Duke Department of Dermatology :: Residency Program

Residency Program

Rotations
Duke | Durham VA | Pediatric | MOHS | Dermatopathology

Duke Clinic

Residents see patients in outpatient clinics at the Duke South Clinic and the Center for Aesthetic Services (satellite clinic). All attendings (Drs. Atwater, Bellet, Burton, Cook, Hall, Lee, Murray , Myers, Nelson, Olsen, Pipkin, Prose, Rao, Walters) have residents assigned to their respective clinics. Approximately 36,000 total outpatient encounters are recorded each year. Since Duke is the major private tertiary care center in the Southeast, physicians and other hospitals refer complicated, hard-to-treat diseases from all over the region. Duke is also a primary care facility for the people of Durham and surrounding counties.

We realize that increased information processing is crucial to first quality medical care and clinical investigation now and in the future. For this reason, our department has made a commitment to develop and implement an on-line clinical data base. We have selected and helped to develop software that will integrate the chores of running the clinic and information collection in an on-line fashion. Computers with access to medical literature and the Internet are available in all clinic locations and residents develop the skills necessary to utilize all of these resources. Residents are also educated in billing and compliance issues.

Durham VA Hospital

The dermatology service at the Durham VA Hospital has active inpatient, outpatient and consult services. The general dermatology clinic has approximately 6,600 outpatient visits per year. Dr. Russell Hall and Dr. Navjeet Sidhu-Malik are supervising attendings at the VA. There are two general dermatology clinics at the VA per week and in general, a resident is assigned to one per week.

In addition, a weekly Dermatologic Surgery clinic is held in which outpatient surgery for both benign and malignant skin disease is performed. Phototherapy, including both UVA and UVB is also available for inpatients and outpatients. 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. The VA hospital provides an active general dermatology service offering to the resident staff direct patient care of a broad spectrum of clinical problems.

Pediatric Dermatology

Dermatology residents rotate through an active pediatric dermatology clinic which is held six half days per week and is directed by Dr. Neil S. Prose. In addition, first and second year residents will each spend a month devoted to pediatric dermatology. Patients come from the primary care population of the pediatric service and referrals from pediatricians and dermatologists from outside Duke University . Most patients (approximately 15-20 per half day clinic x 6 per week) are seen by residents and faculty. Hospitalized infants and children are seen in consultation with the pediatric inpatient service. Didactic sessions are held within the framework of the conference schedule to familiarize trainees with the full spectrum of the developing area 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.

Mohs' Surgery and Dermatologic Surgery

The Mohs' Surgery and Dermatologic Surgery Unit, directed by Dr. Jonathan Cook, provides residents with training in cutaneous surgery. The unit is located at the Center for Aesthetic Services and includes four well-equipped procedure rooms, two laser rooms (CO2 Laser, Vascular Laser and Q-Switched Nd:YAG Laser), and a histology laboratory. The unit is staffed by two nurses, two histotechnologists, and a complete support staff.

Former graduates of the dermatologic surgery fellowship program are now chiefs of dermatologic surgery at Ohio State University , Boston University , the University of Arkansas , and Emory University . Although the clinical emphasis is on microscopically controlled excision for skin cancer (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, acne surgery), reconstructive procedures (skin flaps, skin grafts), cosmetic surgery (hair transplantation, dermabrasion, chemical peel, dermal augmentation), CO2 laser resurfacing surgery, and lasers used to treat vascular lesions, tattoos, and pigmented skin lesions. Several clinical research studies dealing with wound healing, scar treatment and skin cancer biology are also in progress.

Residents rotate through the dermatologic surgery service a minimum of one month each year and may also spend additional elective time in dermatologic surgery. Residents hold a dermatologic surgery clinic monthly, which provides an opportunity for them to perform additional surgical procedures under supervision.

Dermatopathology

Dermatopathology Rotation and Other Exposure
All dermatology residents undergo formal, supervised training in dermatopathology each year of their residency, rotating 1-2 months/year in the dermatopathology unit. 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. The consultation team dermatopathology working conference is held by senior dermatopathology staff daily from 1:00-1:30 PM, and reviews and discusses all consult service biopsies. This session is attended by the resident on the dermatopathology rotation and by the house staff performing inpatient consultations at Duke University Hospital. 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.

Didactic Conferences
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.