University of Missouri - Columbia Department of Dermatology

PGY1	Internal medicine, general surgery, family practice, obstetrics & gynecology, pediatrics, or emergency medicine is a prerequisite for dermatology residency.
PGY2 through PGY4	The purpose of residency training in the Department of Dermatology is to develop the knowledge, skills, habits and experience of a competent dermatologist. To achieve that goal, residents participate in provision of medical care and in education as outlined.

Residency Contract (in Word Format)

General Dermatology Resident Responsibilities:

1. To attend the assigned clinics and didactics fulfilling the American Board of Dermatology’s requirement that 100% of training time in residency program must be in the direct care of outpatients and inpatients. Time spent in clinical conferences, didactic lectures, consultations, inpatient rounds, dermatologic surgery, dermatopathology, and other subspecialty rotations concerning dermatology fulfills this requirement.

2. To see patients in the ambulatory care clinic on assigned days. Adequate participation includes avoiding tardiness, responding to patient inquiries and current illness, and maintaining adequate and legible medical records. Residents are also responsible for calling patients with results of biopsy, lab or x-ray studies after appropriate discussion and review with dermatology faculty.
3. To involve the attending physician in all patient care, with progressively increasing levels of autonomy, based on experience and demonstrated competence. Reasonable expectations for attending physician involvement include discussion with the attending on all outpatients, consults and admissions, and all patients who have unexpected morbidity or deaths.

4. All residents are required to complete at least one scholarly project per year. The Dermatology research coordinator will provide information about ongoing research and assist in planning for projects and presentations for all residents.

5. To provide no specialized dermatologic care outside the program, and to provide no specialized dermatologic care without the supervision of an attending physician.

6.      All residents will sit for the Dermatology In-Service Exam held in April as scheduled by the American Board of Dermatology.
·         Scores below the twentieth (20) percentile overall or tenth (10) percentile on any specific item will be reviewed by the faculty as insufficient performance, requiring a plan for improvement.
·         Experience over decades with the selection process and system of teaching indicates the validity of this standard with the in-service exam.

7. All residents will participate in the evaluation process as directed by Residency Program Director and Residency Program Coordinator.

Resident Evaluations: The Dermatology faculty certifies the clinical and surgical competence of resident physicians for the American Board of Dermatology (ABD). The faculty bases their decisions regarding certification on its periodic review of each resident's formal evaluations. Faculty on a daily basis evaluates residents informally in clinics or during didactics.

Twice per year, each faculty member evaluates each resident utilizing a computer based system (New Innovations), based on interactions during the prior six-month time frame. The composite evaluation is compiled from the computerized faculty evaluations and is discussed with the resident by the Resident Program Director. The composite evaluation is placed into the resident's permanent record. Residents may review this file at any time. Academic appeals are reviewed first by the Dermatology faculty as a whole and then by the Associate Dean for Education.

Each resident, in conjunction with the Residency Program coordinator, maintains a portfolio of activities. The portfolio is reviewed during the end of the year evaluation, when the composite evaluation is discussed.

Residents, under direct one-on-one supervision by Dermatology faculty, perform procedures.
The attending physician remains in the room for most or all of the duration of the procedure
performed by the resident, depending on the complexity of the procedure and the resident’s expertise. From personal observation, faculty can assess the residents' progress in regards to clinical, surgical and patient care skills. The Dermatologic Surgery faculty evaluates and certifies specialized surgical and cosmetic procedures for PGY3 and PGY4 residents.

Annually, all residents are reviewed for matriculation and certification. The computer based forms are sent directly to the Residency Program Director from the American Board of Dermatology to complete. All copies of the forms are retained in the residents’ permanent file, which is accessible in the department office.

In addition, residents are required to keep a log describing all procedures performed (including recording the patient identification number, type of procedure performed, findings, and supervising faculty). Procedure numbers are only one of the factors used to determine surgical competency. Technical skill, patient safety and comfort, and recognition of normal and abnormal findings are also expected of the residents.

Procedure Log
The electronic procedure log is accessible from any computer when logged onto the Network at www.acgme.org/residentdatacollection. Karla will provide the required log on information. A copy of the American Board of Dermatology Surgery Reporting form is attached. This reporting form lists the procedures needed on the electronic worksheet. The patient’s name should be substituted with the MR# or SS# or birthdate. This worksheet will be submitted with the year-end evaluation to the American Board of Dermatology. It should accurately reflect the procedures performed from July 1 to June 30. This will serve as documentation for hospital credentials after leaving the program. It is important to retain a copy for your personal files and portfolio. The log requires documentation of date, attending, pathology (benign vs malignant), lesion size (includes margins), and closures length including type of closure (layered, flaps, grafts).

· Dermatology Faculty Evaluations: Dermatology residents evaluate all faculty twice per year, utilizing computer based evaluations (New Innovations). During the entire process, residents perform evaluations anonymously. The Residency Program Coordinator is responsible for compiling the confidential evaluation forms received for each faculty member. Summation is then given to Department Chairman to discuss with each faculty member individually.

· Department of Dermatology Program Evaluations: Residents have the opportunity to semi-annually evaluate the program overall, using a written evaluation form. This evaluation is performed anonymously. The evaluations are submitted directly to the Residency Program Coordinator, who compiles a report for review. A composite is prepared, submitted and reviewed by all faculty.

PGY4 dermatology residents are scheduled to attend monthly faculty meetings during the year. This gives the opportunity for residents to discuss suggestions for program improvements throughout the year.

8. Attendance at the American Academy of Dermatology meeting is required for all residents who are not on call. Airfare and hotel rooms are provided by pharmaceutical funding under the auspices of the AAD, and are arranged through a designated travel agency, not through the Department. The Department will cover up to $200 for each resident to register and select courses, with courses subject to the Program Director’s approval. Any additional costs not covered are the responsibility of the resident.

A list of all educational events should be submitted to the program coordinator and director prior to enrollment. All First year residents are required to enroll in the Introduction to Dermatopathology course. During the second or third year, residents are required to enroll in the Basic Dermatopathology Self-Assessment course. The list of educational events are kept in each residents’ permanent record.

It is expected for residents to attend the entire AAD meeting, unless an exemption is approved by the residency program director. Five educational days are allowed for the AAD meeting, not to be included as vacation. Attending courses, symposia, forums, poster sessions, committee meetings, resident presentations, faculty presentations, and discussion groups at least 6 hours per meeting day is required; otherwise the day will be counted as a vacation. It is required that all residents attend the annual University alumni reception usually held on Sunday evening, unless an exemption is approved by the residency program director.

A second year resident (or resident agreed upon by the residency program director) will be on call with appropriate faculty backup during the AAD meeting. Residents will select courses, symposia, and forums for the AAD, and review selections with the Residency Program Director prior to finalizing plans.

Attendance at the resident practice management symposium (held immediately preceding the annual AAD) is an optional activity. One day of conference time will be allowed only once during three years of residency. Residents are responsible for any additional cost to attend the symposium. If a resident chooses to attend the practice symposium more than once in the three-year residency, it will be considered vacation.

9. Dermatology Residents are required to attend the Missouri Dermatology Society Annual Meeting held in October. One First year resident will take call.

10. All Dermatology Residents are required to attend the month Mid Missouri Dermatology Meeting held the first Tuesday of each month at 7:00 PM in the University clinic.

11. First and Second Year Residents are required to attend the Cutaneous Biology Course offered at Indiana University each fall. A Third year resident takes call during the course. Shared hotelaccommodations, daily university meal allowance, transportation by rental van, and registration cost is provided by the Dermatology Department. It is expected for residents to attend the entire course. Conference days will be used for Thursday and Friday.

12. To inform the Residency Program Coordinator of any sick leave absence.
If a resident is sick, the resident informs the administrative office of the illness as soon as possible. If sick leave is used, arrangements for coverage for any clinics or call are the resident’s responsibility and must be provided to the administrative office. Upon returning to work, a completed leave form is submitted to the Residency Program Coordinator, who acquires the Program Director's signature.

13. To inform the Residency Program Coordinator of any vacation or conference attendance absence.

Inform the Residency Program Coordinator of any vacation needs by filling out a leave form in advance and attaching a completed schedule for clinic and call coverage for the requested leave. Call and clinic coverage is arranged by the resident requesting vacation. The leave form is submitted to the Residency Program Coordinator, who will obtain the signature from the Program Director if approved. The request for leave must be approved in advance of any absence. Do not assume that every request for leave will be approved, and do not make travel plans before vacation time has been appropriately approved.

· Vacation is twenty (20) days Monday through Friday. Vacation days are not carried over from the prior year or borrowed from the next year.

Requests for vacation will be considered by seniority.

Vacation time should be spread throughout the year to facilitate coverage. First and second year residents are encouraged to use at least 7 days of vacation the first half of the academic year.

Pagers must not be left with administrative office personnel. If a pager needs to be covered, plan to leave the pager with a resident of the same program year. If there is a change in coverage for call or consults the residency program coordinator will assist in making resident call schedule changes and contacting the hospital’s paging operators.

When requesting time off, please remember that no resident may be absent from the program for any reason for more than six weeks per year, or fourteen weeks total, over the three-year residency.

· A clinic will not be cancelled except in certain situations instructed only by an attending physician.

· Residents are not permitted to take vacation two weeks prior to mock board examinations, during the annual AAD meeting, and during the Missouri Dermatological Society annual meeting.

· No First or Second year residents are eligible for vacation June 15 through June 30. This will avoid the lapse of coverage while graduating residents are leaving and new First year residents are arriving.

· If greater than one day of vacation is requested, it must be consecutivedays.

· All residents are expected to be present and responsible for patient care from 8 AM to 5 PM Monday through Friday, even if not scheduled for clinic, or if scheduled for the CMS rotation and the dermatologic surgery attending is on vacation. You must be available by pager if you are studying outside of the office. Unscheduled residents will frequently be required to assist in clinic. If absences are noted or you are not available by pager for patient care, vacation days will be used.

· Do not expect coverage to be paid back equally. If a long vacation is anticipated, spread clinic
coverage among all available residents. Post clinic coverage in the residents’ room.

· Residents are strongly discouraged from taking vacation or leave while on consult months. Because occasionally this is unavoidable, it is expected for the consult resident to pass the consult pager to another resident without clinic. Be sure the consult pager is always covered, and clarify any changes to coverage with the hospital operators, with the assistance of the program coordinator. First year residents will not be eligible to cover the consult pager until Labor Day, and are only asked to cover if no other upper level resident is available. Special attention to continuity of patient care is crucial during consult pager coverage. The consult resident is responsible for the initial and continuing care of each patient seen while on consult duty.

· If a resident is the only available person to cover a clinic, the available resident will be asked to reschedule previously scheduled appointments (e.g. doctor, dentist, therapy, etc.).

· Once vacation is granted, no changes are accepted except for a personal emergency (jury duty, or last minute interviews/contract deliberations.)

· Prepare quizzes ahead and reassign slide show or other responsibilities during a planned vacation.

14. To participate in the Consult Resident Rotation as a Second and Third year resident.

· The Consult Resident’s responsibilities are from 8 AM to 5 PM Monday through Thursday, and 8 AM to 4 PM on Friday. These duties are assigned on a monthly rotation. Responsibilities include hospital consults at the University, Columbia Regional, and VA hospitals, ER and Urgent Care coverage, phone call coverage for those on vacation including Deb West, talking to patients who have no assigned resident, and being responsible for non-covered phone calls and prescription refills for patients seen solely by faculty. “Curbside” or unstaffed outpatient consultations are strongly discouraged, and whenever possible, outpatient consult patients should be scheduled into an appropriate clinic or seen with the faculty on call. Attending faculty should be informed promptly regarding all inpatient and outpatient consultations, with arrangements for staffing on a case-by-case basis.

· Do not refill a prescription if the patient has not been seen within one year.

· Patient inquiries should be addressed as soon as possible, at least within 24 hours of receiving the chart. All phone calls should be recorded in the patient’s chart, including any prescriptions or other pertinent information. Notify the attending on call for all inpatient consults, to schedule daily rounds. Outpatients may be scheduled into University clinic based on availability.

· Please fill out the consult book for all patients seen on consults and photograph. Interesting consult patients are presented weekly at case conference, including follow-ups from the previous week.

· The Consult Resident is responsible for sending the weekly department schedule.

· The VA consult folder in the clinic should be checked regularly to triage patients needing appointments.

15. To participate in the Dermatology inpatient service as a First year resident.

· First year residents will rotate inpatient admissions on a per patient basis.

16. To participate in the Call Schedule.

· Call is scheduled in one week blocks from 8 AM Monday to 8 AM the following Monday. During the week, the consult resident handles responsibilities from 8:00 A.M. to 5:00 P.M. on Monday through Thursday, and from 8:00 A.M. to 4:00 P.M. on Friday. The on-call resident takes over all duties at 4:00 PM on Friday.

· The resident on-call takes all calls and consults after 5PM Monday through Thursday, after 4 PM on Friday, and 24 hours on Saturday and Sunday, until 8 AM Monday morning.

· If a patient is instructed to come to clinic in the morning, please record DOB, full name, phone number, and notify clinic ASAP. It is the on-call resident’s responsibility to see the patient unless other arrangements for resident coverage are made.

· First year residents do not take call or consults until Labor Day. Consult coverage should be avoided for first year residents throughout the first year, unless there are no upper level residents available to cover consults.

· Telemedicine is available in the Emergency Room. It may be utilized to see patients referred by off-site physicians.

· If a prescription is refilled or patient calls are returned while on call, document the information in the chart. If the patient calls back at a subsequent date, it is the responsibility of the existing on-call physician to handle the problem (or the last resident who saw the patient in clinic.)

· Do not refill a prescription if the patient has not been seen within one year.

· If any CMS complications occur after 5 PM, notify the CMS resident who will assist in the evaluation of the patient. The CMS attending should be contacted rather than the on call attending.

16. To participate in community service events including Skin Cancer Screenings.
1. Moonlighting:
Moonlighting will be allowed only in certain circumstances for residents in good standing. A written request must be submitted to the Program Director detailing the specific moonlighting opportunity, dates, and times for all moonlighting (non-dermatology and dermatology). The Program Director and the Department Chairman must approve the moonlighting session prior to any agreements made for moonlighting. A written proposal must be submitted to the Residency Program Coordinator for presentation at the next month’s faculty meeting; faculty meetings are held at 4:00 PM the second Thursday of the month.

General Guidelines regarding Moonlighting
First Year Derm Residents (PGY 2)	No moonlighting of any kind.
Second Year Derm Residents (PGY 3)	Moonlighting outside of dermatology will be considered.
Third Year Derm Residents (PGY 4)	Dermatology moonlighting will be considered.
Moonlighting absences will be considered vacation days with exceptions granted only at the discretion of the faculty.

2. Externships (Away Rotations):

Each resident will be allowed to be away from the program for a dermatology rotation for a total of two weeks, to enhance dermatology training and knowledge (only during the PGY3 or PGY4 years). The Residency Program Coordinator and the Residency Program Director must approve the away rotation prior to making permanent arrangements to be gone. Affiliation agreements must be made with the sponsoring institution prior to the away rotation. The legal agreement is often very time consuming process; it is recommended to apply for externships several months in advance. Coverage must be arranged for all responsibilities. Only one resident will be allowed to do away rotations at any given time. No away rotations are allowed in June or July.