Curriculum
In general pediatric dermatology clinics, fellows will see a broad range of common and uncommon pediatric skin diseases represented in a diversity of skin types, ethnicities, and races. Referrals to pediatric dermatology are made by community pediatricians, the Cincinnati Children's Pediatric Primary Care Clinic, Cincinnati Children's subspecialists and community dermatologists.
The pediatric dermatology fellowship program participates in several interdisciplinary centers, including the Rheumatologic Skin Disease Center, the Epidermolysis Bullosa Center, and the Hemangioma and Vascular Malformations Center. The program also collaborates closely with other subspecialists, including the Divisions of Allergy and Immunology, Hematology, Oncology, Plastic Surgery, and Rheumatology.
Fellows participate in coordinating a busy hospital-based inpatient consultation service, which covers consults in the Emergency Department, the general, surgical and subspecialty wards, the bone marrow transplant unit, and the neonatal, cardiology, and pediatric intensive care units.
Fellows are required to participate in subspecialty electives, which may include outpatient clinics in disciplines such as Allergy and Immunology, Genetics, and Rheumatology; the Emergency Department; and outpatient clinics and/or office and operating room-based procedures in Pediatric General Surgery and Plastic Surgery.
Fellows will also participate in the Procedural Dermatology Clinic, which focuses on the use of pulsed dye laser in the treatment of vascular birthmarks and other vascular lesions; minor nail procedures; and skin biopsies and excisions.
Fellows will also be instructed in digital skin photography, including use of digital cameras and archival photography software. The Division has a dedicated medical photographer who will provide technical supervision.
Fellows will receive exposure to and training in utilization of health care systems and medical care. This will include interaction with both clinical and administrative staff on a regular basis, instruction in proper coding and billing at time of service, education on issues related to insurance coverage such as prescription drug formulary usage and pre-certification for procedures and other services, and education in facilitating coordination of care with referring providers and other subspecialty care providers.
Additional Information
The didactic curriculum includes exposure to dermatology conferences (Grand Rounds at UC Health University Hospital of the University of Cincinnati, Cincinnati Dermatological Society meetings, pediatric dermatology conferences/journal club) and pediatric conferences (Pediatric Grand Rounds, pediatric resident noon conferences). Fellows will have the opportunity to review histology slides with dermatopathologists at the Department of Dermatology at UC Health University Hospital of the University of Cincinnati and with pediatric surgical pathologists at Cincinnati Children's. Fellowship training will also include pediatric dermatology journal reviews, and there is the expectation that the fellow will actively participate in the preparation of manuscripts and presentations for national meetings (1-2 per year). Fellows will also have opportunities within the Division of Dermatology for clinical research. Within the broader Department of Dermatology at the University of Cincinnati College of Medicine and at Cincinnati Children's, opportunities in basic science research, if desired, are available on a case-by-case basis with the approval of the Program Director.
The pediatric dermatology fellowship program at Cincinnati Children's is currently expanding and fully-staffed with appropriate administrative support. This includes clinic-based staff (four dedicated registered nurses and three medical assistants) and office-based staff (a business manager and senior administrative assistant as well as three patient service representatives). Pediatric dermatology clinical trials are conducted in coordination with a research coordinator and the clinical trials office staff under attending physician guidance as principal investigator. Digital photography is utilized within the division, and an archival database is updated and will be maintained regularly by the medical photographer under supervision by attending physicians.
All patient care activities are directly supervised by an attending physician. The fellow is expected to triage clinical questions from patient / caregivers, referring physicians, and other healthcare providers. This will be done in conjunction with the dermatology resident on service and the pediatric dermatology nurses. Activities will include, but are not limited to, patient appointment triage, prescription refills, pathology report notifications and home management issues. All such duties will be directly supervised or reviewed by an attending pediatric dermatologist.
The didactic curriculum includes exposure to general dermatology conferences and pediatric conferences as well as to divisional conferences in pediatric dermatology
Dermatology Conferences
- University of Cincinnati Department of Dermatology Grand Rounds
- Cincinnati Dermatological Society meetings
- The Procter and Gamble Scientific Lectureships at the University of Cincinnati Department of Dermatology
Pediatric Conferences
- Pediatric Grand Rounds
- Pediatric resident noon conferences
Pediatric Dermatology Conferences
- Dermatopathology case conference at the University of Cincinnati Department of Dermatology (weekly review of pediatric dermatology cases)
- Journal review (focusing on Pediatric Dermatology, JAAD, Archives of Dermatology, and Pediatrics)
- Case conferences
- The Eczema Center
- The Pigmented Lesion Center
- The Dermatology-Rheumatology Center
- The Epidermolysis Bullosa Center
- The Hemangioma and Vascular Malformations Center
- Procedural Dermatology Clinic
Outpatient Clinical Care
Fellows will provide tertiary care to pediatric dermatology patients during a weekly continuity clinic, and also in regularly scheduled attending clinics throughout the academic year, so as to afford the maximal amount of continuity. The fellow clinics will emphasize continuity of care for inpatient consults requiring outpatient follow-up as well as evaluation of new patients requiring urgent care. Fellows will concentrate on patient / caregiver interactions, diagnostic acumen and therapeutic management with an emphasis on developmental and behavioral issues as pertinent to pediatrics.
Fellows will be trained and supervised in the performance of bedside diagnostic studies, including mineral oil preps, potassium hydroxide wet mounts, dermoscopy and hair analysis. Fellows are expected to assist in the triage of telephone inquiries from both patients/caregivers and other physicians with regards to home management and appointment requests.
Outpatient Dermatologic Surgery
Fellows are expected to become proficient in skin biopsy, curettage, cryotherapy, use of topical agents such as cantharidin and podophyllin, and full-thickness excision as well as in simple skin closure techniques. Fellows desiring exposure to more complex surgical issues, including skin grafting or complex closure techniques, may elect to spend time with a pediatric general surgeon or pediatric plastic surgeon in the operating room.
Fellows are also expected to become proficient in the indications and use of the pulsed dye laser for the treatment of vascular skin lesions in children. Fellows will also be trained on the use of the excimer laser for the treatment of vitiligo and psoriasis in children. Fellows desiring experience on other laser modalities, including carbon dioxide and Nd:YAG lasers may elect to spend time with a Pediatric General Surgeon or Pediatric Plastic Surgeon in the operating room.
Fellows will be instructed in the evaluation, pre-operative planning, and delivery of pediatric dermatologic surgery services, including post-operative wound care and pain management. Decision as to the proper timing and approaches for dermatologic surgery in children will be emphasized, including consideration of patient age, developmental status, and school and social activities.
Inpatient Clinical Care
Fellows will actively participate in inpatient consultative services, including the general and subspecialty pediatric wards; surgical wards; neonatal, cardiology and pediatric intensive care units; and the emergency department. The fellow will be responsible for coordinating communication with the requesting service and with other consultative services.
Call and Coverage
The fellow will take call from home on evenings and weekends, and will be required to see emergent and/or complicated inpatient and emergency department consults. The fellow will also see consults and round with the on-call pediatric dermatology attending on the weekends.
Fellows are encouraged to engage in clinical research during their fellowship. Participation will include study design, protocol preparation and submission to the Investigational Review Board, analysis of data and manuscript preparation. It is anticipated that initial selection of a research topic will begin prior to the commencement of the fellowship training period. A pediatric dermatology and/or other pediatric subspecialty attending will serve as mentors during this process. Cincinnati Children's has a large clinical trials office that can assist with the coordination and completion of research-related activities.
Fellows will have the opportunity to participate in basic science research, if interested. This may be undertaken with various faculty members in the Department of Dermatology at the University of Cincinnati or at Cincinnati Children’s Hospital. Programs should be designed based on the individual fellow’s interests, skill level and availability. Appropriate funding sources for basic science research fellowships will need to be arranged in advance by the fellow and faculty mentor.
Fellows will be expected to prepare at least one to two manuscripts for submission for publication during their fellowship. Selection of cases or topics, review of author guidelines, and preparation of the final manuscript will be supervised by a pediatric dermatology attending. Fellows will also be expected to submit a case for presentation at the Annual Meeting of the Society for Pediatric Dermatology. Additional presentations at local, national or international conferences are encouraged.
The fellow will be responsible for preparing didactic lectures for the pediatric and dermatology residents, approximately four per year. With experience, the fellow will provide supervision of rotating pediatrics and dermatology residents and medical students in the outpatient clinics and on the inpatient consultation service.
The fellow will be evaluated biannually by the program director through the use of a standardized evaluation form that addresses the six core competencies as defined by the ACGME. All pediatric dermatology clinical and administrative staff are encouraged to provide feedback as well. These reviews will be discussed with the fellow by the program director.
The program will be evaluated biannually by the staff of the pediatric dermatology fellowship program, including both the administrative and clinical staff. The fellow is expected to participate in these reviews. Areas to be reviewed include whether the program is able to meet the educational goals as outlined above and whether the clinical and research needs of the faculty are being appropriately met.
Fellows will provide tertiary care to pediatric dermatology patients during a weekly continuity clinic, and also in regularly scheduled attending clinics throughout the academic year, so as to afford the maximal amount of continuity. During the fellow-run continuity clinic, fellows will formulate diagnostic and therapeutic plans under the supervision of a pediatric dermatology attending. These clinics will provide continuity for inpatient consults requiring outpatient follow-up as well as appointments for new patients requiring urgent evaluation. Participation in a minimum of five outpatient half-day clinics in pediatric dermatology per week is required. Fellows will concentrate on patient / caregiver interaction skills (with both patients and parents), diagnostic acumen and therapeutic management. The pediatric approach will have an emphasis on developmental and behavioral issues as pertinent to pediatrics.
Fellows will be instructed in the evaluation, pre-operative planning and delivery of pediatric dermatologic surgery services, including post-operative wound care and pain management. Decision as to the proper timing and approaches for dermatologic surgery in children will be emphasized, including consideration of patient age, developmental status, activities, etc. Fellows will learn hands-on surgical techniques in skin biopsy, curettage, cryotherapy and full-thickness excision as well as simple closure techniques. Fellows desiring exposure to more complex surgical issues, including skin grafting or complex closure techniques may elect to spend time with a pediatric general surgeon or pediatric plastic surgeon in the operating room. Fellows will be instructed in the indications and use of the pulsed dye laser, and receive hands-on training in the use of this laser for therapy of vascular skin lesions in children. Fellows will also be trained on the use of the excimer laser for the treatment of vitiligo and psoriasis in children. All laser procedures will be performed under the direct supervision of an attending pediatric dermatologist with local anesthesia. Fellows desiring experience on other laser modalities, including carbon dioxide and Nd:YAG lasers, may elect to spend time with a pediatric general surgeon or pediatric plastic surgeon in the operating room. The opportunity exists for the fellow to observe in the Phototherapy Center at the University of Cincinnati, which provides PUVA, broadband UVB and narrowband UVB therapy and currently treats about 100 patients per week.
Fellows will actively participate in inpatient consultative services, including the general and subspecialty pediatric wards, surgical wards, neonatal and pediatric intensive care units and the emergency department. Formulation of diagnostic and therapeutic plans will be expected of the fellow, who will supervise the resident and / or medical student on service under the supervision of an attending pediatric dermatologist. The fellow will be responsible for coordinating communication with the requesting service. Rounds with the pediatric dermatology attending on service will take place daily during weekdays and as needed during the weekends. Weekdays rounds average five to 10 hours per week, depending on patient volume and complexity.
Fellows will be instructed in digital dermatological photography, including use of digital cameras and archival photography software. The division has a dedicated medical photographer who will provide expert instruction.
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