Mohs and Cutaneous Oncology PGY-4

Mohsand Cutaneous Oncology Rotation Goals/Objectives for PGY -4
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 identify information and subtle clinical patterns to diagnose complex disease
   (eg. identify signs of perineural disease, nerve palsies). PC3
2. Teach junior learners to accurately interpret laboratory and imaging test results, including the
   selection of tests that are evidence-based and cost-effective. PC6
3. Consistently integrate mental status, functional status, and psychosocial factors into care of
   common, uncommon, and complex patients. PC3
4. Articulate the limitations and challenges of dermatopathologic interpretation. PC4
5. Usually able to select alternative or adjuvant treatment for patients with recurrent disease.
   complex tumors or significant hurdles to surgical treatment. PC3
6. Consistently counsel patients and families with complex tumors. PC3
7. Consistently and independently educate patients. PC3
8. Consistently make independent management decisions, including customizing care in the
   context of patient preferences, overall health, feasibility in the office setting, and ability to
   comply. PC3
9. Able to independently diagnose and manage all but the most complex bleeding and infectious
   complications. PC3
10. Can independently and proficiently perform and excision and layered closure. PC3
11. Can independently and proficiently and can place the skin graft with minimal assistance. PC3
12. Pursues and synthesizes additional information to reach high-probability diagnoses with
    continuous re-appraisal PC7
    Medical Knowledge
    Goal: To acquire knowledge in pediatric dermatology, demonstrate competence in knowledge
    of topics specified by the American Board of Dermatology and develop expertise in patient
    management.
    Objectives:
13. Consistently demonstrate comprehensive knowledge of clinical and laboratory manifestations,
    expected course, and management options of common, uncommon, and complex surgical
    dermatologic disorders, including non-melanoma skin cancer, melanomas, rare skin tumors,
    keloids, and scars. MK1
14. Identify and manage urgent dermatological surgical conditions appropriately. MK1
15. Consistently demonstrates knowledge about socio-behavioral aspects and the value of
    preventive care in surgical dermatology. MK1
16. Consistently demonstrate ability to organize, present, and apply relevant basic science
    knowledge to the care of surgical dermatology patients. MK1
17. Identifies variable presentations of uncommon and rare disease MK2
18. Demonstrates full knowledge of the methodology of common, complex procedures such as
    Mohs Micrographic surgery. MK1

7. Able to relate basic science information (anatomy, wound healing) directly to patient care.
   MK1
8. Demonstrates full knowledge of medications germane to procedural dermatology. Able to
   customize treatment plan based on patient co-morbidities and medications MK1
   Practice-Based Learning and Improvement
   Goal: Develop skills in acquiring, analyzing, applying and teaching surgical dermatology
   knowledge. Develop the ability to self-analyze.
   Objectives:
9. Incorporate principles and basic practices of evidence-based practice and information mastery
   into clinical practice. PBLI1
10. Identify alternative resources to answer clinical questions (for example, microbiology lab
    director, E&M coding guidelines, CMS policies, CDC reporting requirements). PBLI1
11. Perform mostly self- directed learning, integrating multiple feedback and assessment sources,
    with little external guidance. PBLI2
12. Demonstrate an effective method, system, or process for staying current with relevant
    changes in dermatologic surgery and dermatology medical knowledge. PBLI1
13. Identify personal gaps in achieving necessary or desired aspects of residency education.
    PBLI2
14. Seek and receive feedback on clinical teaching and assesses this information to determine
    areas for teaching improvement. PBLI2
15. Is able to independently 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
16. Intentionally seeks performance data consistently with adaptability and humility PBLI2
    Interpersonal Communication
    Goal: To communicate with patients, their families, and other health professionals in a clear,
    concise, caring, and respectful manner.
    Objectives:
17. Consistently communicates effectively and build rapport with patients and families in routine
    and stressful encounters. ICS1
18. Consistently recognizes and effectively uses non- verbal communication skills in relating to
    patients and families. ICS1
19. Consistently paces clinical interviews appropriately. ICS1
20. Consistently communicates effectively in difficult conversations with patients and families in
    routine and complex circumstances. ICS1
21. Customizes communication of emotionally difficult information for patients and families.
    ICS1
22. Consistently communicates effectively with health care team members in ways that
    demonstrate appreciation for their skills and contributions in routine and difficult or contentious
    situations. ICS2

7. Consistently obtains and provides consultation independently, and communicates effectively
   and efficiently with supervisors, consultants, and referring providers in routine and complex or
   nuanced patient care situations. ICS2
8. Provides some examples of the medicolegal repercussions of inappropriate medical record
   documentation. ICS3
9. Independently recognizes personal biases while attempting to proactively minimize
   communication barriers ICS1
10. Communicates clearly, concisely and in an organized written form, including anticipatory
    guidance ICS3
    Professionalism
    Goal: Develop a commitment to excellence, integrity, and sensitivity in the care for surgical
    patients and in the interactions with other health professionals and staff.
    Objectives:
11. Demonstrate ethical and professional behavior, and manage real and potential conflicts of
    interest in all professional activities, including patient care, research, publication, and
    relationships with industry. PROF1
12. Achieve sufficient self- awareness and understanding to manage work-life balance, and to
    recognize signs of impairment, mental illness, substance abuse, or burnout in oneself or one’s
    colleagues to take appropriate action. PROF3
13. Assist junior residents in recognizing their own limitations. PROF2
14. Adjust priorities in response to changing demands. PROF2
15. Anticipate the needs of patients, and work to meet those needs in daily practice. PROF2
16. Effectively advocate for individual patient needs. PROF2
    Systems Based Practice
    Goal: Competently navigate the health care system using the resources available to provide
    effective yet cost-conscious patient care.
    Objectives:
17. Recognize the differences between a system change and a work-around (a bypass of a
    recognized system fault that attempts to improve efficiency). SBP1
18. Identify at least one work-around, explore opportunities for change, and when possible, take
    steps to improve the system fault that incited it. SBP1
19. Demonstrate how to manage, utilize, and coordinate the inter-professional team. SBP2
20. Participate in an interdisciplinary team meeting for clinic or program improvement. SBP2
21. Consistently encourage open and safe discussion of error, and begin to identify and analyze
    error events. SBP1
22. Articulate an awareness of current debates/issues of health care financing and how it will
    affect patients, providers, third party payers, and other stakeholders. SBP3
23. Demonstrate the incorporation of cost-awareness principles into standard clinical judgments
    and decision-making. SBP3
24. Assess outcomes of quality improvement efforts, and apply these towards continuous quality
    improvement. SBP1