Clinical Rotations

Residents rotate through an abundance of services and clinics during their time at Michigan. Most rotations occur in one-month or 6-week blocks. Each month is split in half (12 months per year—24 ½-month rotations), with residents changing assignments on the 1st and 16th of each month. A sample block schedule is below.

Dermatology sample block schedule

Key:

CDLC: Cosmetic Dermatology & Laser Center
Clinic: Primarily Taubman Center or Domino's Farms Clinics
CONS: Inpatient consult service
DTC/Patch: Dermatology Treatment Center and patch testing
Elective: Elective
MEL: Melanoma/Merkel cell
Mohs: Mohs/Cutaneous Surgery & Oncology
UHS: University Health Service
VA1: Veterans Affairs Healthcare System (1st year)
VA2: Veterans Affairs Healthcare System (2nd year)
VA3: Veterans Affairs Healthcare System (3rd year)
VAChoice: Veterans Affairs Healthcare System (3rd year)

General and Complex Dermatology (Clinic)

The bulk of each resident’s time is spent in general and complex dermatology. Our two main clinical sites are the Taubman Clinic, located on the main medical campus, and the Domino's Farms Clinic, located approximately 5 miles from main campus on the north side of town. 

Clinics at Taubman are a mix of specialty and general dermatology clinics. As a large referral center, residents gain familiarity with diagnosis and treatment of common and rare dermatologic conditions. 

Clinics at Domino's Farms are general dermatology clinics. Resident continuity clinics also occur at Domino's Farms. Each resident has a dedicated continuity clinic every other week; the goal is for residents to follow patients (especially more challenging patients) longitudinally over time.

Specialty Clinics:

  • Cutaneous Lymphoma—led by faculty member Dr. Trilokraj Tejasvi, residents gain an understanding of and experience in the diagnosis, multidisciplinary care, and treatment of this disease. 
  • Immunobullous disorders—led by faculty member Dr. Anj Dlugosz, residents learn to manage diseases such as pemphigus and pemphigoid. Residents graduate feeling very comfortable managing medications such as mycophenolate, rituximab, methotrexate, and cyclosporine.
  • Multidisciplinary Cutaneous Oncology Program—The U-M Multidisciplinary Cutaneous Oncology Program is one of the largest dermatology-based clinical programs in the United States, with approximately 1,200 new patient consultations per year. Residents learn about evaluation techniques, clinical findings, staging, sentinel lymph node biopsies, and therapies. Residents participate in multidisciplinary tumor board meetings to develop consensus treatment recommendations for patients requiring multispecialty care.
  • High-Risk Skin Cancer Clinic—led by faculty members Dr. Milad Eshaq and Dr. Yolanda Helfrich, residents examine and treat patients at higher risk for skin cancer. Residents routinely examine and treat patients who are immunosuppressed or at higher risk for skin cancer. Residents become adept at using dermoscopy to examine patients with difficult skin exams.

Community Outreach

We invite residents to volunteer at our dermatology community outreach clinic, hosted one Saturday morning each quarter at our Taubman Center clinic. Our Hope @ UMHS volunteer physicians deliver dermatology specialty care to patients who are uninsured or under-insured, in coordination with the Hope Clinic, a regional free clinic.

Inpatient and Consultative Dermatology (Consults)

As a PGY-3 or PGY-4 resident, house officers spend 6 weeks managing our inpatient consult service. This busy service receives up to 10 new consults each day. Residents become comfortable managing the most challenging and complex dermatologic cases and work as hospital-based teams with other services to manage these patients. PGY-2 residents spend occasional half-days assisting the senior resident and learning how to approach inpatient care of patients.

Dermatopathology

Proficiency in interpretation of histologic sections of the skin and an understanding of laboratory procedures is required of dermatology residents. In addition to a robust didactic curriculum in dermatopathology, with weekly textbook assignments and weekly unknown slide sessions, residents spend half-days at the scope with dermatopathology faculty reading slides.

Elective

PGY-4 residents have one month of elective time. House officers can submit proposals to our institutional GME office to seek approval for off-site or international rotations. Residents can use this time to do additional training in procedural dermatology or dermatopathology, to pursue research projects or write papers, or to spend time with other services in the hospital. Residents have rotated on the inpatient rheumatology service, spent time in vulvar clinics, and observed hair transplants. 

Pediatric Dermatology

Pediatric patients comprise more than 20% of our nearly 40,000 outpatient general dermatology visits each year. Residents gain an appreciation of the age-related variations in disease and disorders specific to children, as well as pediatric dermatology problems in the context of general dermatology. 

In July 2021, we will start a dedicated pediatric dermatology program, led by fellowship-trained pediatric dermatologist Dr. Jennifer Mancuso.

Phototherapy and Contact Dermatitis (DTC/Patch)

During this 6-week rotation, residents round on patients receiving modified Goeckerman therapy in our Day Treatment Center (DTC) and gain experience and facility with all modes of therapy. Michigan Medicine is one of the few institutions in the country which provides modified Goeckerman therapy—use of tar, topical steroids, and phototherapy to provide rapid relief to patients suffering from extensive skin disease. 

After rounding on patients in the DTC, residents work with Dr. MariPaz Castanedo in our contact dermatitis clinic, learning about evaluation of patients with potential contact allergy and learning how to perform patch testing.

Research

Many residents choose to pursue research projects over the course of their residency. It is expected that senior residents will submit an abstract to the Gross and Microscopic Symposium in order to receive funding to attend the American Academy of Dermatology (AAD) Annual Meeting in spring. Residents are encouraged to write up case reports for publication; in addition, each resident prepares one to two case write-ups for our annual regional Michigan Dermatologic Society meeting. 

In the PGY-4 year, any resident can choose to spend a dedicated half-day each week in our Program for Clinical Research in Dermatology (PCRiD), learning clinical research techniques and serving as a sub-investigator on sponsored and institutional clinical and translational research projects. 

Residents with a strong interest in basic science research can pursue the NIH-funded Training Program in Cell and Molecular Dermatology, a 2+2 program in which residents spend 2.25 years in the clinic, graduate after 3 years, and spend an additional one year as a junior faculty member within the department.

Surgical and Procedural Dermatology

Residents spend one month on our Mohs surgery rotation learning how to perform Mohs surgery and complex repairs from our fellowship-trained Mohs surgeons, typically in the PGY-3 year. Also in the PGY-3 year, residents spend one month in our Cosmetic Dermatology and Laser Center (CDLC) working closely with Dr. Jeffrey Orringer and Dr. Dana Sachs and learning how to perform cosmetic consultations and cosmetic treatments; during this time, they spend one-half day per week in the Thursday afternoon Resident Procedure Clinic staffed by Dr. Kelly Cha at Domino Farms.

There are multiple opportunities for hands-on surgical experience; these increase over time as residents become more experienced.  Residents participate in weekly surgical experiences while rotating at our VA (2-3 months each year).  PGY-4 residents rotate through the Friday Resident Procedure Clinics staffed by Dr. Kelly Cha at Domino's Farms.

We have increased our hands-on cosmetic exposure, with a goal of hitting targets in the 30-50th percentile range nationwide. Residents should expect to perform approximately 6 filler injections and 12 toxin injections over the course of their residency. Residents will also become very familiar with principles and use of vascular, pigmented, and ablative lasers.

Veterans Affairs (VA) Healthcare System

We are fortunate to have a robust VA experience. Residents spend a total of 8 months of their training assigned to our VA service. Residents see general dermatology patients and have multiple surgical training experiences at the VA, working not only with dermatology surgeons but also with ENT and plastic surgeons. PGY-4 residents assigned to the VA become very comfortable with teledermatology, utilizing store-and-forward clinical and dermoscopic images to provide treatment recommendations to distant VA sites. The VA recently purchased a confocal microscope, and residents can learn how to utilize this new technology.

University Health Service (UHS)

In the PGY-3 or PGY-4 year, residents spend 6 weeks practicing as independent providers. Faculty remain on-call to provide remote advice, but residents are able to gain additional continuity experience in a low-intensity, multispecialty group practice providing dermatologic care to students, staff, and faculty associated with the University of Michigan.


Learn more about the training facilities at Michigan Medicine.