Editors



Current Editors: Tim Allen and Keith Wagner



Past Editors: Kristyna Gleghorn, Dung Mac, Alex Acosta, William Tausend, Sheila Jalalat, Rebecca Philips, Chelsea Altinger, Lindsey Hunter, Alison Wiesenthal, Leslie Scroggins, Mara Dacso, Ashley Group, Fadi Constantine, Emily Fridlington, Joslyn Witherspoon, Tasneem Poonawalla.

Monday, December 30, 2013

UTMB Receives Funding for Additional PGY1 Residency Positions

In an effort to provide enough residency programs for Texas Medical Students to remain in our state for residency training, the Texas Higher Education Coordinating Board has provided funding for additional PGY1 residencies in primary care and some specialties (anesthesiology and psychiatry). UTMB is one of the 7 Texas institutions will benefit from this new funding source for postgraduate medical education.

Tuesday, December 24, 2013

Procrastination is the Enemy of Success

Procrastination can stand in the way of academic success. Dr. Kathleen Franco offers some sound advice about how to prevent procrastination from adversely impacting your career goals:
http://www.usnews.com/education/blogs/medical-school-admissions-doctor/2013/11/20/think-like-a-physician-to-avoid-procrastinating-in-medical-school

Do Dermatology Residents Need More Tests?

Dermatology residents are typically tested once during each academic year, during the scheduled in-service examination developed by the American Board of Dermatology. Is one test enough? A recent study reported in the New York Times and reprinted by the Houston Chronicle (Study: Frequent tests can enhance college learning, November 29, 2013, page A28) suggests that more frequent testing could be beneficial to learning. Purdue psychology students who took a short quiz every class based on assigned reading and lecture material improved their performance. The testing also incorporated previous questions that students had answered incorrectly. 

Friday, December 20, 2013

UTMB MS4 Publishes Original Manuscript about Acne in Media

Congratulations to UTMB MS4 Adrian Subrt for his recent publication, “Comparative depictions of acne vulgaris in movies and in animated television cartoons.” This original research was published in the Journal of Medicine and Movies (2013;9:178-187). His article is available at http://revistamedicinacine.usal.es/index.php/volumenes/volumen9/num4/766 . Adrian’s co-author on this research is Dr. Richard Wagner (UTMB dermatology faculty). The original concept for this research developed from a class assignment in Dr. Wagner’s popular film class, DERU-4007 (Skin Diseases Depicted in Film). Several of Dr. Wagner’s students have now gone on to publish manuscripts related to their class work about skin diseases, dermatology and media.

Wednesday, December 18, 2013

Medical Economics Reports on Dermatology Salaries

According to Medical Economics (http://medicaleconomics.modernmedicine.com/medical-economics/news/physician-owners-take-6-pay-cut-2012-other-incomes-relatively-flat-survey-say) dermatologists averaged $360,000 in salary last year (the median was $313,000). Only cardiologists ($381,000), surgeons ($374,000) and urologists ($388,000) had higher average salaries according to this survey. The average salary for plastic surgeons was $345,000.

Texas Medical Board Limits Use of Local Anesthesia in Many Dermatology Offices

During the December 2013 meeting of the Texas Medical Board, new rules related to office based level I anesthesia were adopted. Use of local anesthesia that exceeds 50% of the recommended safe dose is now level II and requires additional patient monitoring. However, Mohs micrographic surgery is exempted under the new rule.
 
CHAPTER 192. OFFICE BASED ANESTHESIA
 
22 TAC §192.1
 
The amendment adds language providing that except as provided by §192.2(b)(9), the administration of certain local anesthesia, peripheral nerve blocks, or both in a total dosage amount that exceeds 50 percent of the recommended maximum safe dosage per outpatient visit is a level II service, in accordance with SB 978 (83rd Reg. Session).
 
22 TAC §192.2
 
The amendment revises language in subsection (b)(1) providing that rules under Chapter 192 do not apply to outpatient settings in which only local anesthesia, peripheral nerve blocks, or both are used in a total dosage amount that does not exceed 50 percent of the recommended maximum safe dosage per outpatient visit, in accordance with SB 978 (83rd Reg. Session).  Additionally, new subsection (b)(9) is added, providing that the rules under Chapter 192 do not apply to the performance of Mohs micrographic surgery.

Monday, December 16, 2013

New York Times Article Criticizes Current Resident Surgeon Work Hour Rules

According to New York Times physician writer Dr. Pauline W. Chen (Are Today’s New Surgeons Unprepared? New York Times, December 12, 2013) the current limitation of physician work hours during surgical residency is having unintended consequences. In her well researched article, Dr. Chen presents substantial evidence that well intended regulations by the ACGME have adversely impacted the clinical proficiency of many new surgeons. Unfortunately, the solution for this problem is not currently known. A link to this article can be found below.  http://well.blogs.nytimes.com/2013/12/12/are-todays-new-surgeons-unprepared/?emc=eta1&_r=0

Is the Dream of Solo Dermatology Private Practice Over?

Many dermatology residents aspire to establishing a solo private dermatology practice once they complete residency training. This type of practice setting will become less likely according to an article in the December 2013 issue of Houston Medical Journal (Physicians’ Forum: Solo physician practice on the decline, pages 7 and 10). Steve Sanders, the CEO of Memorial Hermann The Woodlands Hospital is quoted, “Solo practice isn't dead, but it’s on its last legs.” Expanded regulatory requirements and higher administrative costs were cited by this article as factors for the expectation that solo private practice will decline.

Wednesday, December 11, 2013

Dr. Neda Nosrati’s Published Dermatology Resident Scholarly Project Update

Dr. Nosrati received an email from the Journal of Cosmetics, Dermatological Sciences and Applications (JCDSA) about her dermatology resident scholarly project paper that was published in 2012. Her original clinical research paper, “Efficacy of Nd:YAG laser for the Treatment of Hidradenitis Suppurativa”  has been downloaded 620 times. The journal’s editorial assistant, Kimberly Garcia wrote, “It proves to be one of the most popular papers in the journal. Congratulations!” Dr. Nosrati’s coauthors on this research were Drs. Lindsey Hunter (current PGY3 UTMB dermatology resident) and Dr. Erica Kelly (UTMB dermatology faculty). This paper may be read online at: http://www.scirp.org/journal/PaperInformation.aspx?PaperID=20122

Dr. Nosrati is currently in private dermatology practice in Bellaire, Texas.

Tuesday, December 10, 2013

Dermatology Residency Update Information from Annual JAMA Medical Education Issue

Every year JAMA publishes an issue devoted to medical education. Data from the December 4, 2013 issue (page 2329) about dermatology residency includes the following:
 
Number of dermatology residency programs: 114
 
Number of dermatology residents: 1191 (95.4% USMDs, 64.4% female)

Monday, December 09, 2013

DIG participation at St. Vincent Well-Fair on Nov 9, 2013

On November 9, 2014 DIG members volunteered at the St. Vincent’s Well-Fair to educate the local community members on the ABCDs of skin cancer and sun protection as part of DIG’s Stay Shady Project. We gave out sunscreen samples, skin moisturizers, and educational brochures at the event to encourage sunscreen use. Many participants at the fair had expressed confusion as to who can get skin cancer and what exactly are the ABCDs of skin cancer. They were very appreciative of DIG volunteers for the education and for clarifying their confusion. Special thanks to DIG volunteers: (pictured) Dung Mac (MS2), Suhas Kochat (MS1), William Tausend (MS4), and Alexandra Martirossian (MS1, not pictured).


How did the UTMB dermatology residents score in the top 70th percentile on dermatology boards this year?

The UTMB dermatology residents scored in the top 70th percentile on the dermatology boards this year. We recently asked the recent graduates what they did to score so well and if they could identify anything about the UTMB dermatology residency that helped them achieve this academic excellence.

“I think it is hard to pinpoint exactly what prepared us for this test...we have so much clinical exposure in our clinics at UTMB that I think that is #1. I think our Friday academic day was important (Kodachromes in particular). My suggestion regarding journal club would be to read through “Journal Watch”, they publish the Top 10 "stories" of the year and also list the 10 most important/impactful articles). It would be great to definitely read and analyze those articles as a group.  The other residents and read those together this year and I think it helped. DermPath unknowns (I think we stress DermPath quite a bit in our program which came in very handy on the boards). The two board review courses that I attended really helped as well (Galderma Review in Dallas and Barron's DermPath review in Cincinnatti, OH).”

“I don't think there is one thing in particular that helped us to score well on the boards, however I do think that the academic curriculum at UTMB is very strong, and this has been demonstrated over the years with the program's very low fail-rate on the boards over the years. I have always thought that giving lectures in your third year is one of the best ways to solidify your knowledge (after learning the material for the 3rd time - "see one, do one, teach one" method). I also think our faculty members were very helpful in gearing their lectures and teaching sessions toward high yield and board-relevant material. A lot of the studying comes down to your own methods and integrating all of the materials you have. I think a combination of Galderma, referencing (and studying) Bolognia, looking at as many clinical photos as possible (including the AAD kodochrome database on the website), and doing tons and tons of practice questions worked best for me. Also, I attended several review courses including the Galderma course in April and the Dermpath100 course in Ohio. It was helpful to get a sense of the types of questions and topics that were high yield (as well as those topics that I was weaker in). All in all, I don't think there is a "magic bullet" for this test. It really comes down to how prepared you are to choose the "best" answer on the exam, as well as stamina to do hundreds of questions in one day. I don't think anyone felt super confident after this exam, which shows you that it really is variable.”

“I agree with my fellow residents, however, I didn't attend any of the extra review courses, which made me nervous I was missing out, but I think we are prepared well enough. I personally didn't want to spend the money on the reviews and travel and it was difficult to be away from my family.  But, yes, Galderma binder, lots of review questions, clinical reading and presentations throughout residency. Reviewing lots of slides (UTMB has large study sets).”


Thank you for your very useful information!

DIG member attends Innovations in Dermatological Sciences Conference

On November 19, 2013 DIG member, Dung Mac (MS2), attended the Innovations in Dermatological Sciences Conference hosted by Rutgers University in East Brunswick, New Jersey. There were numerous topics for discussion including optical nanoparticles (Dr. Rox Anderson), toxicology of nanoparticle (Dr. Nancy Monteiro-Riviere), the utilization of nanomaterials for the diagnosis and treatment of skin disease (Dr. Adam Friedman), drug delivery with nanospheres (Dr. Bozena Michniak-Kohn), StrataGraft tissue as an alternate to autografting deep partial thickness burns (Dr. Cathy Rasmussen), alopecia areata (Dr. Angela Christiano), treatment of dystrophic epidermolysis bullosa intravenously with recombinant collagen 7 (Dr. Mark de Souza), and soy skin care products (Dr. Miri Seiberg).

Is skin a portal for nanoparticle exposure? How can nanoparticle be used to deliver drugs through the skin? In Dr. Monteiro-Riviere’s talk, it was discovered that the majority of nanoparticles do not penetrate past the epidermis layer. In Dr. Michniak-Kohn’s talk, the development of a novel nanoparticle, Tyrosphere, could be used as a delivery system for lipophilic drugs across the skin. Although currently, tyrosphere particles do not penetrate past the epidermis, it was demonstrated that they continually release drug into deeper layers of the skin (increasing the solubility of candidate drugs by as much as 5000 fold without penetration to the vasculature).

What are the developments in optical nanoparticles? Dr. Anderson discussed how gold-antibody nanoparticles could be used to target CD8 lymphocytes and selectively kill them with a laser pulse.  This provided the potential for novel tumor therapy. Additionally, recent development in tattoo removal uses microencapsulated soluble pigments that could serve as an alternative to tattoo ink. These pigments have the benefit of being readily degraded with a laser without scarring. Dr. Anderson also spoke about the use of silica core coated with gold particles that are used to selectively target sebaceous glands and damage them with laser, hinting at a possible use for acne treatment.


Wednesday, December 04, 2013

UTMB Dermatology Invites 30 Medical Students from Outside Institutions to Interview for Dermatology Residency Positions

From over 400 dermatology residency applications received this year, the UTMB Department of Dermatology has selected 30 medical students to interview in late January 2014 for the 4 dermatology residency positions available through the upcoming 2014 NRMP match. Of the selected students, 29 will receive an MD degree by 2014, while one will receive a DO degree. Students from 17 different medical and osteopathic schools were invited to interview, including every school in Texas and Louisiana. Twenty five of these applicants were AOA members. Their Step 1 scores ranged from to 235 to 273 (mean 252, median 250, mode 250). One applicant will complete a pediatric residency in 2014. Additional applicants were placed on the waiting list, and will be notified if an opportunity for an interview becomes available.

In addition to these 30 invitations to interview, all 7 applying UTMB students and house staff were invited to interview with the department on December 6, 2013. Six visiting medical and osteopathic students who took a clinical rotation at UTMB during the 2013-2014 academic year were also interviewed for a dermatology residency position at the time of their summer or fall rotation in Galveston.

Wednesday, November 27, 2013

Dr. Julie Martin Publishes UTMB Dermatology Residency Scholarly Project

Dr. Julie Martin, currently in private dermatology practice in Austin, recently published her scholarly project entitled, “Dermatology Procedural and Surgical Skills Workshop for Medical and Physician Assistant Students,” in the Journal of Cosmetics, Dermatological Sciences and Applications (JCDSA, Volume 3, Number 3A2, 2013). Her coauthors on this educational research were UTMB MS4 DIG President Sheila Jalalat and Dr. Richard Wagner from the UTMB Department of Dermatology. This open access publication is available at: http://www.scirp.org/journal/JCDSA/ ( http://dx.doi.org/10.4236/jcdsa.2013.33A2011  ).

Dr. Martin completed three years of general surgery residency at UTMB before taking a one year fellowship in cutaneous oncology at Harvard and then starting dermatology residency at UTMB. She completed her dermatology residency at UTMB in June 2013.

Tuesday, November 26, 2013

Dermatology Research: Ways to Get Involved

Students interested in dermatology often ask how to get involved with research. Dr. Tyring’s clinical research fellow has given us some recommendations on ways students can find dermatology research opportunities:
  1. Many faculty members have research opportunities for medical students but it must be sought out. A better approach may be meeting dermatology faculty at interest meetings, rotations, and inquiring in person or by email.
  2. On 3rd/4th year medicine or ICU rotations patients will present with interesting dermatological complaints that can be written up as case reports. Express interest to your attending/resident that you would like to write your patient up.
  3. Enroll in research elective during 4th year (details in previous DIG@UTMB blog post)
  4. While generally reserved for residents, medical students can present patients at conferences (ie. Texas Dermatological Society meetings) if there is space and time available.
  5. Some students applying to dermatology will elect to take a year off for research to make their application more competitive. Before considering this, talk to a mentor who can give you a realistic idea if you will match into dermatology given your current stats or if taking a year to conduct research would be beneficial.
  6. Dr. Tyring is happy to have students rotate with him for a month to work in both his private clinic and do research.
    1. His email address is styring@ccstexas.com. Just this year they had one UTMB medical student write and publish a paper in a major dermatology journal. It was accepted, too! Another student rotating for a month wrote a paper that was also recently accepted, helped input data for a project that residents were already working on, and presented a poster at the Texas Dermatological Society meeting.
    2. Students can also contact Dr. Tyring’s clinical research fellow at cdowning@ccstexas.com to inquire about any projects. 

DIG would like to thank Dr. Tyring’s research clinical fellow for providing all of this helpful information!


Thursday, November 14, 2013

UTMB Dermatology to Interview Internal Candidates for Residency Positions

UTMB Dermatology will interview all of its internal applicants for a dermatology residency position on Friday morning, December 6th. Invited to this interview are current UTMB MS4 ERAS applicants as well as ERAS applicants from within UTMB who have already graduated from medical school.

Wednesday, November 13, 2013

UTMB Dermatology Resident selected to serve as a member of AAD's Residents/Fellows Committee

We are pleased to announce that Dr. Lindsey Hunter-Ellul, UTMB PGY-3 Dermatology Resident, was recently appointed to serve as a member of the American Academy of Dermatology's (AAD) Residents/Fellows Committee from 2014-2016. This committee serves to support the interests of and address issues of concern to residents and fellows in training during post-graduate education.

Monday, November 11, 2013

Lack of Research Interest Among Medical Students Investigated

Researchers at King Edward Medical University in Pakistan conducted a case-controlled study in 2007 at their institution with MS4s about why some medical students were not interested in research. They found that student attitudes of considering research useless (odds ratio 4.570) and lack of internet facilities (odds ratio 0.218) were statistically significant. However, further research is needed to determine why some of their medical students view research as useless. This article, “Factors contributing to lack of interest in research among medical students,” was published in Advances in Medical Education and Practice 2013;4:237-243.

Thursday, November 07, 2013

UTMB DIG President Publishes Dermatology Education Article

Congratulations to UTMB MS4 Dermatology Interest Group (DIG) President, Sheila Jalalat on her new publication, “Medical student dermatology interest groups,” that was published in the September-October issue of Clinics in Dermatology (31:656-60. doi: 10.1016/j.clindermatol.2013.02.001). Her coauthors on this paper were Drs. Lindsey Hunter-Ellul, a second year dermatology resident at UTMB and Dr. Richard Wagner, UTMB dermatology program director. The abstract for this article is available at http://www.ncbi.nlm.nih.gov/pubmed/24079594 and the entire article is currently available at http://www.sciencedirect.com/science/journal/0738081X

DIGA Posts Dermatology Residency Interview Calendar

As in past years, DIGA (Dermatology Interest Group Association) has posted a calendar and additional program information for the current dermatology match. It is available at: http://interviews.derminterest.org/ UTMB participated in the request for interview information, and our interview dates for nonrotating outside applicants (January 30 or January 31) are listed along with other participating programs. This calendar is especially useful for applicants trying to avoid interview conflicts, as it is often difficult to change an interview date once it is set.

Monday, November 04, 2013

Dr. Nate Davis Publishes UTMB Dermatology Residency Scholarly Project

Dr. Nate Davis, currently in private dermatology practice in Corpus Christi, recently published his scholarly project entitled, “Dermatology Resident Generated Textbook Questions as a Resident-centered Educational Strategy,” in the Journal of Cosmetics, Dermatological Sciences and Applications (JCDSA), Vol.3 No.3B, 2013). His coauthors on this educational research were Kimberly Cooper, UTMB Dermatology Residency Program Coordinator, and Drs. Erica Kelly, Sharon Raimer, and Richard Wagner from the UTMB Department of Dermatology. This open access article is currently available at: http://www.scirp.org/journal/JCDSA/ Dr. Davis’ UTMB residency group (Drs. Nate Davis, Ashley Group and Neda Nosrati) was the first from our medical school to have everyone in the class publish their scholarly project!

Saturday, November 02, 2013

Medical School Graduates Without a Residency Offer an Increasing Concern

Atul Nakhasi, a medical student at Johns Hopkins, published an opinion piece in the October 31, 2013 Wall Street Journal (One Quick Fix to Ease the Coming Doctor Shortage, page A15). He reported that last year, 1761 MDs could not find residency positions. He thinks this situation may become worse as more US medical schools are opening (a 30% increase in the number of first year medical students by 2017) coupled with less federal funding for residency education (proposed $11 billion budget cut over the next 10 years).

Should Standardized Test Scores be Included in CV?

Should residency applicants include their Step scores in job resumes? How about MCAT scores, or going back further, SAT/ACT scores? The December 2013 issue of Kiplinger's published an interesting article by Knight Kiplinger (A College Degree Isn't Enough, page 16). Some applicants are now including their GRE scores to demonstrate that their GPAs are not inflated and that they are intellectually capable of doing the work demanded by employers. This article also mentions that some references provided by applicants are not reliable.

Monday, October 28, 2013

UTMB Graduate Medical Education (GME) Program Granted 7 Year Institutional Accreditation by ACGME

UTMB GME was recently awarded a 7 year cycle for institutional accreditation from the Accreditation Council for Graduate Medical Education (ACGME). This is the maximum accreditation possible for an institution. The next reaccreditation is scheduled for 2020. UTMB currently trains 572 residents, 11 of them in the UTMB dermatology program. In July 2014, the dermatology program will increase by one permanent resident, for a total of 12. This additional dermatology residency position has already been filled through the 2013 NRMP, when UTMB matched with 4 applicants for PGY2 positions.

Sunday, October 27, 2013

St. Vincent’s WelFair: Volunteer Sign-Up

DIG is looking for volunteers for the St. Vincent’s WelFair 2013. DIG is hosting a table to educate people on the ABCDEs of skin cancer and how to properly use sunscreen to prevent sun damage. 

This event will be on Sat Nov 9, 10AM-2PM at St. Vincent’s Clinic 2817 Post Office St. Galveston, TX. 

Please sign up via this link:
 
Email dhmac@utmb.edu if you have any questions.
 
Thank you,
 
DIG officers

Wednesday, October 23, 2013

UTMB DIG President Publishes Case Report

Congratulations to Sheila Jalalat, our UTMB MS4 Dermatology Interest Group President, for her interesting recent case report about vitiligo associated with Gefitinib treatment that was published in the October 2013 (Volume 19, Issue 10) of Dermatology Online Journal. Her coauthor on this case report was Dr. Philip Cohen. This article is available online at: http://www.escholarship.org/uc/item/758988k7 

Dermatology Professional Office Attire Featured in Bloomberg Businessweek

The October 21, 2013 issue of Bloomberg Businessweek featured Dr. Peggy Fuller, a dermatologist in Charlotte, NC in their “What I Wear to Work” feature (page 95). She was wearing a yellow outfit from the Banana Republic with a stethoscope around her neck, but without a white doctor’s coat. Her shoes were Prada, and she also wore a Cartier ring, vintage bracelet and ear rings, and a Baum & Mercier watch. The interviewer, Arianne Cohen also asked, “Is the dermatology lifestyle as great as reputed?” In part, Dr. Fuller’s responded, “…you can be a physician but also have a life.” Dr. Fuller founded the Esthetics Center for Dermatology seven years ago.

What was your Interviewer’s Eye Color?

An article from the October 21st issue of Bloomberg Businessweek suggests that if you can’t recall your interviewer’s eye color, you may not be making enough eye contact (Jessica Grose, Look Away! Eye contact is overrated, page92 ). Of course, too much eye contact is not good either.

New UTMB Dermatology Research and Case Report Opportunities

Research and publications are important components of medical student applications for dermatology residency positions. With this in mind,  Dr. Lindsey Hunter-Ellul, PGY-3 UTMB Dermatology Resident, has created a “Dermatology Research and Case Report Opportunities” list of dermatology projects (i.e., research, case reports, posters, presentations, and resident scholarly projects) for UTMB and rotating medical students interested in pursuing dermatology research opportunities. The list provides a brief project description, the faculty and residents involved in the project, how much time the project will require, IRB requirements, and the number of students allowed per project. This list is available on the Resident Bulletin Board within the UTMB Department of Dermatology and will be updated weekly. This is also a great way for medical students to get involved and interact with dermatology faculty and residents. Medical students interested in a particular project listed on the bulletin board should contact the faculty and resident involved with the project for further information.
 
UTMB offers medical students several research electives for students to have protected time for scholarly activities in addition to the Honors Research Program. Research electives include: the UTMB Medical Student Summer Research Program (MSSRP) (an 8 week elective) between first and second years of medical school; DERU-4015 elective (4-8 week elective), which requires research elective committee approval 1 month prior to the rotation, and DERU-4004, a BSHS selective which requires a C-form. Students who wish to participate in the Honors Research Program must apply for entry by submitting a research proposal that has been approved by a Research Director, a full time faculty member under whom the student will perform the research. 

Monday, October 21, 2013

395 Completed ERAS Applications Received for 4 UTMB Dermatology Residency Positions

Applications for UTMB’s four dermatology residency positions offered through the 2014 NRMP continue to increase prior to the November 1, 2013 application deadline. In addition, 5 additional applications have been received but were not complete last week. The UTMB dermatology selection committee will begin reviewing applications on Monday, November 4th  for outside students who did not take a dermatology elective at UTMB during 2013 and hope to send out invitations for a late January interview by the end of December.

Thursday, October 17, 2013

Texas Medical Board Considers Restrictions on Dermatology Practice


In a move that could adversely impact dermatology practice in Texas for patients, the Texas Medical Board (TMB) is considering a proposal that would limit the amount of local anesthesia used in dermatology offices across the state. The proposed amendments to §192.1 and §192.2 currently read:
 
CHAPTER 192. OFFICE BASED ANESTHESIA 22 TAC §192.1 The Board proposes amendments to §192.1, relating to Definitions. The amendment add language providing that the administration of certain local anesthesia, peripheral nerve blocks, or both in a total dosage amount that exceeds 50 percent of the recommended maximum safe dosage per outpatient visit is a level II service, in accordance with SB 978 (83rd Reg. Session).
 
CHAPTER 192. OFFICE BASED ANESTHESIA 22 TAC §192.2
The Board proposes amendments to §192.2, relating to Provision of Anesthesia Services in Outpatient Settings.
The amendment provides that rules under Chapter 192 do not apply to outpatient settings in which only local anesthesia, peripheral nerve blocks, or both are used in a total dosage amount that does not exceed 50 percent of the recommended maximum safe dosage per outpatient visit, in accordance with SB 978 (83rd Reg. Session)
 
These new regulations would restrict the use of local anesthesia to doses that are 50% or less of the maximum does, even though there is much evidence based medicine that the maximum does is safe in Level 1 outpatient settings (see Arch Dermatol 2004;140:1379-1382). According to the new proposal, local anesthetic in excess of half the maximum does would require additional patient monitoring (Level 2), that is not currently available in most dermatology offices. This new regulation could greatly limit the availability of Mohs surgery for Texans with skin cancer, since Mohs surgery may require multiple excisions under local anesthesia on the same day to completely remove the skin cancer and additional local anesthesia for the wound repair. Those interested in contacting the TMB about this matter may email them by November 29, 2013 at: Rules.Development@tmb.state.tx.us  The TMB will meet on December 5, 2013 about this new proposed regulation at the William P. Hobby Building, 333 Guadalupe Street, Tower 2, Suite 225, Austin, Texas, 78701. Those who want to voice their opinion at this public meeting to the TMB may signup to do so.

Wednesday, October 16, 2013

UTMB Dermatology Residents Achieve 70% Percentile Rank on 2013 Dermatology Certification Examination

According to the American Board of Dermatology, our three recent dermatology graduates achieved a percentile rank of 70 on the 2013 certification exam (“the boards”). This means that their examination score average was equal or higher than 70% of other dermatology programs participating in testing. There were 118 participating programs during 2013, including UTMB. Congratulations for our residents for doing so well!

Monday, October 14, 2013

Tougher Grading Standards Anticipated for Dermatology Resident Milestones

Presentations at the Association of Professors of Dermatology (APD) last month indicates that more stringent evaluation of dermatology resident milestone competencies are expected from those creating the evaluation tools that will be used starting in July 2014. Evaluation forms presented at the 2013 APD meeting had ratings ranging from “1” (“below expected first year”) to “9” and “10” (mastery level). It was clear from the educational presentation that most residents would never achieve mastery level during residency because the comparison is senior dermatology faculty. A rating of “8” denotes “ready for unsupervised practice” and has been the standard for program completion. Ratings of “6” or “7” are “senior resident performance.” PGY2 dermatology residents are expected to be achieve a rating of either “2” or “3” (“beginning resident level”).

2013 Texas Legislature Protects Texas Medical Schools

Medical schools in the Caribbean often need clinical clerkship positions in the US for their students and are willing to pay for them. According to an article in the October 2013 issue of Texas Medicine (Texas first: Legislature preserves training spots for Texans, pages 49-53), our 2013 legislature “… passed legislation barring foreign medical schools from buying up core clinical training spots at Texas teaching hospitals and institutions.” During 2013, 94%  of US allopathic MS4s matched for residency, while only about 50% of US citizens attending international medical schools were able to do so.

UTMB Dermatology Department hosted Texas Dermatological Society Fall Meeting Oct 4th-5th

The University of Texas Medical Branch Dermatology Department hosted the Texas Dermatological Society fall meeting October 4th-5th at the Moody Gardens Hotel. It was one of the largest meetings with over 200 registered attendees. 

The meeting transported attendees to the UTMB Dermatology Clinic Saturday morning for 12 live patients viewing and 9 virtual cases.
Patient Cases Included:
1.Inflammatory Eruptive Porokeratosis
Rebecca C. Philips, M.D. and Bernard R. Gibson, M.D.

2.Nail-Patella Syndrome
Rebecca C. Philips, M.D., Ashley Group, M.D., Bernard Gibson, M.D., and Sharon Raimer, M.D.

3.Alopecia Mucinosa
Brandon Goodwin, M.D. and Sharon Raimer, M.D.

4.Lepromatous Leprosy Presenting as a Reactional State
Brandom Goodwin, M.D. and Ashley Group, M.D.

5.Darier Disease
Jason K. Jones, M.D., and Erica Kelly, M.D.

6.Congenital Erythropoietic Porphyria
Jason K. Jones, M.D. and Michael Wilkerson, M.D.

7.Diffuse Plane Xanthoma
Tanya Trynosky, M.D., and Michael Wilkerson, M.D.

8.Refractory Prurigo Nodularis Treated with Lenalidomide
Tanya Trynosky, M.D., Erica Kelly, M.D., prepared by Amber Gill, M.D.

9.Infantile Digital Fibromatosis
Helen Malone, M.D., and Ashley Group, M.D.

10.Infantile Perianal Pyramidal Protrusion
Helen Malone, M.D., and Ashley Group, M.D.

11.Erosive Pustular Dermatosis
Megan Moody Neill, M.D. and Brent Kelly, M.D.

12.Transient Myeloproliferative Disorder of Infancy
Megan Moody Neill, M.D., Bernard Gibson, M.D., and Brent Kelly, M.D.

13.Lymphomatoid Papulosis Type C
Samantha Robare-Stout, M.D., and Brent Kelly, M.D.
14.Inflammatory Vitiligo
Samantha Robare-Stout, M.D and Sharon Raimer, M.D.

15.Reed Syndrome
Janice Wilson, M.D. and Ashley Group, M.D.

16.Kaposi Sarcoma
Janice Wilson, M.D., Michael Wilkerson, M.D., prepared by Amber Gill, M.D.

17.Adult Onset Still’s Disease
Lindsey Hunter-Ellul, M.D., and Sharon Raimer, M.D.

18.Acquired Spiny Keratoderma
Lindsey Hunter-Ellul, M.D., and Bernard Gibson, M.D.

19.Telangiectasis Macularis Eruptiva Perstans
Lindsey Hunter-Ellul, M.D., and Ashley Group, M.D.

20.Morphea in Osteogenesis Imperfecta Type 1
Audra Clos, M.D., Brent Kelly, M.D., and Michael Wilkerson, M.D.

21.Brooke-Spiegler Syndrome
Audra Clos, M.D and Aaron Joseph, M.D.

UTMB Resident and Faculty presentations included:
Great Pediatric Cases
Sharon Raimer, MD

When Better is Small
Michael Wilkerson, MD

What’s New in Non-Prescription Skin Care
Erica Kelly, MD

An Evidence-Based Approach to Brittle Nails
Alma Berlingeri, MD

Oral Care for Patients with Oral Dermatosis
Tanya Trynosky, MD

Internal Medicine: The Skin and the Kidney
Brent Kelly, MD

UTMB Medical Student (MS4) Podium Presenter
Exacerbation of Bullous Pemphigoid After Hand, Foot, and Mouth Disease
Sheila Jalalat, BS
Case with: Lindsey Hunter-Ellul, MD, and Michael Wilkerson, MD
The Department of Dermatology, The University of Texas Medical Branch, Galveston, TX

UTMB Poster presentations
Linear IgA Dermatosis Secondary to Amlodipine
Tanya Trynosky MD, Adrian Subrt BA, Conner Chan MD, Ramon Sanchez MD, Carlos Nousari MD

A Rare Case of Cutaneous Metastases from Cholangiocarcinoma
Lindsey Hunter-Ellul MD Kathrene Tajnert, Brent Kelly MD, Vicki Schnadig MD, Ranjana Nawgiri MD

1st  place podium presentation:
Serving the Underserved: How to make a low cost sunscreen with natural ingredients
Maria Elena Miyar, MD
University of Texas Southwestern
Austin, Austin, TX

1st Place Poster
Development of new melanomas and progressive dysplasia in pre-existing nevi in patients undergoing BRAF-inhibitor therapy
Lotika Singh, MD
UT-Houston

2nd Place Poster
Chronic erosive pustular dermatosis of the scalp: emphasizing frequent follow-up and low biopsy threshold for the practicing dermatologist
Rod Mahmoudizad, MD
Scott & White Healthcare

3rd Place Poster
Efficacy and Safety of Field Treatment With Ingenol Mebutate Gel After Cryosurgery for Actinic Keratosis: Comparison With Phase 3 Results for Ingenol Mebutate Monotherapy
Whitney LaPolla, MD
UT Houston


We would like to thank those who helped make this meeting a success. A special thank you also goes out to the DIG members who volunteered their time to help direct meeting attendees around the UTMB campus.