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I realized that despite having been in my dermatology residency for nearly 1.5 years now, I have never explained what exactly I do on a day-to-day basis! I’ve written about what it means to be “on call” as a dermatologist but I’m on call on average only once per week to once every other week (and I’ll be done with call by December 2016! Can you tell I’m excited :). The rest of the time, my life is clinic clinic clinic, studying, and some interesting consults thrown in the mix. Photos are a mix of ones I took randomly and ones I took as part of my Figs instagram takeover (check out their account @wearfigs on Instagram). So here is a typical day in the life of a dermatology resident:
8:00 – 9:00 Lecture
Every morning starts with a lecture for all of the residents in the program, regardless of which hospital rotation we are on. I think our didactic program is especially strong, and I actually genuinely enjoy going to lecture. Each week we have one lecture that is a textbook talk given by one of the residents (we are going through Jean Bolognias "Dermatology, kind of like the Bible of Dermatology), a faculty lecture, a dermatopathology session at the multi-headed scope, some visiting faculty lectures (Grand Rounds), and then random ones thrown in like clinicopathologic correlation conferences, journal clubs, or research presentations. My personal favorite lectures are the Grand Round lectures; I find it so cool that we get to hear from some of the giants in Dermatology about their lifelong work, anecdotes, advice, and research. This is how you know you’re in the right field — you’re actually excited to get up early to learn about it!
9:00 – Noon: After lecture we break up to go to our scheduled hospitals depending on which rotation we are on. We see patients in clinic until lunchtime. Clinic volume is totally variable; some days are lighter and some days are crazy, just like you would expect. In outpatient clinic we see a variety of skin diseases, ranging from the routine like acne, rosacea, and psoriasis, to complicated ones like blistering diseases (bullous pemphigoid, pemphigus vulgaris), connective tissue diseases (lupus, dermatomyositis, scleroderma); then there are the zebras (strange autoimmune diseases that aren’t well described, infections we don’t commonly see anymore like leprosy or leishmaniasis, etc.). You never know what is going to walk through your door and I love the variety of pathology we get to see! On certain days we have specialty clinics where we see specific types of diseases, and those clinics are always great learning opportunities because the attendings on those days are experts in those diseases.
Noon to 1:30: LUNCH! I’ve been trying to bring lunch more often but it’s hard >_< I end up getting salads or soups at nearby delis most of the time. Lunch is also the time for us to finish up clinic notes, call patients back if there’s questions, get in touch with other fields if we need a consult or to discuss patient cases, call pharmacies to make sure our medication orders are all squared away, or call insurance companies for prior authorizations, etc. Another thing I like to do during lunch is to go through lab results, dermatopathology results, mostly follow-up stuff for patient care.
1:30 – 5:00 Afternoon clinic with patients. Once to twice per week as seniors we get to do surgery clinic too, where we do excisions for skin growths like skin cancers or cysts. We work with attendings who are usually Mohs surgeons in their own practices, and they teach us proper surgical techniques. It has been really rewarding to see how I’ve gotten more and more comfortable with surgery, and now I take pride in how nicely the wound heals and looks when the patient returns for follow up.
Sometimes instead of being in clinic we are assigned to be on a dermatopathology rotation. We spend this rotation, usually a week at a time, learning how to diagnose skin conditions by looking at slides of skin biopsies. Dermatopathology has been really challenging for me to learn because it is pure pattern recognition, and you really need to spend time with the slides to learn what features to look for. Not only do we have to recognize what skin diseases look like on the skin, but we also need to be able to diagnose skin disease on a microscopic level as well. Now in my second year of dermatology residency I’m finally starting to feel a little more comfortable with dermpath, but as a first year I often would not have even heard of the name of the diagnosis before, much less recognize what it looks like at 10X.
This is an example of what stitches look like when they are being expelled through the skin. See all the little threads? This is actually considered an “easier” case to diagnosis because the suture is quite striking and stands out as foreign material. There are a whole slew of diagnoses that are extremely subtle, and you have to look really carefully to find the clues to the disease, or else you’ll accidentally call it normal skin. I’ve been tricked by dermatophyte so many times; those thin hyphae are tricky to locate in the stratum corneum (uppermost layer of the epidermis) and you have to have the patience to zoom in and look for those little buggers.
5:00 onwards: In the evenings we do a mix of things. We usually stay behind a little bit to tie up loose ends, make sure all patient follow up has been completed and labs and biopsy results are tended to. Then we usually go home, but once in a while we have training sessions in the evening. We have cosmetic dermatology training sessions in the evening when we learn how to inject fillers or botox or most recently Kybella from experienced attendings. The other thing I do in the evenings is…you guessed it, try to study. Medicine is a lifetime dedication to studying, so if studying and learning is not your thing, this probably isn’t the right career for you. Many of my friends are shocked that I’m still a “student,” but I try to explain that we don’t actually learn dermatology in medical school or intern year, so we have to learn it now in residency. Seeing patients is wonderful learning but we don’t get to see everything in dermatology so reading textbooks and studying is a HUGE part of residency. I’ve been trying to spend quality time with my textbooks this year and though it’s not always easy to motivate myself to study (more on that and my study tips here), it has been getting easier now that I’m more familiar with the subject.
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After that, I cook, order in, or eat out with my husband, and then it’s pretty much bedtime! An occasional workout may sneak its way in once in a while too…but I’m trying to improve on that as well.
There’s never a boring day in residency, and I really love what I do. Hope you enjoyed learning about a day in the life of a dermatology resident!