Visiting Practitioner Program - Dermatology

Faculty:
  • Rosanna Marsella, DVM, DACVD (Service Chief)
  • Joy Barbet, DVM, BSC, DACVD
  • Diane Lewis, DVM, DACVD, 1 day/week
  • Stefano Toma, DVM
Residents/Interns:

   None

Visiting practitioners should meet in the Dermatology Room on the first Monday of the Junior/Senior rotation for orientation. In addition to orientation to the service there is a discussion of the various shampoos and their appropriate uses.

Daily Routine:

Dermatology receives patients on Tuesdays, Thursdays and Fridays. We also see equine cases which are co-scheduled with dermatology and medicine on Wednesdays as needed. We see 10-12 cases on Tuesdays and Thursdays and variable numbers on Friday with a minimum of three but often more. Most cases are referred but we also receive cases that are not referred. We begin to see appointments at 8:30 a.m. and work through the lunch hour (bring lunch). Dermatology cases are worked-up as day cases so that after the students examines the patient and gathers a history, they present their findings to the resident/faculty and discuss the differentials. Then the client is addressed by the veterinarian and a diagnostic plan is discussed. Cases are discharged before 3:00 or after 4:30 with often complex discharge discussions. Rounds are held on Tuesdays and Thursdays from 3-4:30 pm. On Fridays, dependent on whether we have juniors or seniors there may be rounds (at 2 p.m. or we may have case discussion from slides or short talks presented by the students).

Cases are occasionally hospitalized for drug eruptions, autoimmune disease or sepsis with demodicosis. In these cases, additional management is necessary and students will be responsible for whirlpool bathing, etc. Cases are assigned to specific students who present regular reports during rounds.

Dermatology does not receive on Mondays. Students are given a series of exercises to complete on these days which include slide quizzes in the library, questions to answer about shampoos, flea control and variations on their cases to write up for a portion of their grade. Consultation of cases from other services are done on an as-needed basis on Mondays. The remainder of the week various residents do all the in-house consults as well as consult phone calls. These are then discussed with the faculty on duty and if particularly challenging, may be discussed on Wednesday with all.

On Wednesdays the dermatologists meet for 3-4 hours. We look at the histopathology slides from the previous week's cases together either through a multi-headed microscope or via a projecting scope. Journal club follows as well as a textbook discussion period. We also entertain general questions from the residents about cases or consults or spurious results or advice they may want (where we all add our point of view). We may discuss questions relative to their resident projects at this time as well.

Additional Points:

There is an advanced teaching set available of complex cases for those visiting practitioners who wish to work independently through them. These cases are gathered from several dermatologists around the U.S. There are also teaching sets of histopathology slides available for perusal.

Visiting practitioners might wish to prepare a short (20 min) seminar to give to the group on the last Friday of their visit. This could be on a topic that requires use of the reading room resources or it could be more of a philosophical talk about practice or practice pointers.

Because we do not see cases on Mondays and Wednesdays, some visiting practitioners may wish to not participate in the Wednesday activities which are in the form of a long meeting and choose to share their dermatology block with another service. They may wish to attend medicine rounds or general medicine during those two days of the week. That would be flexible on a case by case basis.

Expectations:

The practitioner will be expected to be an active participant in the working up of cases and case discussions. It will be anticipated that he/she will try to see all of the dermatology cases during the time interval of the visit, and for the visit to be an exchange of information for all participants.

At the end of the rotation, the visiting practitioner should feel comfortable with the general diagnostic procedures and techniques in dermatology and should understand the importance of repeat visits for many of our dermatologic patients. They should be capable of defining primary lesions and with the use of various textbooks, be able to generate a valid list of differential diagnoses and a diagnostic plan plus treatment to begin the diagnosis of the dermatologic patient. Expectations for this program will depend on the knowledge entry level and interest of the veterinarian and can be tailored somewhat to the practitioner's wishes.