Upon successful completion of the fellowship, the fellow will be recommended for membership in the American College of Mohs Micrographic Surgery and Cutaneous Oncology. There is currently no American Board of Medical Specialties certification or sub certification in any aspect of dermatologic surgery. The fellowship shall be of a minimum of 1 year in duration. Additional fellowship time can be negotiated for individuals who desire more laboratory experience or additional clinical experiences. As currently planned, there will be only one fellow at any time (no junior and senior fellow). The fellow will participate in the following activities plus have other appropriate duties and responsibilities as the fellowship evolves:
Mohs Micrographic Surgery
The fellow will participate in Mohs surgery and repair at least 3 days each week. The fellow will participate in the cases, first as an assistant and gradually evolving into the primary surgeon and further beginning to instruct the residents. The fellow must master both the surgical and histologic aspects of the procedure. This involvement includes the intake, evaluation and follow-up of patients. The fellow will also learn and master the technical portion of the procedure including the ability to prepare the microscopic slides and establish a laboratory consistent with current medical and legal standards.
Repair of Surgical Defects
Approximately 80% of the Mohs cases are followed by an immediate repair at the same operative setting. The fellow will participate in the same manner as above. In addition, the fellow will participate with the ENT, Plastic Surgery and Oculoplastic Surgery specialists as appropriate in the reconstruction of the defects.
The fellow will learn how to deal with difficult tumor cases throughout the fellowship. In consultation with our colleagues in Pathology, Oncology, Radiation Therapy and the Surgical Specialties strategies for dealing with difficult cases will be developed and the fellow will become accustomed to the need for a multidisciplinary approach to many tumors.
The fellow will participate in the care of solid organ transplant patients. These patients give rapid exposure to the evolution of cutaneous malignancies.
General Dermatologic Surgery/Cosmetic Dermatologic Surgery
The full-range of general dermatologic surgery will be performed during the fellowship period. Several lasers are readily available. Exposure to cosmetic surgery will be limited, but a wide range of cosmetic procedures is being performed by faculty members. The opportunity for additional exposure may be made available according to the fellow's interests and skill levels.
Currently, the fellow spends one day each week at the Nashville Veterans Administration Medical Center performing general dermatologic surgery (excisions, reconstructions, etc.) and supervising and instructing the Dermatology residents in such procedures. No Mohs Surgery is currently performed at the VA.
Call and Consultation
The fellow, when available, will always take first call from the residents for problems relating to Dermatologic Surgery patients. A faculty member will also be available. The fellow may also be assigned periods of call and/or consultation coverage for General Dermatology in the role of a junior faculty member.
As noted above, the fellow will be intimately involved in resident teaching in the clinical setting. A willingness to fully participate in resident education is essential. When appropriate the fellow will also participate in the resident conferences and reviews. The fellow is also responsible for the bimonthly dermatologic surgery journal club. The fellow will select and assign the articles as well as moderate the session.
Research and Publications
Adding to the knowledge base of Dermatologic Surgery and contributing to the propagation of that knowledge are essential parts of the fellowship. The fellow will be expected to publish at least two papers based on materials developed during the fellowship. Attendance and presentation of work at appropriate specialty meetings will also be required. Partial support for attendance at the combined Annual Meeting of ACMMSCO/ASDS and the Annual Meeting of the AAD may be available.
The fellow will attend a course on surgical anatomy. This will most likely be the Superficial Anatomy and Cutaneous Surgery Course at UCSD/Scripps in July. Other arrangements may be possible. Although tuition will be covered, the fellow will be responsible for transportation and living expenses for the course.
The fellow will be certified in Advanced Cardiac Life Support.