Competency Based Medical Education, as defined by the Accreditation Council for Graduate Medical Education, measures the progression toward specific competencies (including the knowledge, skills, and attitudes within them). The CBME system promotes progressive development of a competency, defined as Milestones. Milestones are knowledge, skills, attitudes and other attributes for each of the ACGME Competencies organized in a developmental framework and arranged into levels. Tracking from Level 1 to Level 5 is synonymous with moving from novice to expert resident in the specialty.

Additionally, Competency Based Medical Education allows for longitudinal assessment of the learner and provides feedback, coaching, and adjustments structured to the learning plan.

• Patient Care and Procedural Skills – Provide compassionate care, appropriate, effective treatment for health problems and promote health
• Medical Knowledge – Demonstrate knowledge about established and evolving biomedical, clinical and basic sciences and their application in patient care.
• Practice-based Learning and Improvement – Be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence and improve their practice of medicine
• Interpersonal and Communication Skills – Demonstrate skills that result in effective information exchange and collaboration with patients, their families and professional associates (e.g. fostering a therapeutic relationship that is ethically sound, uses effective listening skills with non-verbal and verbal communication; working as both a team member and at times a leader)
• Professionalism – Demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to diverse patient populations
• Systems-based Practice – Demonstrate awareness of and responsibility to larger context and systems of healthcare. Be able to call on system resources to provide optimal care (e.g. coordinating care across sites or serving as the primary case manager when care involves multiple specialties, professions or sites)

Together, these competencies strive to measure physicians’ ability to administer a high level of care to their patients.

University of New Mexico Dermatology Residency Program requires that residents demonstrate competence in six core competencies as mandated by ACGME and the American Board of Dermatology. The ACGME Core Competencies are integrated into each of the clinical rotations in which the residents participate and in the educational material taught.

During Boot Camp orientation, residents receive an introductory course to the specific competencies, their evaluation and expected progression during residency training.

https://www.acgme.org/Portals/0/PDFs/Milestones/DermatologyMilestones.pdf

The schedule for first year dermatology residents will be structured as follows:

• 5 months of UNM Outpatient Clinics
• 5 months of VAMC Outpatient Clinics
• 2 months of UNM Inpatient/Consultative Service
• 2 weeks of Dermatopathology
• 2 weeks of Dermatologic Surgery
• Resident Continuity Clinic at UNM

The schedule for second year dermatology residents will be structured as follows:

• 5 months of UNM Outpatient Clinics
• 3 months of VAMC Outpatient Clinics
• 3 months of UNM Inpatient/Consultative Service
• 4 weeks of Dermatopathology
• 8 weeks of Dermatologic Surgery
• 2 weeks of Lovelace Outpatient Dermatology Clinic
• Resident Continuity Clinic at VAMC

The schedule for third year dermatology residents will be structured as follows:

• 5 months of UNM Outpatient Clinics
• 3 months of VAMC Outpatient Clinics
• 1 months of UNM Inpatient/Consultative Service
• 6 weeks of Dermatopathology
• 4 weeks of Dermatologic Surgery
• 2 weeks of Lovelace Outpatient Dermatology Clinic
• 6 weeks of Elective
• Resident Continuity Clinic at UNM

UNM Outpatient Clinic is a major area of resident outpatient experience which offers exposure to an extensive array of both adult and pediatric dermatologic problems. Approximately 32 percent of our outpatient visits are pediatric. As part of the UNM Outpatient Clinics, residents gain experience in general dermatology, complex medical dermatology, pediatric dermatology, contact dermatitis and patch testing, phototherapy, and skin cancer surveillance. While at UNM, residents spend time with different attending physicians. UNM utilizes Cerner electronic health record for charting and has excellent nursing and support staff to allow for an optimal learning environment focused on developing clinical skills and knowledge. Faculty at UNM Clinics are Drs. Aimee Smidt, Emily Altman, Therese Holguin and John Durkin.

The outpatient dermatology clinics at the Raymond G. Murphy VA Medical Center are Resident Continuity Clinics under the supervision of Drs. Romeo Morales, Charles Phillips and Phillip Strange. The patient population is primarily veterans and occasionally veteran’s families. The VA experience includes a mix of general and procedural dermatology. There is a large burden of skin cancer in VA patients due to extensive sun exposure as part of their military service. Every Tuesday morning is a surgical continuity clinic for the residents rotating at the VAMC. The PGY-3 residents have their Wednesday Continuity Clinics at the VA. Every fourth Wednesday of the month is a Surgical Continuity Clinic.

One of the unique aspects of the UNM Dermatology Residency Program is the weekly Resident Continuity Clinic, where residents follow a core group of patients throughout the majority of the program, as well as follow-up of inpatients and patients seen as consults during night or weekend call. Continuity of care is associated with better longitudinal follow-up, improved patient adherence, and overall increased satisfaction for both physicians and patients. In Continuity Clinic, residents develop expertise in the diagnosis and management of a broad range of dermatologic conditions, follow their patients’ progress and, if needed, reevaluate and modify diagnoses and treatment strategies with increasing autonomy under the supervision of Department faculty.

Resident Continuity Clinics are held every Wednesday at the UNM Outpatient Clinic for PGY-2 and PGY-4 residents and at the VAMC for the PGY-3 year. At the UNM Clinics, residents see both adult and pediatric patients. Every fourth Wednesday of the month, residents have a Surgical Continuity Clinic, where they do excisions, nail surgery, laser treatments and cosmetic procedures.

Residents rotating with Dr. Aimee Smidt, our Chair, New Mexico’s only Board-certified pediatric dermatologist and the founder of the Multidisciplinary Vascular Anomalies Clinic (VAC) at UNM Health spend one full day every other month at the VAC, which brings together multiple medical and surgical services that specialize in vascular anomalies and birthmarks.

VAC provides care for children and adults with vascular tumors, such as hemangiomas, and misdevelopments such as venous, lymphatic and arteriovenous malformations. After the team conducts a thorough exam and reviews the patient’s imaging and pathology records, they provide a definitive diagnosis and treatment plan and coordinate follow-up care with primary care providers. 

VAC has an active participation in the International Society for the Study of Vascular Anomalies (ISSVA) and brings in a nationally and internationally recognized expert consultant/guest lecturer once annually.

The VAC team includes professionals from:

• Pediatric dermatology
• Interventional radiology (general and neurosurgical)
• Diagnostic radiology
• Pediatric hematology-oncology
• Pediatric otolaryngology (ear, nose and throat surgery)
• Pediatric surgery
• Facial plastic/reconstructive surgery and plastic surgery
• Pediatric orthopedic surgery and rehabilitation
• Dermatopathology
• Oculoplastic surgery
• Neurosurgery

The Cutaneous Oncology Clinic, founded by dermatology faculty, Drs. Naiara Barbosa and John Durkin, is a collaboration between UNM Department of Dermatology and the UNM Comprehensive Cancer Center, part of the National Cancer Institute, recently named the best in cancer care in New Mexico by US News and World Report, which offers patients outstanding multidisciplinary cutaneous oncology care.

The Cutaneous Oncology Clinic focuses on the following services:

• Evaluation and management of basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma; cutaneous lymphoma (mycosis fungoides), graft vs host disease (GVHD), rare skin cancers including Merkel cell carcinoma, dermatofibrosarcoma protuberans (DFSP), sebaceous carcinoma, leiomyosarcoma, extramammary Paget’s disease, and others
• Skin manifestations of immunotherapy, radiation and chemotherapy
• Surveillance of high‐risk individuals, such as those having organ transplants and long‐term immunosuppression or prior history of skin cancers
• Non‐invasive skin imaging using dermoscopy, digital photography, and reflectance confocal microscopy
• Biopsies and skin cancer excisions
• Mohs micrographic and reconstructive surgery and reconstruction
• Multidisciplinary melanoma care and clinical trial opportunities

One to two residents on the UNM Outpatient Rotation spend Mondays at the Comprehensive Cancer Center seeing patients with complex cutaneous or systemic oncologic conditions.

Dr. Naiara Barbosa heads the Transplant Clinic one-two Friday afternoons per month, where she sees patients with solid organ transplants on immunosuppressive medications, who are at high risk for skin cancers. Residents on the UNM Clinic rotation or the Dermatologic Surgery rotation rotate through the Transplant Clinic.

The Surgery resident spends the entire day on Monday, Tuesday and Thursday and Friday afternoons at UNM, VAMC and/or UNM Cancer Center with Surgical Faculty in a procedural setting. In the PGY-2 year and the first half of the PGY-3 year, the Surgery residents participate in cutaneous surgery clinics at VAMC. Second half of PGY-3 and full PGY-4 year, all day Monday is surgery at the VAMC, Tuesday and Thursday are full day Mohs with Dr. Barbosa. Fridays for all surgical residents are spent with Drs. Smidt or Durkin in Friday Procedural/Laser/Cosmetic clinics or the Transplant Clinic. Once a month, the Surgery resident spends Thursday in the OR with Dr. Smidt doing pediatric procedures under general anesthesia.

Residents are expected to write the procedural notes of the patients in whose surgeries they participated. Surgical Residents are expected to make after-hours post-op calls on the patients in whose surgeries they participated. After-hours post-op Mohs/surgical calls needing more than resident assistance should be discussed with the Mohs/Surgical Attending.

Surgery Residents attend their Wednesday morning Continuity Clinic at either UNM or VAMC and Wednesday afternoon and Friday morning didactic sessions at UNM. Residents spend a total of 4 months in Dermatologic Surgery during their residency.

During the inpatient consult rotation, the resident manages all inpatient adult and pediatric consults at the UNM Hospital under the supervision of the inpatient consult attending, Dr. Emily Altman. The resident is responsible for establishing the initial diagnostic and treatment plans with the consult attending. This rotation allows the residents to learn complex medical diagnosis and treatment. Residents work closely with our UNM intensive care and burn units to manage severe blistering and desquamative conditions. UNM is the only academic medical and tertiary referral center in the State of New Mexico. Our residents learn how to care for acutely ill, hospitalized patients with severe and complex dermatological conditions and dermatologic manifestations of systemic diseases.

During the Inpatient/Consultative Dermatology rotation, mornings are spent in UNM Outpatient Clinics, and afternoons on the inpatient rotation. The resident will begin their inpatient rounds/consults at either 1 or 2 pm depending on the demands of the service.

Our Dermatopathology section sees approximately 27,000 specimens yearly. The Dermatopathology resident spends Monday, Tuesday, Thursday mornings and afternoons and Friday afternoons at Tricore in the Dermatopathology Section with Drs. Hillary Elwood and Shelly Stepenaskie.

In the course of the dermatopathology rotation, residents preview slides to be signed out that afternoon during the morning, then participate in the interpretation of slides with the faculty in the afternoon. Residents also have access to an extensive collection of teaching slides. Dermatopathology residents attend their Wednesday morning Continuity Clinic and Wednesday afternoon and Friday morning didactic sessions at UNM. Residents spend a total of 12 weeks in Dermatopathology during their residency.

All residents participate in the Wednesday afternoon 1.5-hour dermatopathology didactics, where they go over the unknown slide sets given to them in the previous week and review the biopsy specimens from their own Continuity Clinics. The unknown slide sets are correlated to the textbook chapters residents review for that week.

On the second Wednesday of the month, the Department participates in a Clinical Pathologic Correlation session. Cases are chosen based on the classical appearance, interesting presentation or a diagnostic dilemma. Both clinical photographs and pathology slides are presented and discussed.

PGY-4 dermatology residents are eligible to design six weeks of elective time. These six weeks can be taken all together or in two-week segments. This option intends to improve skills developed within the Dermatology residency program, or to gain exposure to techniques or individuals not associated directly with UNM. The elective rotation must comply with the level of education required by the ACGME. During the elective rotation, residents are not responsible for Continuity Clinics or call.

Residents on the UNM Outpatient service participate in store-and-forward teledermatology sign-outs with the assigned faculty one afternoon per week. Virtual dermatology visits are also part of our regular outpatient UNM and VAMC dermatology rotations.

Please see Policy for Supervision of Residents and Graduated Levels of Responsibility.

Weeknight after hours call (Monday through Thursday 5 pm to 8 am, Friday 5 pm to Monday 8 am) is covered by the UNM On-Call Resident on a weekly rotation. On-call week includes the weekend at the end of the week (see below), unless otherwise notified. The approximate number of weeks on call per year varies by PGY level:

PGY-2       10   weeks per year

PGY-3         9   weeks per year

PGY-4         7   weeks per year

This call covers Inpatient/Emergency Department consults as well as all urgent patient phone calls from the entire UNM Dermatology practice. The dermatology resident on-call is contacted via AMION (directly) or via secure messaging with TigerConnect. If an appointment is needed, send an email to Ashley Sierra or the attending caring for the patient. If it is an urgent matter, you can call/page the attending caring for the patient in the morning to inform them of the situation and ensure a quick response to the patient.

Inpatient consults will be listed as routine, urgent and emergent. Urgent and emergent consults must be seen that day. Routine consults can be seen the following day, if that was the primary team’s intention. It is best practice to call back any consult page received to discuss the patient with the team. It is expected that you will be available to respond immediately via telephone to any urgent consult request. Since many dermatology consultations require in person examinations, make sure that you are immediately available. As a rule, do not find yourself in a location or activity such that you cannot be at the medical campus within 30 minutes of being notified. Every nighttime consult request must be discussed with the on-call attending immediately.

The On-Call Resident will hand off information to the regular Consult Resident first thing in the morning for further actions.

Weekend call is from Friday 5 pm to Monday 8 am. The on-call week includes weekday call and weekend call. If you need to change your on-call week, you must clear it with the chief resident/Associate Program Director and notify AMION, PALS and the VA Operator (Check VA procedure with the VAMC Site Director, Dr. Romeo Morales). Discuss the timing of consult rounds with the on-call attending. It is expected that you will be available to respond immediately via telephone to any urgent or stat consult request. Since many dermatology consultations require an in-person examination, make sure that you are immediately available. As a rule, when you are on-call, do not find yourself in a location or activity such that you cannot be at the medical campus within 30 minutes of being notified.

Every weekend consult request must be discussed with the on-call attending immediately.

The On-Call Resident will hand off information to the regular Consult Resident first thing on Monday morning for further actions.

The holidays recognized by the University of New Mexico are Independence Day, Labor Day, Thanksgiving, Christmas/New Year, Martin Luther King Day, Memorial Day. The residents on call cover the holidays as a 24-hour call, including the weekends that go with that holiday.

The holidays are divided as follows:

Winter break, which includes Christmas, New Year and the days between them, is divided between the PGY-2 residents.

Labor Day and Memorial Day (including the weekends starting at 5 pm on Friday) are covered by PGY-3 residents. The call for each of these weekends is 8 consecutive days: the call week preceding the holiday (Monday-Sunday) and including the Monday holiday itself.

Independence Day and Thanksgiving (including the weekends starting at 5 pm on Friday) are covered by PGY-4 residents.

Martin Luther King Day is covered by the resident on call that week.

The exact days that are included in these holidays will be given out at the beginning of the academic year.

Residents may exchange call days or weeks with one another, provided doing so does not violate ACGME regulations. Residents can exchange holiday call with residents of the same PGY level. It is the responsibility of the residents exchanging call to assure that the correct resident is listed in Amion.

Boot Camp takes place the first two weeks of residency.

Incoming Dermatology residents spend their first two weeks in “Boot Camp,” which gives them a focused, practical introduction to dermatologic clinical care. It is designed to help residents feel more comfortable and competent in essential dermatologic clinical and professional sills.

Grand Rounds takes place at 8 a.m. every Friday

At UNM Dermatology Grand Rounds, clinical case sessions alternate with a nationally/internationally recognized faculty from another institution. 

Each resident gives one Grand Rounds presentation each year.

Grand Rounds Speakers

Two Fridays each month, 9 am-10 am (Zoom until social distancing rules are lifted, previously UNM Dermatology Clinic Conference Room)

1. Journals routinely reviewed are the JAMA Dermatology, Journal of the American Academy of Dermatology, British Journal of Dermatology, Journal of Investigative Dermatology, Dermatologic Surgery, and Pediatric Dermatology.  Though certain articles from JAMA Dermatology and Journal of the American Academy of Dermatology are assigned for discussion, residents are expected to read the entire journal monthly. 
   • Develop an ability to critically analyze published articles. 
   • Recognize important advances in the basic understanding, diagnosis, and management of dermatologic diseases. 
   • Develop a life-long habit of reading and analyzing the medical literature.
   • Demonstrate communication skills in presenting an analysis of articles in a clear and concise manner.
2. John Durkin heads the Journal Club section and assigns the residents a selection of articles to review. Each resident is responsible for at least one article per journal club. The faculty leader moderates the discussion with participation from other faculty members.  

Monthly, Wednesday afternoon 2:30-3:30.

This conference is designed to share interesting patients or obtain input on diagnostic/therapeutic dilemmas. All data from conference is stored securely. The conference takes place via Zoom while social distancing rules are in effect, normally at Tricore facility at a 10-headed microscope to allow all participants to actively review the cases together. 

1. Learning Objectives

• Examine the skin more efficiently and effectively. 
• Construct and prioritize a differential diagnosis for skin diseases. 
• Design an appropriate plan for evaluation and management of patients with skin disease.

1. Procedures

• The assigned resident is responsible for obtaining clinical photographs from the clinical conference and selecting the most representative ones of the patient’s condition to show during the conference.
• The resident and/or faculty discuss the patient’s history after the photographs are viewed and a differential diagnosis is established.

Pathology slides are reviewed and clinical and pathology data discussed.

• Wednesday afternoon, 1-2:15 pm, (Tricore Conference Room)

  1. Learning Objectives
  • Analyze pathology specimens more critically.
  • Develop and prioritize a differential diagnosis for pathology. 
  • Recognize the importance of clinicopathologic correlation in establishing a “final” or “working” diagnosis.
  • Become familiar with the distinguishing features of dermatopathologic diagnoses.
  • Learn how to distinguish and describe the relevant features of the pathology reviewed, and begin to use these findings to develop a dermatopathologic differential diagnosis.

Friday 10 am-12 noon

1. Learning Objectives

• Become familiar with dermatologic disorders and their diagnosis and management. 
• Understand the scientific basis of skin disease.
• Review of one or more dermatology textbooks. 

Reading schedule will be determined by the APD/PD and chief residents on a monthly basis and will include selections from the following texts: 

• Dermatology: 2-Volume Set, 4^th Editors: Jean Bolognia, Julie Schaffer, Lorenzo Cerroni
• Hurwitz Clinical Pediatric Dermatology, 5^th Editors: Amy S. Paller, Anthony J. Macini
• Dermatopathology: Expert Consult, 2^nd Editors: Dirk Elston, Tammie Ferringer
• Surgery of the Skin: Procedural Dermatology, 3^rd Editors: June K. Robinson, C. William Hanke
• Contemporary Ethics and Professionalism in Dermatology. Editors: Lionel Bercovitch, Clifford Perlis

Residents regularly attend meetings of the American Academy of Dermatology (annual and/or summer sessions), and other regional and national dermatology meetings

1. Learning Objectives 

• Expand knowledge base for diseases of skin, hair, nails, and mucous membranes.  
• Develop contacts with residents and faculty from other programs.

Wednesday 3:30 pm-4:30 pm quarterly

Morbidity/ mortality conference -- Residents will report on 2-3 cases (one procedural and one-medical dermatology case) that depict actual clinical scenarios from a clinic visit or hospital consult.

QA/QI – projects will be developed and presented by each resident once in the PGY-3 year of residency.

1. Learning Objectives
2. Recognize sources of medical error and understand pitfalls in decision-making to avoid misdiagnosis of skin conditions.
3. Identify threats to patient safety in the form of misguided therapy, adverse events, ethical quandaries, or poor patient outcomes and formulate measures that can be taken to prevent similar occurrences in the future.
4. Formulate quality measures and institute system changes that minimize error, maximize patient safety, and improve clinical care