We are very happy that you have joined us this year. We hope and expect that this will be an exciting and intellectually challenging (and fulfilling!) year for our Fellows. This introduction/orientation is meant to serve as a general outline for you regarding aspects of the fellowship-training program. Please le us know if there are issues of concern to you that are not addressed below.

I. Orientation Basics

A. UCSD
Relating to sign-in at UCSD, Sandy Hoffert (619-543-6929) is your contact person; call her and arrange to sign in with human resources (Suzy Goodman) at UCSD. Sandy is located at the Pediatric Business Office at 220 Dickinson Street, Room 300. There are maps in our office, which are useful for navigating to UCSD. While there, speak with Sandy or Suzy regarding obtaining parking permits for UCSD, as these are necessary. Also, obtain your photo identification cards.

B. Rady Children’s
Patti Oden will distribute your office keys, pagers and take you to the Badging Office to get an ID badge and parking garage access (Proximity card). She will also inform you of your cafeteria account, computer access - both Internet and Meditech.

II. Scheduling Issues

Please consult the Yahoo calendar/schedule regarding your day-to-day responsibilities and call coverage. We have made an effort to vary your experiences and rotate you amongst the four (4) attendings. Please let us know if you have any ideas that might improve your experience, while at the same time providing for optimal patient care.

Vacation time: Hopefully you have already turned in your vacation time requests. Vacation time includes meetings and board prep or other courses if needed. Please let us know as far in advance as possible if other issues arise regarding a need for time away. We will always try to accommodate needs; however, scheduling issues are now quite complex and the more advance warning the better!

III. The Consultation Service and Night Call

A. Consults
We provide inpatient consultation service to Rady Children’s Hospital, UCSD Hillcrest, and Sharp Mary Birch Hospital. Some of the most interesting patients we see come through the inpatient consultation service. At the same time, these are often the most time consuming cases, and they comprise a significant responsibility in terms of both initial time investment, review of relevant literature, and follow-up. Ideally, the on-call person would review cases first; however, since this is difficult to mandate on a day-to-day basis, the following structure has been designed. If a resident is rotating for a month with us on service, they should see the patient first, either alone or with the designated fellow.

The Fellows will rotate coverage on a bi-weekly basis, with the “home base” person covering if the “on-call” Fellow is at a satellite. Obviously, there is some flexibility in this arrangement, as long as the Fellows can make certain that coverage is available and the appropriate attending is aware of the plan. When one fellow is on vacation, the other will be expected to cover the other’s urgent responsibilities. This may, in some cases, require “freeing up” a fellow from his usually defined responsibilities; again, the attendings should be consulted regarding this. The attendings rotate sequentially on a weekly basis, and should be contacted when the service is first notified that a consult has been requested.  In some cases, the attending may elect to have the fellow first report back on the patient. All consults should be seen within 24 hours of the consult request.

B. Night Call
The fellows will alternate every 2 weeks (as mentioned above) to include both daytime and nighttime consults. A UCSD resident is always first call for our service; they will then call the fellow if an issue cannot be resolved. For the first three months, the attendings will be assigned specific nights to provide back up for the fellows, and will be available to see all cases. Every effort will be made to ensure that at least one attending is in town at all times to provide backup for the fellows; 5pm will serve as the cut-off period for call purposes.

C. Messages and Call Backs
The fellow on call has the responsibility of reviewing daily messages that have been left for the physician or office. The attending is available for back up. Coverage between the fellows should be organized when the on call fellow is at an outside clinic.

IV. Other Fellow Responsibilities: Schedules and Conferences

A. Vascular Lesion Clinic
This is a multi-specialty comprehensive clinic that takes place monthly. It is a remarkable learning experience and provides a venue where children and adults with difficult vascular lesions can be evaluated by plastic surgeons, radiologists, and other specialists who can provide useful input into their care. Deborah Nielsen (DJ) is available to help with the details of this meeting. The fellows will be rotating with specific attendings for one month and will be following up on routine issues therefore, the messages/callbacks should be primarily acute issues.

B. Dermapathology Conference
This conference takes place on the second Tuesday of each month and incorporates clinic pathologic correlation of interesting cases the pediatric dermatology service has seen in the previous month. Each month, one interesting case will be highlighted; the fellow will discuss the choice of case with the senior resident who is on service for the month as well as appropriate attendings, and ensure that an appropriate literature search has occurred relating to the topic. Usually the senior resident will prepare and present the case; however, the fellow has the responsibility to ensure this occurs. On months where there is no senior resident available, the fellow will present the case.

C. San Diego Dermatology Conferences
This citywide conference meets the first Monday of each month, rotating at different sites. The fellows should try to attend these; they are great learning experiences. Once a year we host this meeting. The fellows will split responsibility regarding this meeting, and along with the attendings, select the most interesting cases of the year to be presented that evening. The fellows will each present at least one case, and oversee other cases that the UCSD and Navy Derm residents will prepare and present.

D. Pediatric Dermatology for the Practitioner
Every other year we sponsor a comprehensive 2 day course; next year it will be held April 10-12, 2003 at The Hilton Torrey Pines. You will present at this meeting; it is an excellent opportunity to learn how to present at national meetings. Please contact the office for your assignments.

E. Fungal Cultures
The fellows are responsible for reviewing fungal cultures weekly. Contact Isabelle Puente regarding this very fascinating job!  (We have had all colors of culture specimens, including purple!)  This job takes all of 5 minutes twice weekly.

V. Teaching Responsibilities

A. The Students
This is probably the most fun, as the students are happy with just about any form of attention you give them. The format in the past has been a monthly session, which is a “slide show” of interesting and basic cases. The fellows should probably alternate months on this responsibility. The attendings have lots of slides; ask them for help if needed.

B. The Dermatology Residents
The Chief Resident in Dermatology will ask the peds derm service to provide several Fitzpatrick Chapter reviews for the residents over the year. These are 7:30am Wednesday conferences. You should expect to do a few of these per year. Check with Jennifer Eastlack (Chief Resident) regarding this, her pager number is 619-290-3458.

C. Tuesday - Journal Club and Slide Review
Tuesday lunchtime (11:15-12:15pm) will be devoted to Journal Club and Slide Review for our staff and the residents rotating through our service. All derm residents from UCSD will also be strongly encouraged to attend this session. Journal Club weeks will alternate with slide review weeks. Journals to be covered include Pediatric Dermatology, JAAD, Archives of Dermatology, J. Pediatrics, Pediatrics, New England Journal of Medicine and Pediatric Infectious Diseases if appropriate. During the first week of the fellowship, the fellows and attendings will select the journals they would like to review for the first six months; in January, we will switch these assignments to keep everyone interested!  Mandatory review of Pediatric Dermatology, JAAD and Archives should take place every month; the other Journals should be included only if there are relevant articles present. Dr. Jim Bergman can give you a list of the derm and pediatric monthly rotators; these people can be incorporated in the presenter’s list for the Tuesdays they will be on service with us. In addition to the lunchtime conferences, a morning book review is conducted. This Review involves reading/reviewing The Textbook of Neonatal Dermatology. Chapters for discussion will be selected and assigned.

A schedule will be developed incorporating residents, fellows and attendings after the staff have chosen their journals. Clinical slide reviews on the alternate Tuesdays will be run by the fellows and consist of educational and interesting cases recently seen in the practice. The fellow should contact the attendings if they are uncertain of the format, or if they need instructive cases. We all have extensive teaching files that can be utilized for this purpose.

VI. Intellectual Endeavors

The Fellowship should provide you with an opportunity to choose an interesting question in pediatric dermatology and investigate it during your time here. Some people think it is a good idea to have two projects or questions in mind that you can investigate, in case one doesn’t pan out. Please discuss your interests with the faculty; we will support you in whatever way we can. In addition, you should plan on writing up interesting cases you see and preparing them for presentation at the AAD, SPD, etc. You may also want to direct the residents or an exceptional student in such an endeavor. Please contact the attendings regarding interesting projects or cases; we have many waiting for a motivated writer! Think of the Fellowship as a time to develop these writing and investigational skills, with willing mentors to help direct you.

VII. The Real Goals of the Fellowship

For you to learn, have fun, take good care of the patients, help us, and become a great pediatric dermatologist!

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