Description

Two week long component of the Year 4 Specials (Dermatology, Otorhinolaryngology, Ophthalmology) attachment.

Departments

Dermatology

Aims & Objectives

Overall aims

To facilitate a problem-orientated approach to understanding the management of skin diseases in the hospital and community setting.

To understand the concept of skin failure in the context of both acutely ill patients and as a large burden of preventable morbidity in the community.

Specific Objectives

Examination of the Skin

The student will be able to:

• Identify normal cutaneous changes
• Examine and describe a solitary skin lesion
• Distinguish between dermal and epidermal changes
• Examine and describe a cutaneous eruption using dermatological terms correctly Demonstrate their ability to examine the skin of a patient in a sensitive and courteous manner
• Recognise the psychological importance of skin disease to patients
• Recognise the direct and indirect cost of skin disease to the patient and community

Common inflammatory skin diseases

The student will be able to:

• Assess and be competent in treating the following skin disorders: atopic eczema, contact dermatitis, psoriasis, acne, infections and infestations of the skin.

The skin and systemic disease

The student will be able to:

• Interpret physical signs which may indicate underlying systemic disease

Tumours of the skin

The student will be able to:

• Recognise the clinical features of malignant melanoma, basal cell carcinoma and squamous cell carcinoma of the skin
• Demonstrate a knowledge of the risk factors for skin cancer
• Plan appropriate management of skin cancer lesions
• Establish differential diagnoses for benign skin tumours

Leg ulceration

The student will be able to:

• Make an accurate assessment of the cause of leg ulceration in a particular patient
• Plan a coherent management schedule
• Interpret Doppler assessment
• Demonstrate a knowledge of the correct application of graduated external compression for venous ulcers
• Recognise the problems associated with leg ulceration in relation to the primary/secondary care health care interface

Transferable Skills

To acquire a systematic approach to the assessment of a solitary skin lesion or cutaneous eruption. To acquire the basic skills which will enable the student to pursue more detailed study of relevant subject matter in the years which follow.

Content

The core curriculum will cover:

• Clinical assessment of a skin eruption, leg ulceration, pigmented lesions and solitary skin tumours.
• Principles of treatment of common skin diseases such as acne, eczema, psoriasis and cutaneous infections will be emphasised.
• Cutaneous signs of systemic disease will also be covered.

Emphasis is placed on patients’ problems rather than specific disease categories during the course. The course has strong links (in terms of shared handouts, course objectives and glossary of terms) with the department of General Practice.

Teaching Methods

Directed clinical teaching in dermatology outpatients which will involve the students clerking new patients. Registrar-led tutorial sessions which require students to bring along a clinical problem related to a real patient. Students are required to assess and present patients on ward rounds, and they participate in a practical session of skin surgery, PUVA treatment and leg ulcer assessment including Doppler measurement. A programme of core curriculum lectures will operate throughout the Specials attachment dealing with the core material. Each lecture is supplemented by written material. The clinical project, based on the McMaster “triple jump” test employs self-directed teaching method.

Assessment

Formative
A satisfactorily completed and signed logbook. A fully signed up logbook shows that the student has attained an acceptable degree of skills and attitudes during the two week attachment and that he/she has satisfactorily attended the timetabled sessions. There is also ample opportunity for the course organiser (who meets with the students on day one and during the second week of the course) to identify any serious problems and suggest ways of overcoming difficulties at an early stage. The small project tests the students ability to:

1. Choose a clinically important question
2. To retrieve the necessary information
3. To assimilate and critically appraise that information
4. To present that information in a coherent form to their colleagues

Summative
Following satisfactory completion of the logbook, factual knowledge of the course objectives will be tested in a short MCQ.