Resident Rotations and Sites
Most of the clinical training of residents takes place in hospitals located in Providence, Rhode Island, as well as at the Providence VA Medical Center. The total number of outpatient visits in Dermatology (excluding emergencies) exceeds 25,000/year. Each resident spends a portion of their training time rotating among the affiliated hospitals. Additional training facilities including the Hasbro Children's Hospital and Women & Infants Hospital.
The Rhode Island Hospital, Hasbro Children's Hospital, and Women & Infants Hospital, located within walking distance of each other, form Southeastern New England's largest academic medical center.
Rhode Island Hospital
Rhode Island Hospital is a 719-bed tertiary care center and is one of the largest and busiest teaching hospitals in New England. The hospital is the region’s trauma center and has nearly 150,000 emergency visits per year. There are residencies in nearly every ACGME specialty and numerous fellowships. At any one time, there are over 500 graduate trainees at Rhode Island Hospital.
Hasbro Children's Hospital
Hasbro Children’s Hospital is the main pediatric teaching affiliate of the Warren Alpert Medical School of Brown University. It is the only children’s hospital serving Rhode Island, southeastern Massachusetts and eastern Connecticut. The hospital houses ambulatory clinics in virtually every pediatric subspecialty and has a very busy emergency service and surgical service. There is a large pediatric intensive care unit and three inpatient floors. The Pediatric Sedation Center is the site of the department’s pediatric vascular laser program. The hospital is the site of a large pediatric residency, a medicine-pediatrics residency, and a “triple board” residency in pediatrics-child psychiatry-psychiatry. Residents from these services do elective rotations in pediatric dermatology.
Women & Infants Hospital
The dermatology service provides inpatient consultation coverage for the obstetrical and gynecological services as well as the newborn nurseries and the Neonatal Intensive Care Unit. The new NICU has 80 beds, each housed in an individual room, and is the largest single-room nursery in the country. Women & Infants Hospital is the main OB/GYN teaching site for Brown’s medical school and has one of the busiest obstetrical services in New England.
The Miriam Hospital is a 247-bed teaching hospital which provides a broad range of primary, secondary, and tertiary care in a patient-friendly community setting on the East Side of Providence. The hospital has particular strengths and clinical focus in infectious disease, oncology, and cardiovascular disease. The range of clinical dermatology encompasses general dermatology, HIV-related dermatoses, and travel-associated dermatoses.
Providence Veterans Affairs Medical Center
As a leader in the development of the ambulatory care model in the VA system, the VA Medial Center in Providence provides dermatologic care in a very busy outpatient clinic. Providence has also been the pioneer teledermatology program in the VA system, providing continuous service to remotely located veterans since 1997. Residents and attendings staff the busy inpatient consultation service and the teledermatology clinic.
Pediatric Dermatology Rotation
Pediatric dermatology training takes place at Hasbro Children's Hospital, Women & Infants Hospital, and in the faculty practice setting at Rhode Island Hospital. The educational goals are to provide the dermatology residents, medical students taking the dermatology elective, and pediatric residents taking the dermatology elective with expertise in the diagnosis and treatment of common pediatric skin conditions. In addition, dermatology residents receive exposure to dermatologic genetics and vascular anomalies. Each resident is expected to develop the special interpersonal and communication skills required for successful interaction with parents and children. Residents and students are required to evaluate patients, present each case to the attending for discussion of each differential diagnosis and the underlying medical decision-making, and maintain careful records.
The Academic Private Practice Rotation
The academic private practice rotation offers the opportunity for residents to see a large number of tertiary care patients, many referred by practicing dermatologists and primary care physicians from the community. Referrals from other academic medical centers are also evaluated. Residents also gain experience in the management of patients with pigmented lesions or those requiring PUVA. Most of these patients represent difficult diagnostic and management challenges encompassing a broad range of dermatologic disease. Regardless of the degree of severity of the disease process, the objectives of the rotation are that the residents establish a firm foundation in dermatologic diagnosis and the development of a management protocol. Every aspect of the rotation represents a learning opportunity ranging from the psychology of the very sick patient to efficient time management.
Inpatient/Day Hospital Rotation
The adult Inpatient and Day Hospital rotation is designed to give an opportunity to gain experience in the care and management of patients requiring an intensive treatment program and gain expertise in a variety of treatment modalities. Patients who require inpatient care are admitted to the Medicine Service of Rhode Island Hospital with dermatology consultations. Patient rounds occur daily with the attending. Severely ill, unstable patients are admitted to the intensive care unit and are followed by the medicine service with close dermatology consultation.
The Dermatologic Surgery Rotation
The unit’s emphasis is on Mohs surgery, reconstructive surgery, and cutaneous oncology. Several members of the full-time staff perform other dermatologic surgery procedures, including cosmetic and laser procedures. It is one of the busiest academic units in the country with over 1,500 cases performed each year and over 30,000 cases treated by our team since 1989. Complicated cases may be presented to the Interdisciplinary Melanoma and Cutaneous Oncology Clinic for collaboration with surgeons, oncologists, radiation oncologists, and medical dermatologists. Due to the unique nature of this Interdisciplinary Melanoma and Cutaneous Oncology Clinic, cases are referred to us from all over Southern New England. The majority of postoperative wounds are reconstructed in the unit. However, coordinated care with other specialists such as plastic or oculoplastic surgeons is easily accomplished on-site at the Rhode Island Hospital campus.
Senior Medical Student Electives
Clinical rotations in dermatologic surgery are available only by special request and are reserved for students who have completed a clinical dermatology elective and intend to pursue a career in dermatology. However, medical students will have exposure to the unit in the general dermatology elective.
Laser Surgery Rotation
The department has developed a special curriculum for teaching laser surgery and cosmetic dermatology. The goal is to provide comprehensive instruction in both these areas through a combined approach including didactic sessions and treating in the specialized consultation and communication skills required for cosmetic patients. Senior residents perform laser surgery and cosmetic procedures with one-on-one faculty supervision in their senior clinic. The didactic sessions in basic and advance dermatologic surgery and cosmetic/laser surgery are given throughout the year. Journal reviews are also performed.
The dermatopathology experience consists of weekly dermatopathology teaching conferences, clinical-pathologic correlation, and rotations for second and third year residents. Lectures are presented by board-certified dermatopathologists, or the rotating senior resident. Known glass slides pertaining to the week's chapter are provided for review and presentation. Patients' biopsies are routinely reviewed with a dermatopathologist or pathologist at the VA Medical Center and Rhode Island Hospital. Teaching glass slides and Kodachrome slides are available for review.
Contact Dermatitis Center
The Contact Dermatitis Center is based at Rhode Island Hospital. It acts as a referral center for the region to which patients are referred for evaluation of more complex cases of contact dermatitis and occupational skin disease. The Center has specialized patch test panels containing over 300 allergens, a reference library, and access to computerized allergen replacement databases. Residents rotate through the center for 3 months and do the initial evaluations of all patients referred to the unit and interprets the patch tests alongside the attending physician. Didactic teaching in contact dermatitis is part of the residents’ educational experience.
The Consultation Service Rotation
Rhode Island Hospital / Hasbro Children’s Hospital / Women & Infants Hospital
This consultation service rotation allows the assigned resident to expand his/her knowledge base and diagnostic skills in a busy 1,000-bed hospital setting. Patients on the medical, surgical, pediatric, and obstetric and gynecology services are seen in consultation. In addition, many patients in the neurosurgical, surgical, medical, cardiac, and neonatal intensive care units are evaluated. The emergency departments in each of the hospitals also frequently request urgent consultations. Residents on this rotation develop increased skill and confidence in evaluating complicated dermatologic problems and in communicating with other physicians, nursing staff, and hospital personnel.
The Senior Elective Rotation
Our senior residents, in good academic standing, are allowed 2-3 weeks in their third year to pursue an uninterrupted course of study or patient care at this or another institution, in the United States or abroad. This elective time allows the individual resident to expand knowledge in a particular subspeciality in dermatology such as pediatrics, surgery, international health, HIV-related disease, etc.