENCE AND PROGRESS
91
Site:
Could
not
Judge
Strongly
Disagree
Strongly
Agree
0
0
0
0
0
0
1
1
1
1
1
1
2
2
2
2
2
2
3
3
3
3
3
3
4
4
4
4
4
4
5
5
5
5
5
5
6
6
6
6
6
6
7
7
7
7
7
7
0
1
2
3
4
5
6
7
0
0
1
1
2
2
3
3
4
4
5
5
6
6
7
7
0
1
2
3
4
5
6
7
0
1
2
3
4
5
6
7
0
0
0
1
1
1
2
2
2
3
3
3
4
4
4
5
5
5
6
6
6
7
7
7
0
0
1
1
2
2
3
3
4
4
5
5
6
6
7
7
0
0
0
0
1
1
1
1
2
2
2
2
3
3
3
3
4
4
4
4
5
5
5
5
6
6
6
6
7
7
7
7
0
0
0
0
0
1
1
1
1
1
2
2
2
2
2
3
3
3
3
3
4
4
4
4
4
5
5
5
5
5
6
6
6
6
6
7
7
7
7
7
0
1
2
3
4
5
6
7
0
1
2
3
4
5
6
7
COMMENTS (Including Strengths, Weaknesses and Need for Special Attention.
Please use reverse side if necessary)
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
_______________________________________________
______________________________ ____________________________
Signature of Supervisor
Signature of Trainee
Date
Date
DISAGREE
Adapted from McGill Paediatric Residency Forms
92
AGREE