While on their Duke rotations, residents see patients in outpatient clinics at the Duke South Clinic and Patterson Place Clinic. Approximately 30,000 outpatient encounters are recorded each year. Since Duke is the major private tertiary care center in the Southeast, physician and hospitals refer complicated cases from all over the region. Duke is also a primary care facility for the people of the city/county of Durham and surrounding cities/counties. When our residents rotate through outpatient clinics, they focus on either
general dermatology or specialty dermatology. We have a robust and experienced group of general dermatologists, Drs. Atwater, Pipkin, Powers, Myers, Murray, Wolfe, Nicholas, and Pavlis. We see primary care dermatology patients from the surrounding communities, as well as complicated medical dermatology referrals from North Carolina and surrounding states. Most of our faculty also hold specialty clinics. We are especially proud of our Resident Continuity Clinic. This is a weekly clinic where each resident, with attending supervision, is the primary dermatologist for his/her panel of patients. In addition, second and third year residents have the opportunity to develop a weekly Continuity Clinic in a field of interest, and first year residents have a weekly general dermatology continuity clinic.
Durham VA Medical Center
The dermatology service at the Durham VA Medical Center has active inpatient, outpatient and consult services. The general dermatolo
gy clinic has approximately 6,600 outpatient visits per year. Dr. Caroline Rao is the Chief of the Dermatology Section at the VA. Clinics are staffed by Drs. Cardones, Hall, Lesesky, Rao, Ronald, Sidhu-Malik, Wolfe and Pavlis. There are two general dermatology clinics and three procedure clinics at the VA per week. The VA Chief rotation (2nd and 3rd year) is an excellent experience which includes consults, dermatologic surgery, general clinics, high risk clinics, teledermatology and administrative experience.
A resident-staffed Dermatologic Surgery clinic is held bi-weekly in which outpatient surgery for both benign and malignant skin disease is performed. The inpatient consult service provides dermatologic consultation to the entire hospital and sees over 800 consults per year. Immediate dermatologic consultation is provided to all VA outpatient clinics, as well.
Dermatology residents rotate through an active pediatric dermatology clinic, located at Patterson Place, with Dr. Neil Prose and Dr. Jane Bellet. Our patient population comes from both internal Duke Pediatrics referrals and external referrals from pediatricians and dermatologists from across the Southeast. Hospitalized infants and children are seen in consultation with the pediatric inpatient service. Residents have exposure to pediatric dermatologic surgery and laser therapy. Didactic sessions are held within the framework of the conference schedule to familiarize trainees with the full spectrum of pediatric dermatology. 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.
The Mohs Surgery Unit, directed by Dr. Jonathan Cook, provides residents with training in cutaneous surgery. The unit is located at Patterson Place. Although the clinical emphasis is on Mohs Surgery, residents are also exposed to a variety of common dermatologic surgical procedures. These include routine operations (cyst removal, nail surgery, curettage, electrosurgery, simple excisions), reconstructive procedures (skin flaps, skin grafts) and dermabrasion. Second and third year residents spend 3 weeks per year in this clinic. In select circumstances, second and third year residents with a strong interest in Mohs surgery can request an additional two week block with Dr. Cook.
Procedural and Cosmetic Experience
In addition to the Mohs surgery component of surgical training, 1st year residents spend five weeks in procedure clinics, 2nd year residents spend 2 weeks in procedure clinics and 1 week in cosmetic clinic, 3rd year residents spend 3 weeks in procedure clinics and 2 weeks in cosmetic clinic. In addition, our residents work with our general dermatology attendings who perform dermatologic surgery, including excision of benign and malignant lesions, nail procedures, acne surgery and destruction of benign lesions (Drs. Atwater, Lesesky, Nicholas, Pavlis, Powers and Wolfe). Our residents have resident surgical clinic every other month in conjunction with the resident continuity clinic. Dr. Powers precepts our resident cosmetic continuity clinic at Patterson Place.
Increasingly, laser therapy of skin conditions is a part of everyday dermatology practice and knowledge of the strengths and weaknesses of laser will be useful for appropriate advice and referral. You will observe laser surgery in an extraordinary diversity of conditions. Dr. Claude Burton directs the Laser Clinic. The Resident Laser Clinic offers the opportunity to independently evaluate the patient, explain the procedure, obtain informed consent, and treat the patient, with attending supervision. There is also a resident laser clinic at the VA hospital and opportunity for laser use at Patterson Place clinics.
All dermatology residents undergo formal, supervised training in dermatopathology each year of their residency,
rotating 1-2 months/year in the dermatopathology unit. Our dermatopathology faculty are Dr. Angelica Selim and Dr. Kenneth Ellington. Residents have an opportunity to review all of the day's slides prior to sign-out at a multiheaded microscope by the attending dermatopathology staff. This case material includes all the in-house skin biopsies and excisions performed at Duke University Medical Center and affiliated practices, all outside dermatopathology consultation cases including a large volume of melanoma specimens, and numerous histochemical, immunohistochemical, and immunofluorescence studies. A working consensus conference on the day's challenging cases is held daily by the senior dermatopathology staff, and is also attended by dermatology residents. Dermatology residents performing clinical rotations are encouraged to study the slides of their biopsies and excisions. Senior dermatopathology staff and fellows are available to meet with dermatology residents to review any cases, on an individually scheduled basis. Dermatology residents may also have the opportunity to spend elective time within the dermatopathology unit, performing research projects or reviewing particular topics of interest.
The Pathology potpourri conference, directed by the dermatopathology fellows, reviews interesting recent dermatopathology slides and is held weekly throughout the year. This is conducted at a multiheaded microscope. The Pathology text-slide conference, covering topics in dermatopathology systematically, is held weekly throughout the year. The conference is run by the dermatopathology attendings and fellows, and is conducted at a multiheaded microscope, with additional viewing available from a TV monitor. The series is organized topically around a dermatopathology textbook. Residents have one week prior to the conference to review the corresponding chapter and slides. Review sessions on areas previously covered are also mixed in during the course of the year.
Duke Hospital Consults
Our residents participate in a strong hospital consult service at Duke. This is a predominantly second and third year rotation, with some introductory experience for first years. The service is directed by Dr. Adela Cardones. Drs. Caroline Rao, Sarah Wolfe, and Navjeet Sidhu-Malik, and Tara Jaleel are also part of the consult team. Our residents see inpatients on the adult and pediatric inpatient service, in the Emergency Room, and help to coordinate referrals and calls from physicians from within and outside Duke. They read dermatopathology slides of inpatient cases with the dermatopathology team. They are actively involved in the daily care of our inpatients.
Lincoln Community Health Center
First year residents actively participate in dermatology clinics at Lincoln Community Health Center. As taken from
their website, “The Mission of Lincoln Community Health Center is to provide comprehensive primary and preventive health care in a courteous, professional and personalized manner. As a leader in the provision of community health care, Lincoln Community Health Center is committed to collaborating with other institutions dedicated to the continuous improvement in services being provided to decrease health disparities, while assuring access to all.” This clinic focuses on providing dermatologic services to the medically underserved in our community. Faculty attend on a rotating basis, with Dr. Caroline Rao acting as anchor, as a monthly attending supervisor.
Our second year and third year residents rotate through the Duke Student Health Clinic. This clinic is designed as an opportunity for residents to see and manage patients largely in an independent manner. Faculty supervision is provided, but the resident is identified as the primary provider for the encounter. There is opportunity for individual continuity of care as well as colleague to colleague communication to ensure the care plan is carried out smoothly. In addition, the resident is responsible for providing feedback to the primary care physician as the majority of the patients in the clinic are referred for dermatologic evaluation.
Second and third year residents have the opportunity to do clinical and/or research electives during the academic year. This opportunity is dependent upon a variety of factors including the status of the resident, the purpose of the proposal, the timing and location of the elective, departmental resources and administrative issues. Examples of previous resident electives include an elective in Africa, an elective at the NIH, specialty electives at other academic dermatology departments in the United States, and administrative/research electives.