Resident Continuity Clinic
The Resident Continuity Clinic is a unique component of the Residency Program in that it allows residents to develop expertise in the diagnosis and management of a broad range of dermatologic conditions with relative autonomy under the tutelage of departmental faculty. Residents are encouraged to use their knowledge of disease processes and evidence based therapies to formulate differential diagnoses and systematically evaluate treatment options for their patients. A comprehensive treatment plan is formulated by the resident with the aid of attending physician in order to provide safe, effective and efficient care. Residents are subsequently able to follow their patient's progress and, as needed, re-evaluate and modify diagnoses and treatment strategies. This clinic also is the home to the department's Phototherapy center. Residents will learn how to use NBUVB, UVA, UVA-1, and photodynamic therapy throughout their training.
General Dermatology Clinics
The foundation of necessary skills for a practicing dermatologist is based in an exhaustive knowledge of medical dermatology. Exposure to the vast array of clinical presentations, diagnoses, and treatment strategies in the practice of dermatology comes primarily in the setting of general dermatology clinics. Residents in the UPMCMEP in Dermatology are active participants in numerous general dermatology clinics, which are conducted in a number of different settings, from the traditional university based clinic to private practice offices. The unifying theme for these experiences is an emphasis on the mastery of differential diagnoses based on morphology, sound medical decision making and an appreciation for diverse approaches to management.
Adult Inpatient Consult Service
The inpatient consult residents with attending supervision are responsible for covering the UPMC hospitals on the Presbyterian, Shadyside campus. This will expose the resident to general medicine, general surgery, ob-gyn, oncology, and transplant services as well as extensive consultations from our innumerable intensive care units. Residents have relative autonomy in accepting and completing consultations. The residents usually have more time to accomplish the intense consults because they do not have any clinic requirements during their month on service. The Department of Dermatology does not directly admit patients to the hospital; we admit patients to the medicine service and follow the patients as consultants.
Pediatric Clinic and Inpatient Consult Service
Pediatric dermatology clinics operate in free-standing facilities separate from the other general dermatology clinics in order that clinical care setting, evaluation, and treatment can be tailored to meet the unique needs of children. Therefore, the pediatric dermatology rotation allows residents the opportunity to become familiar with the vast array of dermatologic conditions specifically affecting the pediatric population. Residents gain an in-depth knowledge of the clinical and pathologic findings of pediatric skin conditions and develop skills for making informed decisions regarding treatment modalities. Through both outpatient and inpatient experiences, residents also gain an appreciation for common cutaneous manifestations of systemic disease in children as well as the effects that therapeutic interventions have on growth and development.
The cutaneous oncology clinics consist of Pigmented Lesions clinic, Cutaneous T-cell Lymphoma clinic, Mohs Surgery clinic, and the inpatient Photopheresis Unit for the treatment of CTCL. The clinics are designed to provide dedicated treatment environment for the unique needs of patients' melanocytic and lymphoproliferative conditions. Under the direction of authorities in the fields of dermatology, medical, and surgical oncology, residents acquire the skills needed for comprehensive clinical evaluation and appropriate multi-disciplinary management of melanocytic lesions and cutaneous lymphomas, respectively. In addition, time is dedicated to honing surgical skills required for the management of these diseases as well.
Psoriasis is traditionally one of the most commonly encountered diagnoses in the field of dermatology. Despite this relative frequency and the advent of biologic therapies, there is a subset of patients for whom complex treatment regimens are required in order to achieve maximal control. The psoriasis clinic allows residents to participate in the care of such patients while developing a thorough knowledge of the disease process and the various therapeutic options available. In addition, special attention is paid to effects on the physical, emotional and functional well being of psoriatic patients.
A number of cutaneous findings can occur as a result of the skin's contact with substances in the environment. The most commonly recognized condition is allergic contact dermatitis, which can occur from common, well recognized substances such as Toxidendron (poison ivy) or less commonly seen things such as preservatives and topical corticosteroids. The gold standard for the diagnosis of a causative agent for contact dermatitis is patch testing, developed more than 100 years ago. At the UPMCMEP in Dermatology, residents have the opportunity to participate in both the intricate evaluation of patients with contact dermatitis as well as devising and performing focused, expanded panel patch testing.
Specialty: Hair and Nail
This clinic offers the residents the ability to diagnose and manage a wide range of scarring and non-scarring alopecia as well as all forms of onychodystrophy. Residents will become competent in scalp biopsies and all forms of nail unit procedures.
Blistering disorders represent a wide array of fascinating cutaneous diseases that require extensive pharmacologic knowledge of immunosuppressive drugs. Residents get exposed to a variety of epidermal and sub-epidermal immunobullous diseases, as well as all immunodiagnostic techniques. The use of immunosuppressive agents and biologics for the management of such diseases is stressed and residents will develop a high-degree of comfort in using and managing patients with these drugs.
Third-year residents are encouraged to go to any ACGME-accredited program in the country for four weeks during their final year of training. This time is used to supplement any area the resident feels he or she needs additional educational experiences.
Specialty: Procedural Dermatology
Residents in the UPMCMEP in Dermatology gain procedural experience in several different clinical settings. Surgical skills, focused around excisional surgery, are developed in resident surgical clinics at the University, the VA medical center surgical procedural clinics, and in general and cosmetic surgical clinics at the Cosmetic Surgery and Skin Health Center. Through their surgical rotations and general dermatology rotations, residents are trained in the appropriate use of local anesthesia, cryosurgery, electrosurgery, and various standard biopsy techniques. Moh's micrographic surgery is incorporated into the procedural dermatology experience as monthly resident Moh's surgery clinics as well as rotations with well renowned community based Moh's micrographic surgeons. In addition, residents gain experience in the performance of a wide variety of cosmetic dermatology procedures, skin health, and skin rejuvenation through clinics at the department's Cosmetic Surgery and Skin Health Center. They are able to participate in a number of different types of cosmetic dermatologic procedures including chemical peels, Botox injections, laser skin rejuvenation, laser hair removal, dermabrasion, blepharoplasty, rhytidectomy, fat augmentation and liposuction.
Dermatopathology plays an intricate role in the overall practice of dermatology. The dermatopathology rotation allows residents to participate in daily dermpath diagnostic sign-out in order to gain experience in interpreting cutaneous biopsies. This intensive experience enhances the resident's ability to generate comprehensive differential diagnoses based on histologic features as well as incorporate histochemical, immunochemical, and microbiologic data in order to make clinico-pathologic correlations. In addition, close contact with the Dermatopathology faculty aids the residents in refining biopsy techniques by learning to optimize histology, select appropriate lesions, obtain adequate biopsy tissue depth and minimize scarring.