Dermatopathology Fellowship

Program Overview

The Dermatopathology Fellowship at Penn State Health Milton S. Hershey Medical Center is a one-year, ACGME-accredited program that admits one fellow per year.

Program Details

This fully-funded program includes training in all aspects of dermatopathology. Faculty include three academic dermatopathologists, and academic anatomic pathologists and dermatologists. The service accessions more than 15,000 cases per year, including in-house and referred samples. Applicants should be board-certified or board-eligible in either anatomic pathology or dermatology.

During the Dermatopathology Fellowship, fellows will be spending half of their time in dermatopathology sign-out. The fellow will be expected to formulate a diagnosis and a differential diagnosis in all cases before the supervising attending signs out.

With approximately 15,000 accessions per year, the fellow will be exposed to a variety of common and uncommon diseases. The fellow will also be responsible for dictation of more than 400 consult cases received from other pathologists and dermatopathologists. The three staff dermatopathologists have an extensive teaching collection of interesting cases that the fellow will be expected to review.

All fellows will be expected to perform research and publish a research project based upon their interests. The Department of Pathology has internal grants available for funding projects requiring monetary support, along with a full-time research technician.

Our Team

Goals and Objectives

The aim of the Dermatopathology Fellowship is to train physicians to excel in clinical dermatopathology. The primary goal of the Dermatopathology Fellowship is producing accurate and
efficient diagnoses. The secondary goal is developing interpersonal and communication skills, and learning the role of the dermatopathologist in the health care system. This is accomplished by providing an environment that encourages personal growth, inquiry and scientific discovery. Critical and analytical skills necessary for the acquisition of new medical information are developed. Fellows will acquire a comprehensive fund of knowledge essential for the diagnosis and management of the wide variety of entities encountered in clinical dermatopathology.

The fellow will be exposed to the subject matter necessary for passing the certifying examination. To accomplish this, a faculty dedicated to patient care, teaching, research and intellectual curiosity will provide the infrastructure for the fellowship learning experience. The fellow will be expected to be self-motivated, collegial, and exhibit the highest level of personal integrity.

Fellows must be responsive to guidance, invest the time and effort necessary for independent learning, and be dedicated to providing the highest quality patient care.

Learning Objectives

The learning objectives include recognizing the basic inflammatory reaction patterns, along with patterns of neoplasia including adnexal neoplasms, melanocytic neoplasms, and soft tissue tumors.

Fellows should also learn the basic pathophysiology of skin diseases and neoplasms. The progress achieving the goals is monitored via direct observation, quizzes, and comparing the fellow’s dermatopathology diagnosis with the final diagnosis. The fellows are also evaluated through New Innovations in regards to the quality of their work. As the fellow becomes more comfortable with their diagnoses, they are able to dictate the cases prior to review of the cases with the attending physician. All cases are always still reviewed with an attending physician.

By the end of the fellowship the fellow should have achieved six core ACGME competencies:

  1. Patient Care: Give accurate diagnoses in a timely fashion, and interact with patients with
    compassion.
  2. Medical Knowledge: Gain a solid foundation on the fundamentals of dermatopathology. Learn to
    critically appraise the literature, and develop a foundation for continued learning.
  3. Practice-Based Learning and Improvement: The fellow should learn when to ask for consultations,
    apply knowledge, use information technology, learn quality improvement techniques, and teach
    medical students, residents and fellows.
  4. Interpersonal and Communication Skills: The pathology report should be concise, understandable, and communicate as much useful information as possible. The fellow will also effectively communicate with patients, other physicians and ancillary staff.
  5. Professionalism: The fellow should committed to his or her work, enthusiastically help others, and sensitive to others’ needs.
  6. Systems-Based Practice: The fellow will understand the role of dermatopathology in medicine, understand the costs involved, and learn how to order tests and ancillary stains in a cost-effective and ethical manner.

Achievement of the goals and objectives will be performed by participating in dermatopathology sign-outs throughout the year and through either the rotations in Surgical Pathology/Dermatology clinic. The fellow will also be expected to attend, participate in numerous educational activities and conferences, such as journal club, weekly dermatopathology conference, dermatology grand rounds and tumor boards.

Progress toward these goals will be monitored by correlating the final diagnosis of cases with the fellow’s hot-seat diagnosis. For the clinical aspect of the training (inside, referral and consult cases), during the first third of the year the diagnostic errors should be eliminated. During the next third of the year the amount of editing required for the microscopic reports and comments should be reduced. The final third of the year, all aspects of the report should be perfected.

Progress toward academic pursuits will be monitored by submitting at least one manuscript for publication during the academic year, and at least one presentation at the national dermatopathology or local dermatopathology meeting.

The effectiveness of the teaching of the fellow will be assessed by listening to the fellow teach during dermatopathology conference, presenting journal articles in journal club, and presenting cases in Grand Rounds and Tumor Board.

The fellow will be expected to read the books in the curriculum and will be periodically questioned on the topics covered by the book to assess compliance.

Educational Activities

Fellows from both dermatology and pathology backgrounds are accepted. Through the program, the fellow, regardless of his or her background, should receive an excellent training in dermatopathology, serving as a solid foundation for a future career in either private practice or academics.

Research and Academic Time

Two and a half days a week are left for catching up on work, research, and academic endeavors.

Every fellow is expected to present data or interesting cases at the annual dermatopathology meeting, along with submitting at least one project or report for publication. The abstract should be submitted for the annual dermatopathology meeting by August 15.

Quality Improvement

Quality improvement (QI) is an integral and growing component of pathology practice in academic, community hospital, independent laboratory, and corporate settings. Therefore, resident training in QI must be provided to establish the knowledge and experience base needed for successful practice. The ACGME has espoused this goal as part of the core competency of Practice-Based Learning and Improvement, in which it is stated that “Residents are expected to analyze practice experience and perform practice-based improvement activities using a systematic methodology.”

The department’s QI educational program is designed to provide residents with a broad-based didactic and interactive learning experience that covers all key elements of QI. QI material will be
included in most of the clinical rotations and the Laboratory Management rotation, and will be supplemented by the learning activities described below:

  • Resident participation in QI meetings: All fellows will be assigned to attend the weekly dermatopathology QI meetings/consensus conference. Fellows will also be expected to
    interact with the histology and gross room staff about any quality control issues.
  • QI project: Every fellow will be expected to participate in a QI project with one of the dermatopathology staff. In the spring, fellows will present these projects as brief PowerPoint presentations at our departmental Grand Rounds. The dermatopathology staff
    will serve as mentor for the fellow, and will assist in the planning and execution of the project. Projects should be well circumscribed and can be focused upon quality issues, billing or compliance issues, or evaluation of sendout tests for possibly bringing in-house. Approval of the project must be obtained from the program director, before embarking on the project.

Laboratory Management

The fellow is expected to read the College of American Pathologists Laboratory accreditation manual
so as to become familiar with requirements for running an accredited laboratory.

The fellow is expected to meet with the dermatopathology billing person to become familiar with contracting, registration, charge capture, diagnosis coding, claim submission, payment, patient balances, and accounts receivable.

The dermatology-trained fellow will also spend time in histopathology and the Gross Room.

Gross Room:

  • Fellow will learn the tools necessary in the gross room for handling, identification,
    cryosectioning, prosection, dictation and processing all skin types.
  • Fellow will observe the prosection/dictation of different types of skin lesions including shaves and excisions, melanoma cases, etc. in order to be prepared for situations that may occur.
  • Residents should be able to consult with fellow on how to handle difficult cases.

Laboratory (Histology or Mohs)

  • Fellow should know the instrumentation necessary to run a histology and/or Mohs lab.
    • Processors
    • Embedding Centers
    • Microtomes
    • Water baths
    • Stainers
    • Coverslippers
    • Cryostat
  • Knowledge of the consumables and how they are used for processing; staining etc.
    • Paraffins
    • H&E stains
    • Xylene or substitutes
    • Special stains
    • Microtomy
  • Observe/advise the histotech during microtomy
    • Emphasize the need to see epidermis
    • Look at the embedded block if necessary
    • Advise on the embedding of alopecia; shaves; excisions; tips etc.

Dermatopathology Consult Cases

The fellow will be expected to preview all consult cases and dictate a final report within 24 hours of receiving the consult. Upon completion of the consult the slides and copy of preliminary report should be given to the appropriate dermatopathology attending. Occasional reports should contain a pertinent reference.

Additional Training of Dermatology-Trained Fellows

The fellow will spend one morning a week in the surgical pathology gross room where the fellow will participate in gross dissection, especially specimens of interest to dermatopathology such as skin, soft tissue, and lymph nodes. Two mornings a week will be spent participating in surgical pathology sign-out. One morning a week, the fellow will have elective time to participate in subspecialty sign out of interest such as hematopathology, cytology and neuropathology. Throughout the year the fellow will participate in any autopsies with dermatologic findings or diseases of interest.

Block Schedule for Dermatology-Trained Fellows

The first four months are entirely dedicated to dermatopathology. The fellow will attend all required conferences. The schedule for months five to 12 is as follows:

Required Conferences for a Dermatology-Trained Fellow

The fellow is expected to attend:

  • Dermatology Journal Club – held weekly, Monday mornings
  • Surgical Pathology conference – held weekly, Tuesday mornings
  • Dermatopathology Conference – held weekly, Wednesday mornings
  • Dermatopathology Consensus Conference – held afternoons
  • Dermatology Grand Rounds – held nine of 12 months/year, Thursday mornings
  • ACGME Core Competencies Lectures – held monthly, Thursday mornings

Additional Training of Pathology-Trained Fellows

Pathology-trained fellows will spend 3.5 days a week in Dermatology Clinic.  In these clinics the fellow will see patients, write the notes, dictate referral letters, write the prescriptions, and be responsible for follow up just like a first-year dermatology resident. This active learning rather than passive observation will help provide a good clinical foundation for a career in dermatopathology. One half-day a week will be open for elective time in Mohs surgery, or other specialty clinics of interest.

Block Schedule for Pathology-Trained Fellows

The first four months are entirely dedicated to dermatopathology. The fellow will attend all required conferences. The schedule for months five to 12 is as follows:

Required Conferences for a Pathology-Trained Fellow

The fellow is expected to attend:

  • Dermatology Journal Club – held weekly, Monday mornings
  • Dermatology Attendings Conference – held weekly, Tuesday mornings
  • Dermatopathology Conference – held weekly, Wednesday mornings
  • Dermatopathology Consensus Conference – held daily, afternoons
  • Dermatology Grand Rounds – held nine of 12 months/year, Thursday mornings
  • ACGME Core Competencies Lectures – held monthly, Thursday mornings
  • Spitz Genodermatoses Conference – held weekly, Thursday mornings
  • Andrews’ Dermatology Textbook Conference – held weekly, Friday mornings

Rotations

Rotations vary based on the training of the fellow.

Dermatology Clinic Experience for Pathology-Trained Fellows

Goal

To provide and learn about continuity of dermatologic care in a university based outpatient setting.

Objectives

  • Patient care
    • Formulate a plan of care in concert with the attending dermatologist and support staff.
    • Educate the patient and provide rationale for treatment options.
  • Medical knowledge
    • Develop competency in performing a clinical history and physical exam.
    • Demonstrate knowledge about a broad array of dermatologic conditions and
      applicable treatments.
    • Generate broad differential diagnoses.
    • Display technical proficiency in basic clinical procedures such as: skin biopsies, skin scrapings, comedone extraction, and irrigation and debridement.
    • Appropriately follow and manage patients on high-risk medications.
    • Coordinate clinical and pathologic findings to secure a diagnosis.
  • Problem-based learning
    • Weekly review of dermatologic literature and discussion of applicability.
    • Perform literature searches for complex patients.
  • Interpersonal and communication skills
    • Demonstrate effective interpersonal and communication skills with patients and patients’ families both in clinic and on the telephone.
  • Professionalism
    • Display professional responsibilities including: respect, truthfulness and sensitivity
      to diversity.
  • Systems-based practice
    • Learn the costs and billing procedures associated with general dermatology.
    • Work effectively with assistants and colleagues to coordinate comprehensive care.

Surgical Pathology Learning Experience for Dermatology-Trained Fellows

Primary Goal

To become familiar with general surgical pathology, particularly fields such as ear nose and throat,
GYN pathology, cytopathology, soft tissue pathology, and hematopathology, which have diseases and tumors in common with dermatopathology.

Primary Objectives

  • The fellow is expected to recognize normal anatomy and histology of organs
  • Recognize general categories of pathological processes including tissue injury and repair, infection, inflammation, tumors, and degenerative processes
  • Understand the epidemiology, gross and microscopic pathology, natural behavior, and prognostic features of benign and malignant neoplasms
  • Grossly examine, dissect, and sample a cutaneous pathologic samples including simple biopsies and complex excisions
  • Apply and learn ancillary diagnostic techniques appropriately, including immunohistochemistry

Ultimate Goals and Objectives

  • Patient Care
    • Learn how pathologists give accurate diagnoses in a timely fashion, and interact with patients with compassion.
  • Medical Knowledge
    • Gain a solid foundation on the fundamentals of general surgical pathology. Learn to critically
      appraise the literature, and develop a foundation for continued learning.
  • Practice-Based Learning and Improvement
    • The fellow should learn when to ask for consultations, apply knowledge, use information technology, learn quality improvement techniques, and teach medical students, residents,
      and fellows. The fellow should learn which consultants to use for different dermatopathology issues.
  • Interpersonal and Communication Skills
    • The surgical pathology report should be concise, understandable, and communicate as much useful information as possible. The fellow will also effectively communicate with
      patients, other physicians, and ancillary staff.
  • Professionalism
    • The fellow should committed to his or her work, enthusiastically help others, and sensitive to others needs.
  • Systems-Based Practice
    • The fellow will understand the role of surgical pathology in medicine, understand the costs involved, and learn how to order tests and ancillary stains in a cost-effective manner.

Conferences

Fellows will be required to participate in the weekly Dermatology Journal Cub, the weekly dermatopathology conference, the monthly dermatology grand rounds, monthly dermatology patient conference, and monthly dermatology consult conference.

The fellows will be responsible for presenting the pathology for the dermatology grand rounds and discussing clinical-pathologic correlation (dermatopathology attending physicians are always in attendance at these sessions).

The fellow will also prepare brief (five- to 10-minute) discussions of topics to be covered during the weekly dermatopathology conference.

Dermatology Consult Conferences and Tumor Boards

All fellows will also be expected to attend monthly consult conference, patient conference, and periodic melanoma and skin cancer conference.

The fellow will be expected to keep a log of the weekly activities, patients seen, and dermatopathology cases reviewed, which will be periodically reviewed to assure a well-rounded experience.

The fellow will give the case numbers of patients presented at dermatology tumor board and consult conference to the academic secretary to pull the slides. The fellow should then review the slides prior to the conferences, and be prepared to bring the slides and discuss the pertinent pathologic findings and differential diagnoses at the conference.

Dermatology Grand Rounds

Dermatology Grand Rounds meets eight times a year, the first Thursday of the month. The fellow will be expected to find out what cases are being presented and take photographs of the representative pathology. The day before grand rounds, the fellow will be expected to show their PowerPoint
presentation on all of the cases to the corresponding dermatopathologists.

During grand rounds the fellow will be expected to concisely present the pathologic finding.

Optional Conferences

Penn State Health Milton S. Hershey Medical center has numerous other conferences the fellow will be able to attend if the conference is of interest or pertaining to dermatopathology. Some of the pathology conferences include:

Reading Lists

Dermatopathology Reading List for Dermatology-Trained Fellows

  1. Brinster Dermatopathology: as per Dermpath Conference
  2. AB Ackerman Histologic Diagnosis of Inflammatory Skin Diseases: Complete by July 31
  3. Massi Guido, LeBoit PE. Histological Diagnosis of Nevi and Melanoma. Steinkopff Verglag
    Darmstadt 2013: Complete By Aug. 31
  4. Cerroni. An illustrated guide to Skin Lymphoma: Complete by Sept. 30
  5. Enzinger & Weiss’ Soft Tissue Tumors: Complete by Nov. 30
  6. Ackerman Clues to Diagnosis in Dermatopathology – Volumes 1 to 3: Complete by Dec. 31
  7. Ackerman Differential Diagnosis in Dermatopathology – Volumes 1-4: Complete by Jan. 31
  8. Ackerman Neoplasms with Apocrine Differentiation: Complete by Feb. 28
  9. Ackerman Neoplasms with Follicular Differentiation: Complete by March 31
  10. Ackerman Neoplasms with Sebaceous Differentiation: Complete by April 28
  11. Ackerman Histologic Diagnosis of Inflammatory Skin Diseases second edition: Complete by May 31
  12. Leonard C. Sperling, An Atlas of Hair Pathology with Clinical Correlations: Complete by June 30

Dermatopathology Reading List for Pathology-Trained Fellows

  1. Ronald Rapini Practical Dermatopathology: as per Dermpath Conference
  2. AB Ackerman Histologic Diagnosis of Inflammatory Skin Diseases: Complete by July 31
  3. Massi Guido, LeBoit PE. Histological Diagnosis of Nevi and Melanoma. Steinkopff Verglag
    Darmstadt 2013: Complete by Aug. 31
  4. Cerroni, An illustrated guide to Skin Lymphoma: Complete by Sept. 30
  5. Ackerman Clues to Diagnosis in Dermatopathology – Volumes 1 to 3: Complete by Oct. 31
  6. Ackerman Differential Diagnosis in Dermatopathology – Volumes 1-4: Complete by Nov. 30
  7. Ackerman Neoplasms with Apocrine Differentiation: Complete by Dec. 31
  8. Ackerman Histologic Diagnosis of Inflammatory Skin Diseases, second edition: Complete by March 31
  9. Leonard C. Sperling, An Atlas of Hair Pathology with Clinical Correlations: Complete by April 30
  10. Michael Hertl, Autoimmune Diseases of the Skin: Complete by May 31
  11. Brian Hall, Skin Infections Diagnosis and Treatment: Complete by June 30

Policies

Institutional policies apply in the Dermatopathology Fellowship. Where program-specific policies exist, they are listed below.

Supervision: Dermatopathology

Two levels of supervision are used to allow the fellow to assume increasing levels of clinical responsibility:

  1. Direct Observation (DO): Attendings are physically present with the fellow during the procedure, and can provide verbal guidance or assume direct physical control of the sign out if necessary.
  2. Indirect Observation (IO): Attendings review the cases on their own, after the fellow has dictated and reviewed them, and compares diagnoses and discusses any discrepancies. As the fellow becomes more comfortable with their abilities, during the last month or two of fellowship, the fellow will be expected to be supervised mostly via indirect observation. All cases will be reviewed by a dermatopathology attending before being signed out.

Meetings: Dermatopathology

Professional meetings serve a variety of important functions including provision of education about medical practice, current research, administrative issues and compliance issues. They also offer excellent opportunities for networking that can be invaluable for choosing future employment.

Fellows are expected to attend and present at the annual American Society of Dermatopathology meeting during their fellowship.

Travel expenses associated with attendance at professional meetings are eligible to be reimbursed from
the annual fellow stipend.

For fellows who are presenting posters or podium presentations at meetings, additional financial support can be requested from the Pathology Research Award Program. If the fellow’s attendance at a meeting is contingent upon obtaining this additional support, then approval of the additional funding must be obtained from the Pathology Research Award Program Committee prior to submitting an abstract or agreeing to make a presentation.

On-Call: Dermatopathology

Dermatopathology fellows will not be expected to take call.

Case Hand-Off: Dermatopathology

Surgical pathology cases from fellow going on vacation, or completing their fellowship, will be transferred to the attending on record. All important background information, pending studies, any communication with the submitting physician will be written on the pathology requisition slip.

Evaluations: Dermatopathology

Copies of all evaluations will be provided to the fellow in the program handbook.

Evaluation of the Fellow by Faculty

Fellow will be evaluated monthly by all pertinent faculty through New Innovations. Written objective evaluation of fellow will be conducted two times throughout the academic year by the Program Director. The fellow will be evaluated according to the ACGME Core Competencies (patient care, medical knowledge, practice-based learning and improvement, systems-based practice, professionalism, interpersonal skills and communication) and other factors deemed necessary or desirable to complete the requirements of the program. The fellow will also be evaluated by performance on quarterly tests, and by comparing the fellow’s “hot-seat diagnosis” with the final diagnosis. The final summative written evaluation is entered in the fellow’s file, and significant deficiencies as well as areas of particular strength are noted.

Additionally, the Fellow will meet with the Program Director monthly to review the progress of the educational experiences of the Fellow and for feedback about the program and plans for the remaining time. The fellow will also be present at the annual Curriculum Evaluation Committee meeting and will verbally give feedback and evaluation of the program at that time.

Evaluation of the Fellow by Others

Peer evaluations of the Fellow are solicited bi-annually via Survey Monkey. These include other residents and fellows that interact with the Dermatopathology Fellow.

360-degree evaluations of the Fellow are solicited bi-annually via Survey Monkey. These include any secretarial and/or technical staff that interacts with the Dermatopathology Fellow.

The Fellow is required to complete a Self Evaluation through New Innovations bi-annually. The self-evaluation will be the same evaluation as the Faculty Evaluation of the Fellow, but completed by the Fellow about the Fellow.

The evaluation process is intended to establish standards for the Fellow’s performance and to indicate the Fellow’s ability to proceed to higher levels of training and responsibility. The process will, to the extent reasonably possible, provide early identification of deficiencies in the Fellow’s knowledge, professional skills or character, and to the extent reasonably possible, allow remedial action to enable the Fellow to satisfactorily complete the requirements of the program.

Evaluations will be competency-based (as noted above). If performance is not satisfactory, individuals will be notified no later than the first day of the ninth month (e.g., by March 1 for a fellow starting July 1, or 120 days prior to the end of the contract year).

Evaluation of the Faculty by Fellow

The Dermatopathology Fellowship is accredited for only one position per year. In keeping with ACGME policies that the Fellow should be able to evaluate the faculty anonymously, the Fellow completes the “Pathology Resident Evaluation of Faculty” along with the Residents in our AP/CP Residency (core program) on a quarterly basis.

Evaluation of the Program (Rotation) by Fellow

The Dermatopathology Fellowship is accredited for only one position per year. In keeping with ACGME policies that the Fellow should be able to evaluate the program anonymously, the Fellow completes the “Pathology Resident Evaluation of Rotation” along with the Residents in our AP/CP Residency (core program) on a quarterly basis.

To Apply

We are currently accepting applications for our 2019-2020 position.

To apply, please forward your complete application electronically via email to khelm@pennstatehealth.psu.edu and copy eshultz@pennstatehealth.psu.edu.

Your complete application will include:

  • CAP Standardized Pathology Fellowship Application
  • Cover letter with personal statement
  • Curriculum vitae
  • Copy of USMLE test scores (or equivalent)
  • Letter of recommendation and verification of training from current/most recent program director
  • Two to three additional letters of recommendation

Letters of recommendation may be sent under separate cover directly from your references, but should still be sent electronically.

Note: Our program is NOT participating in the ERAS application system. All applications should be submitted via email as described above.

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Current Fellows

Past Fellows

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Penn State College of Medicine is an equal-opportunity employer and accepts all qualified applications regardless of their gender, ethnic origin or religious background.