Rash decisions made here! ha!
Derm has always interested me since it involves plenty of procedures but also because you often see a lot of it in primary care. Technically, Derm is not considered part of our core rotations (e.g. Family Med, EM, Surgery, IM). As such, it was one of my electives. In rural or medically underserved areas where I’ll be practicing, dermatology consults and referrals are tough to get, so I knew I wanted to learn as much as possible to help my future patients. If you’ve decided on the elective or just want more resources for derm, keep on reading.
In addition to my tips, I’ve asked Lauren Mitschrich, dermatology PA-C (known as @theskinscholar on IG) for her top tips from the perspective of a preceptor. Fun fact: she was preceptor to one of my amazing classmates! Be sure to follow her on IG for all things derm (also to thank her for her awesome contribution).
What was your derm rotation like?
Six weeks of diagnosing/treating a variety of skin infections, skin cancer, dermatitis, acne, and other misc skin conditions. Also saw cosmetic derm patients, which wasn’t too much of my interest, but still learned a lot! I saw about 10-15 patients/day with my preceptor. Depending on the clinic, you will be doing a lot of procedures, make sure you practice your suturing, punch biopsies, etc.
All accessed via school library
How to Rock your Dermatology Rotation
By: Lauren Mitschrich, Derm PA-C & preceptor
On IG: @theskinscholar
1) Learn the Basic Language
I think one important thing to understand in dermatology is the unique subset of adjectives and descriptive words used to describe something. When a new student is tasked with writing a note or describing a rash, I often get "red, rough, dry, itchy" but that's not the language we use in dermatology. A better description might be "annular, erythematous, scaling, pruritic macular." Knowing what a macule, papule, pustule, plaque, vesicle, bullae, etc is important. Same with erythematous, violaceous, hemorrhagic, etc. There are even some really cool ones like sporotrichoid or serpiginous spreading that I like to try to stump students with.
Anyway, this is how we document what we see. Learn this basic language before you come and you'll definitely impress your preceptor. Don't be the student that presents to your preceptor and says "Its a red, itchy, rash...." (insert hand to face meme here, haha).
2) Learn a little Basic Dermatology
PA students don't learn a lot about dermatology in PA school, maybe a few weeks, maybe just a few lectures. Why? Well, there are very few questions on the board exams, I think my boards had 7 dermatology questions. So, many PA students don't know a lot about dermatology. BUT, if you want to work in dermatology or just impress your preceptor, its important to at least know the basics. Would you go into a cardiology rotation and not know at least the basics of EKGs or murmurs? No. Dermatology is the same. Spend a little time upfront learning about what you will do every day in your rotation. Dermatology is very visual, so you might even want to Google some things so you have a few rep under your belt.
Here are just a few of the basic categories I would study*:
3) Next Steps
Knowing the "textbook" description of these conditions/diseases is important, but the patient will never say "oh its a silvery scaling plaque that's itching and on all of my extensor surfaces." I think its important to take it to the next step, have a basic idea of what you're looking for, but also what to do next. How would you test for it, and what is the first line treatment. If you went into a room and looked at a spot you thought would be a wart, what would you do next? What about a spot you thought might be melanoma?
Brown, irregular, spot --> Maybe its melanoma? What should I do? --> Biopsy, what kind? Punch?
Another example: I see a red ring, with scaling and itching --> Maybe that's tinea corporis or ring worm? What should I do? --> Test for it, but how? --> If its positive, how do I treat it?
Let me say a little more and summarize the above 2 things: We DO NOT expect you to be able to diagnose, test for and treat everything. BUT being able to say my differential includes X, Y, and Z, and I would do N to establish a diagnosis will definitely get you an gold star! By the END of the rotation, I usually ask my students the next step after that too. So, if we do N and establish that it is in fact Y, how would you treat it? If he/she can answer my question for most of the basic dermatology diagnoses, they definitely succeeded.
That's all! Hope these help. Enjoy your derm block and/or derm rotation!
Melody, PA-C, MPH & Lauren, Dermatology PA-C