Mission

The mission of the Dermatology Residency Program at Naval Medical Center San Diego is to train the next generation of military dermatologists in providing comprehensive dermatologic services to active duty service members, retired service members, and family members whenever and wherever required. The primary focus of military medicine is the medical support and readiness of the operational forces. Our residents and staff provide the full spectrum of medical and procedural dermatologic services to the beneficiaries in the southwest United States in addition to providing virtual health consultation to operational forces serving in the Pacific Theater.

Vision

• To be a world leader in academic dermatology, a center for remarkable care, and a vibrant community committed to innovation, education, and inclusion.
• To develop future leaders of dermatology whose contribution will impact military medicine and readiness.
• To advance dermatology and the understanding and treatment of dermatologic disease through our commitment to excellence in patient care, innovation, and quality teaching.
• To be a team that cares for one another and builds each other up, embraces diversity and inclusion, collaborates, and serves one another.

Aims

• Provide a staged progression of oversight and autonomy, helping residents build skills, leadership and confidence by training at a large military medical center that provides inpatient and outpatient care to military members and family members of all ages.
• Make medical dermatology the core focus for our trainees. Our residents work closely with and under the supervision of general dermatology faculty to establish a panel of patients and provide a continuum of comprehensive dermatologic services, including necessary procedures and dermatopathologic interpretation.
• Provide cutaneous surgical and procedural training sufficient to equip graduates with the skills for solo practice upon graduation. Laser and procedural dermatology are key elements of our program and the mission of rehabilitating Wounded Warriors. Our trainees work in close partnership with orthopedic, plastic surgery, and physical therapy through Project CARE (Comprehensive Aesthetic Restorative Effort) to improve the lives of those injured while serving in the U.S. Armed Forces.
• Expose our residents to complex inpatient and world-class pediatric dermatologic care through partnerships with Los Angeles County Medical Center/University of Southern California and Rady Children's Hospital.
• Provide an extensive didactic educational series composed of combined Grand Rounds conferences with the University of California San Diego, regular review of dermatology texts, high-yield board preparation lectures, journal club, group side review, multidisciplinary morbidity and mortality conferences, and attendance at local/regional and national professional meetings.
• Encourage ingenuity and innovation in the practice of dermatology through resident involvement in research.

• Morning conferences: 7 - 8 a.m. on Monday, Tuesday, Wednesday and Friday.
• Grand Rounds (GR): Grand Rounds is a combination of traditional and virtual lectures 8:45 - 11 a.m. on Thursdays alternating between NMRTC and UCSD
• Journal Clubs: 2 - 3 p.m. on Fridays
• Dermatopathology: lectures scheduled weekly, and tests scheduled quarterly
• San Diego Dermatologic Society (SDDS) meeting: Quarterly meetings; annual conference typically in May hosted by NMRTC SD
• Cutaneous Surgery Labs: offered to first year residents to provide education in wound healing, plastic surgery techniques, reconstructive techniques, burn models, and artificial skin grafts
• Attendance at the following:
  • Annual Hansen’s Disease course
  • Cutaneous melanoma course

• Dermatopathology: Compass
• Laser: Cosmetic Laser Dermatology
• Mohs surgery: Scripps Clinic or the Veterans Affairs Medical Center (VAMC)
• Pediatric Dermatology: Rady Children’s Hospital
• Tropical Medicine Course: This six-week operational medicine course may also be taken as an elective. If this is chosen the six weeks will count as a 4-week elective. The additional two weeks will count as clinic time.

• The normal work week is Monday through Friday, 7 a.m. - 4:00 p.m. Weekends and evenings are covered by the resident on call with staff backup.
• In mid-November PGY2 residents begin the on-call schedule and PGY4 residents rotate off the on-call schedule.

Dermatology Residents are educated on the military scope of practice prior to their graduation.

• Cancer Screening projects are conducted throughout various military installations to include the Naval Base San Diego and Marine Corps Air Station Miramar
• Implications of immune-modulating or suppressing agents on military medical readiness
• Medical Board/Limited Duty/Profile implications
• Military specific disease manifestations and treatments: skin/hair conditions related to military uniforms/equipment and grooming/appearance standards (pseudofolliculitis barbae, traction alopecia, acne keloidalis nuchae; occupational dermatitis related to uniforms/equipment such as painful truncal acne from body armor) and management of eczema and psoriasis when deployed, etc. Others include treatments for wounded warriors, laser and other physical modality treatments for traumatic tattoos, keloids, scars (more significant instruction than in non-military residencies), and botulinum toxin injections/microwave thermoablation for hyperhidrosis of residual limbs.
• Rare diseases in US with which military dermatologists need to be familiar, such as tropical parasitic infections (e.g., leishmaniasis), Hansen’s disease, atypical fungal and mycobacterial infections, and other infectious diseases from deployed locations. In addition, skin conditions related to extremes of environment (cold-weather, heat-related, and immersion injuries) are emphasized. Military dermatologists also need to be familiar with vaccination reactions, including those from vaccines not commonly administered (e.g., smallpox).
• Resident participation in military exercises onboard the USNS Mercy.
• Telemedicine from the deployed environment and through inpatient consult services.
• Tropical Medicine Course: is a six-week course offered to residents at the beginning of their third year of training. The purpose of the course is to familiarize physicians with the epidemiology, diagnosis, prevention and treatment of infectious diseases encountered in developing nations. The course consists of 4 weeks of didactic at Walter Reed National Military Medical Center, followed by two weeks of field instruction in a selected country.

Dermatology residents are required to maintain their Basic Life Support (BLS) certification throughout their residency training.  

During the first year of residency, a series of lectures and workshops are presented by the staff Mohs surgeons. The topics covered include techniques of biopsy, excisional surgery, nail surgery, principles of flaps and grafts, suture materials, anesthetic agents, post-op complications, and several hands-on lab sessions covering suturing techniques. Additional lectures by the dermatology surgeons given during the rest of the residency include principles and techniques of Mohs surgery, dermabrasion, tissue augmentation and hair transplantation.

Dermatology Residents have opportunities to participate in the following activities:

• Chief Resident Symposium and Transition to Practice Symposium
• Command Leadership courses
• Leadership and team building exercises
• Lean Six Sigma Green Belt Certification
• Navy Intermediate and Senior Leader Courses
• Peer mentorship
• Quarterly program leadership and mentoring sessions
• Resident leadership roles, including educational, clerkship, research, wellness, etc.

• Time for research is available during all rotations.
• Case reports and peer reviewed publications are encouraged.
• Residents all participate in continuing process improvement projects.
• Periodic mini-presentations are provided by the Clinical Investigations Department (CID) in various research topics to include:
  • Regulatory guidance
  • Policy interpretation
  • Protocol development
  • Statistical expertise
  • Scientific writing support
  • Funding and grant searches
  • Institutional Review Board (IRB) processes

At the start of each academic year, the residents and faculty are educated about use of the on-line Patient Safety Report (PSR), Morbidity and Mortality (M&M), “Good Catch”, and Quality, Measures and Outcomes (Q+M=O) tools. During the Dermatology Departments M&M Conference, the residents and faculty are briefed about Dermatology-specific PS and QI metrics at NMCSD. Every resident’s clinic notes in Genesis will be reviewed by a faculty member for accuracy and completeness. Any discrepancies will be discussed with the resident. During the semiannual PD counselling will also receive feedback as necessary on PS/QI issues. Every resident and faculty member is strongly encouraged to complete the on-line course for Patient Safety (PS100 & PS 101) and Quality Improvement (QI 100) offered by the Institute for Healthcare Improvement (IHI). Residents are encouraged to obtain Lean Sig Sigma Green Belt Certification and lead a CPI project.

While developing excellent dermatologic skills, the NMCSD Dermatology Residency also focuses on developing future military Dermatology leaders through mentoring and modeling.

Dermatology Residents may apply for funding to attend a professional conference or present a scholarly project during their residency training. Residents have given national lectures, research podium presentations, held national leadership board positions at:

• American Academy of Dermatology Association
• American Board of Dermatology
• American Contact Dermatitis Society
• American Society of Dermatopathology
• American Society for Dermatologic Surgery
• American Society for Laser Medicine and Surgery
• American Society for Mohs Surgery
• California Dermatology Society
• Cosmetic Surgery Forum
• Masters of Aesthetic
• ODAC Dermatology
• Pacific Dermatologic Association
• San Diego Dermatological Society
• San Diego Dermatology Symposium
• Skin Disease Education Foundation

• Compass Dermatopathology, San Diego
• Cosmetic Laser Dermatology, San Diego
• Dermatology Institute, San Diego
• Los Angeles General Medical Center
• Rady Children's Hospital, San Diego
• Scripps Carmel Valley, San Diego
• Scripps Torrey Pines, San Diego
• UCSD Dermatology
• UCSD In-patient Consultation Services
• UCSD / VA Medical Center, La Jolla
• Veterans Administration Medical Center, San Diego (VAMC)

Medical students may apply for a four-week rotation and if accepted, will be assigned to different faculty and residents in the program. Weekly rotations are on a space available basis and include multiple clinical shifts, didactic opportunities, and simulation experiences. Opportunities for rotations in dermatology subspecialities include Mohs, Lasers, Cosmetics Clinics, and Dermatopathology.

Please visit our Medical Student Rotation informational page to see a listing of available medical student rotations offered at NMCSD.

Interviews are offered from July – mid October. Each applicant will be provided a program overview by the Program Director. Applicants are then given a 30-minute interview with an interview panel consisting of the Program Director, a faculty member, and a Chief Resident. Interviews are normally held in-person.  Virtual interviews may be conducted for those individuals who are deployed or are stationed in remote and/or overseas duty stations.  To request in interview, please contact the Dermatology Program at: dha.san-diego.San-Diego-NMC.list.nmcsd-derm@health.mil

Program graduates take the American Board of Dermatology (ABD), Applied Examination. This exam is offered annually. To become fully board certified, applicants are eligible to take the board certification (“Applied”) exam (1) month after graduation. To be eligible to take specialty board exams, graduates must complete all pre-requisites required by the ABD in mid-April. The Applied Exam is offered in July at partnered test sites, such as the Pearson Test Centers.

ABD Applied Exam Eligibility link: https://www.abderm.org/residents-and-fellows/abd-certification-pathway/applied-exam-eligibility

Opportunities to teach are available several times a week and include presenting at Grand Rounds and resident-to-rotator teaching sessions. Residents hold didactic sessions with fellow residents every morning.

Our Cancer Screening initiative at the local military commands offer opportunities to provide dermatology teaching experience to active duty military service members. Our residents regularly lecture at other department grand rounds, dermatology grand rounds, and to Fleet Medical Officers and faculty members.

• Dermatopathology
• Pediatric Dermatology
• Procedural Dermatology

Dermatology residents work with their assigned faculty advisor and complete quarterly resident performance evaluations. Faculty advisors will additionally provide on-the-spot or periodic feedback throughout the academic year. Residents meet monthly with the Program Director as a group and individually on a semiannual basis. An open-door policy with all faculty is maintained.

• The NMCSD Dermatology residency program provides maximal opportunities for resident wellness consistently over the course of the 36-month residency. We have worked to consolidate all official activities in such a manner as to maximize time off without reducing opportunities for training.
• Residents are provided with 1 day in 7 free (24 hours) from all educational and clinical responsibilities, averaged over a 4-week period, inclusive of call.
• Residents may participate in optional departmental and command level Wellness Committee activities.
• Mind Body medicine has been incorporated into the academic curriculum.
• Resident wellbeing is reviewed at every Clinical Competency Committee meeting.