Mohs and Cutaneous Oncology PGY-2

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Mohs and Cutaneous Oncology Rotation Goals/Objectives for PGY-2
Patient Care
Goal: To provide care for surgical dermatology patients that is caring, sensitive, and effective in
optimizing diagnosis, management, patient education and outcomes.
Objectives:

1. Consistently obtain accurate, targeted history and examination for routine conditions
   efficiently but may need guidance with subtle or complex findings. PC3
2. Usually give a targeted presentation using appropriate terminology and providing pertinent
   negatives. PC3
3. Consistently select clinically-appropriate laboratory and imaging tests. PC3
4. Distinguishes normal from abnormal histology. PC3
5. Usually select appropriate medications for common dermatologic disorders. PC8
6. Consistently select correct vehicle and quantity for topical medications. PCS
7. Consistently prescribe and manage systemic medications for common surgical disease (e.g.
   anesthetics, analgesics, and antibiotics). PC8
8. Usually recognize common and serious side effects, but can need direction in ordering
   monitoring tests. PC8
9. Consistently develop a differential diagnosis that includes common disorders and some more
   complex conditions and only occasionally need guidance for prioritization. PC7
10. Occasionally counsel patients about prevention, disease expectations, treatment, and
    longitudinal care. PC3 and PC8
11. Usually be able to formulate appropriate management plans for patients with commor
    lisorders, including longitudinal continuity care. PCS
12. Usually suggest appropriate specialist consultations. PC3
13. Usually perform in-office procedures (shave biopsy, punch biopsy, electrodessication and
    curettage, intralesional injections, and cryotherapy) proficiently. PC3
14. Consistently perform basic procedures with guidance. PC3
15. Seek input on medicolegal issues (e.g. consent issues, power of attorney for demented
    patients.). PC3
16. Performs pre-operative assessment for basic procedures. PC3
17. Provides anticipatory guidance for procedural outcomes. PC3
    Medical Knowledge
    Goal: To acquire knowledge in surgical dermatology, demonstrate competence in knowledge of
    topics specified by the American Board of Dermatology and develop expertise in patient
    management.
    Objectives:
18. Demonstrate knowledge of the pathophysiology, clinical and laboratory manifestations,
    expected course, and management options of common dermatologic cancers. MK1

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2. Distinguish most urgent from non- urgent surgical dermatological conditions and
complications. MK1
3. Demonstrate rudimentary knowledge about socio-behavioral aspects and the value of
preventive care in dermatology. MK1
4. Understands complex concepts of wound healing. MK1
5. Demonstrates knowledge of and is able to differentiate the properties of different materials
and equipment used on the rotation (e.g. electrosurgical equipment, suture materials) MK1
7. Demonstrates knowledge of anatomy by consistently and correctly using surface landmarks to
identify important deep landmarks. MK1
8. Identifies uncommon diseases with characteristic findings. MK2
9. Describes morphology of skin lesions, with assistance. MK2
Practice-Based Learning and Improvement
Goal: Develop skills in acquiring, analyzing, applying and teaching surgical dermatology
knowledge. Develop the ability to self-analyze and the ability to design quality improvement
projects to optimize patient outcomes.
Objectives:

1. Without being directed, access appropriate print or electronic resources to find dermatology
   information requested or assigned. PBLI1
2. Consistently ask for feedback. PBLI2
3. Remain open to constructive criticism of performance, avoid defensiveness or denial of
   constructive criticisms received PBLI2
4. Participate in the collection and analysis of program-specific resident competency data (for
   example, patient logs, procedure logs, and treatment logs) PBLIZ
5. Identify deviations from standards of dermatologic care (for example, identifies when
   guidelines of care were not followed, and when over- or under- utilization of diagnostic testing
   and therapy has occurred). PBLI2
6. Articulates clinical questions and elicits patient preferences and values in order to guide
   evidence-based care. PBLI1
7. Demonstrates openness to performance data (feedback and other input) in order to inform
   goals. PBLI2
8. Analyzes and reflects on the factors which contribute to gap(s) between expectations and
   actual performance. PBLI2
9. Designs and implements a learning plan, with prompting. PBLI2
10. With guidance, is able to organize Melanoma conference, and all related materials, including
    preparing a cohesive PowerPoint presentation. With guidance is able to complete a literature
    review of and present any requested topics. PBLI1
    Interpersonal Communication
    Goal: To communicate with patients, their families, and other health professionals in a clear,
    concise, caring, and respectful manner.

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Obiectives:

1. Usually communicate effectively and build rapport with patients and families in routine
   encounters, but may require guidance in stressful encounters. ICS1
2. Occasionally recognize non- verbal cues from patients and use non-verbal skills to convey
   empathy, but may require guidance in time- pressed, complex, and stressful situations. ICS1
3. Avoid technical jargon. ICS1
4. Actively seek the patient’s and family’s perspective ICS1
5. Use patient hand-outs and/or diagrams to explain diseases and treatments when appropriate.
6. Counsel and provide clear and specific verbal and/or written instructions to patients related to
   diagnostic tests, risk/benefits of treatment, treatment alternatives, and therapeutic plans
   (including prescriptions), and assesses patient comprehension. ICS1
7. Identify special communication needs of vulnerable populations (for example, pediatric and
   elderly patients, persons with disabilities or illiteracy, immigrants, refugees, veterans, prisoners).
   ICS1
8. Appropriately use translators to facilitate communication with patients and families ICS1
9. Demonstrate appropriate face-to-face interaction while using the electronic medical record or
   completing the patient health record. ICS1
10. Recognize the circumstances related to having difficult conversations with patients and
    families ICSI
11. Communicate effectively with health care team members in ways that demonstrate
    appreciation for their skills and contributions in routine situations, but may require guidance in
    difficult or contentious situations. ICS2
12. Obtain and provide consultation and communicate effectively with supervisors, consultants,
    and referring providers in routine patient care situations, but may need guidance in complex or
    nuanced circumstances. ICS2
13. Demonstrate receptiveness to requests for consultations from other specialties and
    communicate promptly with referring providers. ICS2
14. Consistently document office visits, consultations, letters to referring providers, procedures,
    and counseling with clearly written and relevant information for routine situations, but may
    occasionally need assistance with complex situations. ICS2
15. Ensure that patient records and orders are accurate, comprehensive, timely, and legible with
    attention to preventing confusion and error. ICS3
16. Establishes a therapeutic relationship in straightforward encounters using active listening and
    clear language. ICS1
17. Identifies complex barriers (e.g., health literacy) to effective communication. ICSI
18. Identifies elements of shared decision making. ICS1
19. Solicits feedback on performance as a member of the health care team. ICS2
20. Demonstrates organized diagnostic and therapeutic reasoning through notes in the BHR.
    ICS3
21. Uses documentation tools and short cuts (e.g., copy/paste) accurately and appropriately, per
    institutional policy. ICS3
    Professionalism

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Goal: Develop a commitment to excellence, integrity, and sensitivity in the care for surgery
patients and in the interactions with other health professionals and staff.
Objectives:

1. Treat all patients with respect and dignity, regardless of socio- economic, racial, or ethnic
   background or sexual orientation. PROF1
2. Understand the actions and relationships that constitute potential boundary crossings and
   violations, and actively avoid these. PROF1
3. Respond promptly and appropriately to clinical responsibilities (for example, timely reporting
   for duty, completion of medical records, returning patient phone calls, answering pages). PROF2
4. Carry out timely interactions with colleagues, patients, and their designated caregivers.
   PROF2
5. Promptly complete clinical tasks. PROF2
6. Explain the concept of leading by example. PROF1
7. May need assistance with time management and setting priorities, but all patient care
   activities are completed in a timely fashion. PROF2
8. Consistently demonstrate empathy and compassion to patients of all ages. PROF
9. Demonstrates insight into professional behavior in routine situations. PROF1
10. Takes responsibility for own professionalism lapses. PROF1
11. Analyzes straightforward situations using ethical principles. PROF1
12. Performs tasks and responsibilities in a timely manner with appropriate attention to detail in
    routine situations. PROF2
13. Recognizes situations that may impact own ability to complete tasks and responsibilities in a
    timely manner. PROF2
14. Independently recognizes status of personal and professional well-being. PROF3
15. Independently recognizes limits in one’s own knowledge/skills and seeks help when
    approprate. PROF3
    Systems Based Practice
    Goal: Competently navigate the health care system using the resources available to provide
    effective yet cost-conscious patient care.
    Objectives:
16. Adapt to clinical work in different sites and health care systems (for example, university
    medical center, outreach clinic, inpatient setting, etc.). SBP1
17. Maintain access to all needed systems. SBP1
18. Access support services approprately at different practice sites. SBP2
19. Describe the use of checklists and briefings to prevent adverse events in health care:
    recognize the roles of team members and participate in briefings. SBP1
20. Articulate understanding of institutional risk- management resources available SBP1
21. Begin to identify the social/governmental services necessary for vulnerable populations,
    including determination of eligibility for services and delivery of some aspects of care. SBP3
22. Demonstrate knowledge of how a patient’s health care is paid for, and how this affects the
    patient’s care. SBP3

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14. Articulate awareness of costs for common diagnostic or therapeutic tests, including the cost
of performing and interpreting skin biopsies. SBP3
15. Consider cost of medical and surgical therapies, and incorporate this into therapy decisions
and discussions with the patient. SBP3
16. Demonstrate awareness of minimizing unnecessary care, including tests, procedures,
therapies, and ambulatory or hospital encounters. SBP3
17. Usually apply principles of coding (ICD-9/10) and reimbursement (E&M levels/procedures)
appropriate to medical record documentation. SBP3
18. Identifies system factors that lead to safety events. SBP1
19. Reports patient safety events through institutional reporting systems. SBP1
20. Describes local quality improvement initiatives (e.g., handwashing, needle stick prevention,
wrong site surgery prevention). SBP1
21. Coordinates care of patients in routine clinical situations effectively using the roles of the
interprofessional teams. SBP2
22. Performs safe and effective transitions of care/hand-offs in routine clinical situations. SBP2
23. Identifies specific population and community health needs and inequities for their local
population. SBP2
24. Describes how components of a complex health care system are interrelated, and how this
impacts patient care. SBP3
25. Delivers care with consideration of each patient’s payment model. SBP3
26. Describes core administrative knowledge needed for transition to practice. SBP3