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Dermatopathology

At A Glance

Program Type: Military Medical Center

Location: Bethesda, MD

Accredited: Yes, Accreditation Council for Graduate Medical Education (ACGME)

Program Length: 1 year

Required Pre-Requisite Training: Graduation from an ACGME accredited Dermatology or Pathology Residency

Categorical Year in Specialty Required: N/A

Total Approved Complement: 1

Approved per Year (if applicable): 1

Dedicated Research Year Offered: No

Medical Student Rotation Availability: 4th year

Additional Degree Concurrent with Training (e.g. MPH): No

Program Description

The National Capital Consortium oversees the only Dermatopathology Fellowship Training Program in the Department of Defense. The vast majority of the rotations for the Fellow take place at Walter Reed National Military Medical Center (WRNMMC) in Bethesda, Maryland with additional rotations for two-week intervals both at the Joint Pathology Center and University of Virginia. There are typically four to six Dermatopathologists on staff at WRNMMC and the Fellow receives intense individualized training. The Fellowship is open to applications from any Active Duty Attending or Resident Pathologists or Dermatologists of any branch of the United States military. The lab at WRNMMC typically signs out more than 8,000 primary dermatopathology cases per year, as well as more than 1000 cases sent to WRNMMC for second opinion consultation from military hospitals and clinics around the world. Co-location with WRNMMC’s Immunodermatology service allows the opportunity to interpret more than 300 cutaneous direct immunofluorescence cases per year, as well. Facilities include a separate Fellow office equipped with microscope, fluorescent microscope, and photomicrograph capability, as well as an extensive library. The Dermatopathology is accredited by the Accreditation Council for Graduate Medical Education and has received no citations throughout its existence. Graduates from the fellowship have a 100% board passage rate.

Trainees with a background in Pathology will complete an extended training program through the Dermatology service at WRNMMC. The Dermatology Residency Program offers a well-rounded clinical education in addition to in-depth didactic sessions, weekly dermatopathology reviews, and weekly Dermatology Grand Rounds which are co-hosted by the Dermatology service at the National Institutes of Health and other local Dermatology residency programs. The Dermatology service is equipped with a Mohs lab and performs hundreds of Mohs Micrographical Surgery cases per year.

Trainees with a background in Dermatology will complete an extended training program through the Anatomic and Clinical Pathology service at WRNMMC. The Pathology Residency Program offers daily didactic sessions as well as case-based slide teaching at a multi-headed microscope. The Pathology Service includes several sub-specialty staff, including Hematopathology, Molecular Pathology, Forensic Pathology, GYN and Breast Pathology, Gastrointestinal Pathology, as well as Dermatopathology. Special rotations through tissue processing, staining and additional laboratory techniques, as well as Hematopathology will be completed, as well.

Mission, Vision and Aims

Mission

The mission of the Dermatopathology Fellowship at the National Capital Consortium is to train both Pathologists and Dermatologists in the field of Dermatopathology in order to directly support the patient care mission of the Department of Defense. This includes providing high quality medical care to active duty service members and their dependents in both a primary care setting as well as in the tertiary care setting.

Vision

Train Dermatopathologists who will excel in the field of Dermatopathology.

Aims

Provide Dermatopathology expertise to military hospitals and clinics around the world.
Train clinically competent Dermatopathologists to become empathetic to patient’s needs and collegial to their colleagues.
Continue to have a 100% board passage rate for graduating fellows.

Curriculum and Schedules

Monday - Friday 7:30 – 8:30 a.m.: Daily one-hour didactic session based in either Pathology (for Dermatology trained Fellows) or Dermatology (for Pathology trained Fellows). Curriculum is based on the Dermatology or Pathology curriculum for the year.
Monday 12 – 1 p.m.: Dermatopathology Consensus Conference
Wednesday 12:15 – 1 p.m.: Cutaneous Oncology Tumor Board
Thursday 8 – 10 a.m.: Dermatology Grand Rounds
Thursday 10 – 11 a.m.: Dermatopathology Teaching Session – curriculum based on Weedon’s Skin Pathology

The rotation schedule varies slightly depending on the core residency completed.

Core Pathology Residency Graduate Pathway	Core Dermatology Residency Graduate Pathway
Eight months Dermatopathology Clinic* Two months Dermatopathology signout Two weeks University of VA rotation* Two weeks Molecular Pathology at Joint Pathology Center Dermatopathology Clinic Morning clinic in Dermatology and afternoon sign-outs in Dermatopathology. Fellows also staff Cutaneous Oncology Tumor Board and weekly Dermatology Grand Rounds. Fellows attend all Dermatology Residency Program lectures/didactics during this time. Research and QI projects are performed as time permits, or during five discretionary days that fellows are allotted. Dermatopathology Signout Entire days of Dermatopathology sign-out. Fellows continue to staff Cutaneous Oncology Tumor Board and weekly Dermatology Grand Rounds. Research and QI projects are performed as time permits, or during five discretionary days that fellows are allotted. **University of VA Rotation Two week rotation at the University of Virginia in which the fellow gains additional experience in cutaneous hematolymphoid proliferations and rare atypical melanocytic proliferation. In addition, fellows are exposed to a civilian academic dermatopathology practice.	Eight months Pathology/Dermatopathology signout* Two months Dermatopathology signout Two weeks University of VA rotation* Two weeks Molecular Pathology at Joint Pathology Center Pathology/Dermatopathology Signout Mornings in Pathology and afternoon sign-outs in Dermatopathology. Duties while in Pathology include: grossing, sign-outs, and frozen sections. Fellows also staff Cutaneous Oncology Tumor Board and weekly Dermatology Grand Rounds. Fellows attend all Pathology Residency Program lectures/didactics during this time. Research and PI projects are performed as time permits, or during five discretionary days that fellows are allotted. Dermatopathology Signout Entire days of Dermatopathology sign-out. Fellows continue to staff Cutaneous Oncology Tumor Board and weekly Dermatology Grand Rounds. Research is performed as time permits, or during five discretionary days that the fellows are allotted. **University of VA Rotation Two week rotation at the University of Virginia in which the fellow gains additional experience in cutaneous hematolymphoid proliferations and rare atypical melanocytic proliferation. In addition, fellows are exposed to a civilian academic dermatopathology practice.

Core Pathology Residency Graduate Pathway

Core Dermatology Residency Graduate Pathway

Eight months Dermatopathology Clinic*
Two months Dermatopathology signout**
Two weeks University of VA rotation***
Two weeks Molecular Pathology at Joint Pathology Center

*Dermatopathology Clinic

Morning clinic in Dermatology and afternoon sign-outs in Dermatopathology. Fellows also staff Cutaneous Oncology Tumor Board and weekly Dermatology Grand Rounds. Fellows attend all Dermatology Residency Program lectures/didactics during this time. Research and QI projects are performed as time permits, or during five discretionary days that fellows are allotted.

**Dermatopathology Signout

Entire days of Dermatopathology sign-out. Fellows continue to staff Cutaneous Oncology Tumor Board and weekly Dermatology Grand Rounds. Research and QI projects are performed as time permits, or during five discretionary days that fellows are allotted.

***University of VA Rotation

Two week rotation at the University of Virginia in which the fellow gains additional experience in cutaneous hematolymphoid proliferations and rare atypical melanocytic proliferation. In addition, fellows are exposed to a civilian academic dermatopathology practice.

Eight months Pathology/Dermatopathology signout*
Two months Dermatopathology signout**
Two weeks University of VA rotation***
Two weeks Molecular Pathology at Joint Pathology Center

*Pathology/Dermatopathology Signout

Mornings in Pathology and afternoon sign-outs in Dermatopathology. Duties while in Pathology include: grossing, sign-outs, and frozen sections. Fellows also staff Cutaneous Oncology Tumor Board and weekly Dermatology Grand Rounds. Fellows attend all Pathology Residency Program lectures/didactics during this time. Research and PI projects are performed as time permits, or during five discretionary days that fellows are allotted.

**Dermatopathology Signout

Entire days of Dermatopathology sign-out. Fellows continue to staff Cutaneous Oncology Tumor Board and weekly Dermatology Grand Rounds. Research is performed as time permits, or during five discretionary days that the fellows are allotted.

***University of VA Rotation

Currently in our 1-year program, we are not able to offer elective rotations.

There is no scheduled call for the Dermatopathology Fellow. The Fellow is expected to remain available through normal business hours Monday through Friday for any ‘rush’ cases that may need to be accessioned and grossed, such as inpatient biopsies.

WRNMMC serves as a Center of Excellence in the care of cancer patients provided through the Murtha Cancer Center. To this end, the Dermatopathology Department at WRNMMC provides consultative services to the Cutaneous Oncology Clinic housed within the Dermatology Department. This clinic is uniquely poised to care for active service members with complicated skin cancers and the fellow benefits from participating in the care of these active duty servicemembers. Fellowship trainees also benefit from participating in the weekly tumor boards as well as in assisting in the diagnosis and staging of skin cancers, such as melanomas, which occur in both active duty and retiree military populations with increased frequency as compared to the general population. In addition, Dermatopathology at WRNMMC is in a unique position to help in the diagnosis of rare diseases, in particular, infectious diseases which frequently involve the skin (e.g. leishmaniasis or syphilis) as many of our servicemembers are deployed to austere, remote and varied parts of the world, dermatopathologists can play in an integral part in the diagnosis of rare skin disease which may be acquired in these environments. To this end, the Dermatopathology Department at WRNMMC holds weekly consensus conferences for discussion of complicated cases. This conference is by all Dermatopathologists at WRNMMC in addition to virtual attendance by other MTFs from around the DOD.

There are currently no required courses.

We currently do not offer any simulation curriculum.

The Fellow as time permits can participate in Leadership Courses provided by the command at WRNMMC.

Scholarly and Professional Development Opportunities

The Fellow is required to present at one conference and/or submit for publication on article.

The Fellow will participate in one Quality Improvement project throughout the course of the academic year. This project will be decided upon by the Dermatopathology Fellowship Program Director.

As time permits, the Fellow can participate in Professional Development courses offered by the command.

Participating Sites

Walter Reed National Military Medical Center
University of Virginia, Charlottesville, Virginia
Joint Pathology Center, Bethesda, Maryland

Applicant Information, Rotation and Interview Opportunities

The dermatology residency program offers rotations to fourth-year medical students and transitional year interns. Rotations are typically four weeks long, and medical students rotate through the dermatopathology service as part of their dermatology rotation. Rotators will work with our resident medical student coordinator to finalize their rotation schedule to include at least one day in dermatopathology, and elective days to highlight areas of interest.

To schedule a rotation, contact dha.bethesda.Walter-Reed-Med-Ctr.mbx.gmerequests@health.mil and follow guidance through NCC Graduate Medical Education regarding rotation logistics.

Must be a medical school graduate (MD or DO)
Applicant should be in Senior year of an ACGME accredited Pathology or Dermatology Residency or have graduated from an ACGME accredited Dermatology or Pathology Residency
Two letters of recommendation
Dress Code: Applicants should be prepared to interview in their Class A/ Service Dress uniforms
Interviews are performed both in person and virtually

Program graduates take the Dermatopathology Subspecialty Certification Exam. This exam is offered annually. To become fully board certified, applicants must apply by May 15th of the year in which the candidate plans to take the examination. To be eligible to take specialty board exams, graduates must complete all pre-requisites required by the American Board of Dermatology or the American Board of Pathology to include graduation from an ACGME accredited Dermatology or Pathology Residency

Teaching Opportunities

The Fellow is required to teach and lead 6 Dermatopathology teaching sessions per year.

The Fellow has the opportunity to teach in real time to both Pathology and Dermatology residents during the work up and sign out of complicated cases. The Fellow also has the opportunity to teach at the Pathology Residencies ‘interesting Case Conference’.

Faculty and Mentorship

Dermatopathology – to include Dermatopathologists with both at background in Dermatology and Pathology.

The Fellow will work daily with both Pathology and Dermatology trained Dermatopathology Attendings. Mentorship occurs in real time during sign out session, during the work up of complicated cases and through providing feedback to the Fellow after observing the Fellow present at conferences.

Well-Being

Trainees interact with faculty and other trainees on a daily basis. The work environment is collegial and supportive, and staff inquire after the trainees overall life situation and well being taking into account work life balance. The trainee’s schedule is adjusted when needed to allow for personal appointments and family.