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.

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. 

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.

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.

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.

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.

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)

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 70^th 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.

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.