DERMATOLOGY RESIDENCY PROGRAM

GOAL

The five-year program training in dermatology involves the development of a thorough knowledge of the skin, its appendages and mucous membranes both in health and disease, and the acquisition of clinical and technical skills in the management of all diseases related to the skin. The training will provide expertise in diagnosis, investigation and both medical and surgical management of skin diseases, while promoting aptitudes of competence in dermatological consultation, education and learning.

GENERAL OBJECTIVES

In accordance with objectives specified by the Royal College of Physicians and Surgeons of Canada and by the Collège des médecins du Québec, at completion of training, the resident will have acquired the following competencies and will function effectively as:

Medical Expert

At completion of training, a resident must have a detailed knowledge and understanding of:1. Clinical skills

1.1. Sciences basic to dermatology (embryology, gross and microscopic anatomy, microbiology, biochemistry, physiology and immunology)1.2. Clinical skills in diagnosing cutaneous disease (skin, mucous membranes and appendages) by the use of history, physical examination and pertinent investigative procedures.1.3. The cutaneous manifestations of systemic diseases in patients of all ages.1.4. Dermatological therapy: percutaneous absorption, the pharmacology and side effects of topical and systemic medications, and the use and complications of electrosurgery, cryotherapy and cryosurgery, immunotherapy, ultraviolet light and ionizing radiation, laser surgery, dermatological surgery.1.5. Dermatopathology and immunodermatopathology.1.6. The formulation of an appropriate differential and provisional diagnosis.1.7. The organization of appropriate laboratory investigation. 1.8. The development of an appropriate treatment plan taking into consideration the patient’s age,

general health, risk and cost of investigative procedures, risk and cost of therapeutic interventions and epidemiology and natural history of the disease.

1.9. The dermatological literature and an analytical and critical appraisal of it. 2. Technical skills 2.1. Perform pre-surgical assessment for the most suitable therapeutic modality.

2.2. Obtain written informed consent for dermatological procedures.2.3. Knowledge and experience involved in the use of local anesthesia, sterilization techniques,

appropriate sterile surgical techniques and suture materials.2.4. All technical skills required for the practice of dermatology, such as skin biopsy (punch, shave, saucerization, excisional), curettage and electrodessication, simple excision and layered closure, cryosurgery and nail surgery.2.5. Provide appropriate post-operative care and aid in wound healing2.6. Acquire other diagnostic skills required for the practice of dermatology including, potassium

hydroxide preparations, scrapings for mites, Tzanck smears, Gram stain, fungal culture, Wood’s light examination, viral immunofluorescence, hair mount, patch and photopatch testing, epiluminescence microscopy.

2.7. Knowledge and understanding in the indications, techniques, limitations and complications of complex dermatological surgery including Mohs micrographic surgery, flaps and grafts, dermabrasion, laser surgery and cosmetic dermatological procedures such as chemical peels,

soft tissue augmentation, hair replacement.Communicator

After residency training, the graduate physician will be competent to function as a consultant in Dermatology. This requires the physician to:1. Communicate effectively with patients, their families in clearly understood language.2. Be sensitive and listen effectively to the patients’ voiced concerns to better understand the

patients’ psychological, occupational and social needs, taking into account the diversities of race, culture and gender.

3. Communicate clearly, thoroughly and as frequently as needed with medical colleagues, particularly referring physicians.

4. Deliver in a professional manner written communication that is legible.5. Communicate fully with those carrying out diagnostic tests (e.g. pathologists) in order to ensure

the best outcome for the patient.6. Communicate effectively with and show respect towards nurses, paramedical and other health care

personnel.

Collaborator

As part of his/her competence as a consultant, the graduate physician should be able to:1. Consult effectively other physicians and health care professionals.2. Contribute effectively to other interdisciplinary team activities.3. Provide instruction to medical students, house officers, other health care personnel, patients and

the public at a level appropriate to their professional competence and education.

Manager As part of his/her training, the graduate resident should:

1. Record and maintain complete and accurate medical records for every patient seen.2. Understand and utilize information technology to optimize patient care and for life-long learning

and other activities.3. Utilize health care resources cost-effectively to balance patient care, learning needs and outside

activities.4. Develop effective use of time based on planning and punctuality.5. Develop efficiency as well as accuracy in clinical skills.6. Reserve time for reading and keeping current with the dermatological literature.7. Understand the principles of practice management.

Health Advocate The graduate resident should:

1. Educate and be available as a resource person to counsel patients effectively on skin disorders.2. Counsel patients on the importance of taking responsibilities for their own well-being and of

preventive medicine, specifically on issue of photoprotection and self-examination.3. Understand the role of national and international bodies (e.g. Canadian Dermatology Association

Safety in the Sun, Skin Cancer Foundation) in the promotion of skin health and in the prevention and treatment of skin diseases.

4. Learn about community resources and related patient support group.

Scholar

To maintain the quality of his/her competence, the graduate resident should:1. Develop, implement and monitor a personal continuing education strategy for life long learning.2. Be able to critically appraise dermatology literature as well as non-academic or alternative sources

as they are related to patient diagnosis, investigation and treatment.

3. Be able to participate in clinical or basic science studies as a member of a research team.4. Be able to describe the principles of good research and to judge whether a research project is

properly designed.5. Be able to prepare a paper for publication in a peer-reviewed journal.

Professional

As a competent consultant, the graduate resident should:1. Deliver highest quality care with integrity, honesty, compassion and empathy.2. Exhibit appropriate personal and interpersonal professional behaviours.3. Practice medicine ethically and with sensitivity and respect for diversity, consistent with

obligations of a physician.4. Recognize his/her own limitations with regard to skill and knowledge and seek advice when

needed by appropriately consulting other physicians and paramedical personnel when caring for the patient.

5. Demonstrate knowledge of medico-legal and bioethical issues that pertain to the practice of dermatology.

The goal and objectives of each year will be detailed in the following sections, and only objectives particular to the rotations not mentioned in the general objectives will be listed. Other objectives related to various spheres of competence when not mentioned will be the same as in the general objectives.

POSTGRADUATE YEAR 1

GOAL

The first postgraduate year consists of rotations in general internal medicine and internal medicine sub-specialties and will provide the resident with a comprehensive training in a wide range of diseases in internal medicine, with emphasis on areas of internal medicine that have particular relevance to the practice of dermatology.

CLINICAL TEACHING UNITS: ROTATION-SPECIFIC OBJECTIVESRotations include: CTU and/or ICU

Medical expert1. Acquire a solid knowledge base of basic science and clinical information related to general

internal medicine diseases.2. Develop proficiency in the clinical diagnosis, investigation and management of a wide variety of

internal medicine disorders of a serious nature.Communicator

1. Develop the communication skills required for the effective and sensitive interaction with patient and their families, especially when discussing serious conditions and announcing bad news.

Collaborator1. Function as a member of a hospital-based health team consisting of students, residents, other

physicians, nurses, special therapists and technicians.Manager

1. Learn to coordinate in-hospital care with ambulatory and community based resources for follow-up care.

INTERNAL MEDICINE SUB-SPECIALITIES: ROTATION-SPECIFIC OBJECTIVES

INFECTIOUS DISEASES/MICROBIOLOGY Rotations include: Infectious Diseases, Tropical Diseases, Sexually Transmitted Diseases or Mycology.Medical Expert

1. Acquire a broad knowledge of the basic science and clinical principles of infectious diseases2. Become proficient in the methods of diagnosis, investigation and management of infectious

diseases in particular those relevant to cutaneous diseases.3. Learn appropriate laboratory techniques for the identification of specific infectious agents.

Manager1. Become familiar with community and public health principles in the investigation and

management of infectious diseases.

HEMATOLOGY-ONCOLOGYMedical Expert

1. Develop a solid knowledge base of the basic science and clinical information related to neoplastic diseases.

2. Gain a proficiency in the clinical diagnosis and investigative procedures of neoplastic disease.3. Learn the appropriate application of therapeutic modalities employed in the treatment of

malignancies, including surgery, radiotherapy, chemotherapy and immunotherapy, especially the indications and adverse effects of each modality.

Professional

1. Develop skills in communicating serious conditions to patients and their family with empathy and compassion.

RHEUMATOLOGY, ALLERGY AND IMMUNOLOGYMedical Expert

1. Develop a strong knowledge base of the basic science and clinical information related to: rheumatologic diseases and other autoimmune disorders with a significant dermatological

components, allergic and immunologic diseases, particularly those with a significant cutaneous

component.2. Develop specific diagnostic and investigative skills appropriate to the assessment of

rheumatologic diseases.3. Become proficient in the methods of investigation utilized to identify specific allergic conditions.4. Gain a comprehensive knowledge of therapeutic modalities used in rheumatologic diseases.5. Learn the principles and practical considerations of the management of allergic/immunologic

diseasesCollaborator

1. Develop skills in participating as a collaborative member of the health-care team taking care of patients with complex rheumatological conditions and in consulting effectively other health care personnel when needed, including physical and occupational therapists, social workers and psychologists.

Manager1. Learn to utilize efficiently community resources and patient support groups in the care of patients

with complex rheumatological and immunologic diseases.Health Advocate

1. Counsel patients on the importance of taking responsibilities for their own well-being and avoiding allergens and environmental exposure that may worsen their conditions.

ENDOCRINOLOGYMedical Expert

1. Develop a solid knowledge base of the basic science and clinical principles of endocrinologic diseases, particularly those conditions relevant to dermatology.

2. Develop skills in clinical diagnosis of endocrinologic disorders.3. Gain proficiency in the appropriate methods of investigation and management of endocrinologic

diseases.

POSTGRADUATE YEAR 2

GOAL

The second postgraduate year provides reinforcement of general medical knowledge acquired during the undergraduate years. The resident should become proficient in clinical examination, diagnosis and management of a broad range of medical conditions by exposure to a variety of basic clinical disciplines including Family Medicine, Pediatrics, Emergency Medicine and Plastic Surgery.

FAMILY MEDICINE: ROTATION SPECIFIC OBJECTIVESRotations include: Family Medicine or CLSC.

Medical Expert1. Reinforcement of clinical diagnostic, investigative and therapeutic skills developed during the

undergraduate training period.2. Ability to diagnose, investigate and treat a broad range of common medical conditions.

Communicator

1. Ability to effectively communicate with patients and family for the purposes of information gathering, investigation and explanation of the nature of illness and therapy.

Collaborator1. Ability to function and communicate effectively as a member of a team of health professionals,

including administrative and nursing staff, special therapists, and other physicians both hospital- based and community-based.

Manager1. Competence in formulating comprehensive management plans for common medical problems,

while recognizing the impact of socioeconomic factors on patient care and therapy.2. Understanding of the ambulatory approach to investigation and therapy of medical disorders

including awareness of administrative aspects with respect to patient scheduling, follow-up, investigation, and data retrieval.

ADULT EMERGENCY: ROTATION-SPECIFIC OBJECTIVES

Medical Expert 1. Reinforce diagnostic and investigative skills acquired during undergraduate training. 2. Assess a wide range of acute problems of both medical and surgical natures. 3. Develop efficiency and precision in technical skills used in the diagnosis and investigation of

acute illnesses, including physical examination, laboratory and radiological investigation.Communicator 1. Develop the ability to communicate effectively with patients and families regarding the nature

and management of acute diseases.2. Develop the ability to communicate effectively with other members of the health team including

students, residents, other physicians, nurses, technicians and therapists.

PEDIATRICS: ROTATION-SPECIFIC OBJECTIVESRotations include: Pediatric Wards, Pediatric Emergency and/or Genetics.

Medical Expert1. Acquire a strong knowledge base of common pediatric diseases and an overview of various

genodermatoses, particularly those with important cutaneous features.2. Apply appropriate techniques of diagnosis, investigation and management to the pediatric patient.

Communicator1. Communicate effectively with patients, parents and other caregivers with respect to all aspect of

pediatric patient case-history taking, examination, investigation, management and discussion of the nature of illness.

Collaborator1. Learn to function as member of a health care team in the management of complex genetic

conditions.

SURGERY SUB-SPECIALITIES: ROTATION-SPECIFIC OBJECTIVESRotations include: Plastic Surgery, Ophthalmology, Surgery-Oncology or ENT.

Medical Expert1. Develop diagnostic and investigative skills in the assessment of disorders amenable to surgical

treatment.2. Observe and become familiar with a large variety of cutaneous surgical procedures.3. Acquire a solid knowledge base of the basic principles and practice of surgical procedures and

techniques, including surgical anatomy, pre- and post-operative care, methods of anesthesia, sterilization techniques and instrument care.

4. Learn the role of various surgical procedures in the management of cutaneous diseases, such as biopsies, excisional and corrective procedures.

EPIDEMIOLOGY AND BIOSTATISTICS

Medical Expert1. Gain a solid knowledge base of the basic principles of epidemiology and biostatistics.2. Understand the principles of good research, including ethical responsibilities and obligations and

the limitations imposed by different study designs.Scholar

1. Be able to use the above principles to judge whether a research project is properly designed and to critically appraise the medical literature.

2. Be able to determine the most appropriate study designs for answering a given clinical question or problem within a given set of resources.

Collaborator 1. Learn the principles of effective team work in the setting of clinical studies or basic research.

POSTGRADUATE YEAR 3

GOAL

The third postgraduate year, consisting primarily of rotations in Dermatology clinics, should give the resident a solid grounding in basic diagnostic, investigative and therapeutic principles and techniques pertinent to a wide range of dermatological disorders, and enabling the resident to competently recognize and treat common dermatological conditions.

CLINICAL ROTATIONS AT THE MONTREAL GENERAL HOSPITAL AND THE ROYAL VICTORIA HOSPITAL: ROTATION-SPECIFIC OBJECTIVES

The below objectives will also apply to Clinical rotations at the end of PGY-2.During these rotations the resident will:as Medical Expert 1. Develop skills in the diagnosis and management of skin disorders through the supervised examination, investigation and management of adult dermatological patients in the clinics. 2. Become proficient in simple diagnostic procedures such as microscopic examination for fungi, scabies and viral cytology, Wood’s light examination and epiluminescence microscopy. 3. Develop proficiency in the procurement and interpretation of appropriate laboratory investigations. 4. Acquire competence in basic office procedures, including biopsy techniques, curettage, electrodessication, excisional techniques, cryotherapy and nail surgery. 5. Become knowledgeable of complications of dermatological therapy including emergency procedures pertinent to the clinic setting. 6. Become proficient in the principles and practice of ultraviolet phototherapy, including UVB, narrow-band UVB, topical and systemic PUVA phototherapy (MGH). 7. Acquire basic knowledge of laser therapy and specific skills in the assessment and laser treatment of patients with CO2 laser, Versapulse laser and yellow/green lasers (MGH). 8. Become familiar with the indications and role of advanced surgical techniques such as Mohs micrographic surgery, flaps and grafts and cosmetic procedures (RVH). 9. Acquire proficiency in the diagnosis and management of patients with leg ulcers including specific investigative and therapeutic modalities required in their management, including Doppler assessment, compressive devices and special wound care dressings (MGH). 10. Acquire proficiency in the recognition of atypical nevi and melanoma, and in the management of patients with these diseases in the setting of a multidisciplinary clinic (RVH). 11. Develop proficiency in the assessment, investigation and management of patients with contact dermatitis, including the screening, administration and interpretation of patch test and photopatch testing procedures, and the reporting of results to the referring physician (RVH). 12. Develop skills in the assessment, investigation and management of organ transplant patients with cutaneous problems (RVH).

as Communicator 1. Communicate effectively with patients and their families regarding investigation, therapy and the nature of their illness. 2. Begin to develop consulting skills by communicating effectively both verbally and in written reports with family physicians, other specialists and community health care personnel for the purpose of patient management. 3. Develop proficiency in medical record notation.as Collaborator 1. Function as an effective member of the Dermatology clinic team by interacting with elective students/residents, dermatology staff, nursing and secretarial staff in a cooperative manner for the purpose of optimal patient care.as Health Advocate 1. Develop skills in disease prevention through patient counselling, and facilitating patient access to disease information via information pamphlets, Internet, and other sources.as Scholar 1. Teach basic dermatological diagnosis and management to medical students and elective residents from other services.as Professional 1. Practice prudent techniques of patient care so as to provide a high level of consideration for the safety of patients, medical and nursing staff, and oneself.

POSTGRADUATE YEAR 4

GOAL

During the fourth postgraduate year, the resident will continue to build a broad knowledge base of general dermatological conditions, and to improve surgical and technical skills relating to diagnosis and treatment, enabling them to evaluate and treat a wide variety of dermatological disorders of varying difficulty. They will expand their clinical experience by rotations at the Montreal Children’s and Jewish General hospitalswhere a more diverse patient population will be seen, both in terms of age and of ethnic and cultural diversity.

PEDIATRIC DERMATOLOGY: ROTATION-SPECIFIC OBJECTIVES

During rotations at the Montreal Children’s Hospital, the resident will:as Medical Expert 1. Acquire a thorough knowledge of pediatric dermatologic diseases. 2. Apply diagnostic, investigative and therapeutic techniques appropriate to the pediatric dermatological patient. 3. Become proficient in the topical and systemic therapy of pediatric dermatological disorders. 4. Develop proficiency in the surgical management of common pediatric skin lesions including biopsies, excision of benign tumors and cysts, and warts. 5. Assess a wide variety of patients of various ethnic and cultural origins in the outpatient clinic, emergency and as inpatient consultations.as Communicator 1. Develop proficiency in communicating with patients, caregivers and referring physicians for the purposes of investigation and management.as Scholar 1. Teach medical students and elective residents from other services in basic dermatological diagnosis and management.

JEWISH GENERAL HOSPITAL: ROTATION-SPECIFIC OBJECTIVES

During rotations at the Jewish General Hospital, the resident will:

as Medical Expert 1. Develop skills and proficiency in managing patients with a wide variety of dermatological problems and of diverse ethnic background. 2. Improve skills in simple diagnostic procedures such as KOH examination, Tzanck smears, Gram stain, Wood’s light examination and epiluminescence microscopy. 3. Improve proficiency in basic office surgical procedures such as biopsy, curettage, shave/elliptical excision, cryosurgery, and simple and radical nail surgery. 4. Improve expertise in the use of UVA and UVB phototherapy. 5. Become familiar with various cosmetic procedures such as chemical peels, botox injection, hair transplantation, blepharoplasty, liposuction, sclerotherapy for varicose veins. 6. Develop skills in various laser techniques such as CO2 laser, laser resurfacing, laser hair removal and IPL laser.as Communicator 1. Develop consultation skills, both in requesting and providing consultation 2. Develop communication skills for effective team work with other services.as Scholar 1. Participate in teaching students/residents doing Dermatology electives.

POSTGRADUATE YEAR 5

GOAL

The final postgraduate year of the residency program will provide the resident with the opportunity to consolidate and refine the knowledge and techniques they have acquired in the previous years and utilize them to develop independent consulting skills. They should function as junior consultants in their capacity to examine, evaluate and treat conditions of all degrees of complexity, and be able to successfully manage simple and complex cases with a minimum of supervision.

CONSULT ROTATION MONTREAL GENERAL HOSPITAL AND ROYAL VICTORIA HOSPITAL: ROTATION-SPECIFIC OBJECTIVES

During these rotations, the resident will:as Medical Expert 1. Utilize the cognitive and technical skills acquired during the previous years to evaluate and treat a large variety of dermatological conditions of varying complexity. 2. Practice the techniques of dermatological consultation in a hospital setting, with staff supervision, in preparation for independent practice.as Communicator 1. Become proficient in writing legible and succinct consultation reports. 2. Practice effective communication skills with patients, families and other health personnel to ensure the provision of optimal patient care.as Collaborator 1. Function as a junior consultant within a team of primary care and consulting physicians and nursing personnel.as Scholar 1. Further develop teaching skills by sharing expertise with junior residents, elective students and residents, and house staff from other hospital services involved in patient care.

DERMATOPATHOLOGY ROTATION PGY3-5: ROTATION-SPECIFIC OBJECTIVES

During these rotations, the resident will:as Medical Expert 1. Recognize the normal histopathology of the skin. 2. Develop and progressively improve and consolidate skills in histopathologic diagnosis of

dermatological diseases. 3. Develop proficiency in the appropriate use of histologic techniques such as routine and special histochemical stains, immunohistochemical techniques, immunofluorescence and electron microscopy.as Collaborator 1. Relate histopathologic diagnoses to clinical information and report findings to the referring physician for the purpose of patient care and increased understanding of the pathophysiology of dermatological diseases.

DERMATOLOGICAL SURGERY PGY3-5: ROTATION-SPECIFIC OBJECTIVES

During these rotations, the resident will:as Medical Expert 1. Develop surgical skills and have hands-on experience with advanced dermatological procedures such as Mohs micrographic surgery, complex skin flaps and grafts, complex nail surgery. 2. Develop solid knowledge base of the use and complications of local anesthetics. 3. Gain proficiency in the appropriate use of anesthetic techniques such as infiltrative anesthesia, tumescence anesthesia, regional and peripheral nerve blocks. 4. Gain proficiency in the use of various sutures and other wound closure materials. 5. Develop skills in management of post-operative wounds and surgical complications. 6. Have more hands-on experience in cosmetic procedures such as hair transplantation, liposuction, blepharoplasty, chemical peels, laser dermabrasion, varicose veins injections. 7. Gain more experience in the use of various lasers such as IPL, CO2, hair removal lasers.as Communicator 1. Communicate clearly but with empathy and sensitivity with patients regarding the serious nature of their skin conditions and the need for complex surgical procedures.as Collaborator 1. Learn to work efficiently within a team in complex surgical cases with other health care professionals such as plastic surgeons, ophthalmologists, ENT surgeons, laboratory technicians and pathologists.as Scholar 1. Teach junior residents and elective students/residents basic cutaneous surgical techniques.

RESEARCH PGY3-5

The specific objectives of research will depend on the project undertaken by the resident and will be determined and assessed by the Research Coordinator.In general, during these activities the resident will be able to:as Medical Expert 1. Participate in clinical or basic science studies as a member of a research team. 2. Understand the ethical responsibilities and obligations and the limitations imposed by different study design. 3. Prepare a paper for publication in a peer-reviewed journal.as Communicator 1. Disseminate dermatology knowledge to professionals and the public through formal and informal venues.as Collaborator 1. Interact efficiently and professionally with other members of a research team by recognizing and acknowledging their roles and expertise.as Manager 1. Understand and use proficiently information technology for the purpose of research. 2. Organize time efficiently to combine clinical work and research activity.

Revised May 2005