MS4 Catalog

Mohs Micrographic Surgery

LOCATION: WVU Mary Babb Randolph Cancer Center
PRECEPTOR: Vlad Codrea, MD, PhD
DURATION: 2 week minimum
OFFERED: Not offered Blocks 8,9 & 11 
MAXIMUM ENROLLMENT: 1
STATUS: Elective (approved by curriculum committee 9/13/2021)

ELECTIVE DESCRIPTION:

Students will work alongside Dr. Codrea in the Mohs surgery outpatient clinic and operating areas at Mary Babb Randolph Cancer Center. Students will be expected to take thorough histories, physical examinations and to develop a detailed assessment and plan, as well as study the concepts of dermatopathology, skin surgical reconstruction and various benign and malignant skin diseases. The goal of WVU's Mohs and dermatologic surgery rotation is to develop skills in the diagnosis, pre­ operative, peri-operative, and post-operative medical management. The students will be progressively exposed to these aspects of Mohs and dermatologic surgery, with the goal of increasing professional proficiency and confidence throughout training.

OBJECTIVES:

Patient Care:

  1. Formulate a plan of care with the attending Mohs surgeon that is consistent with the wishes of the patient
  2. Educate the patient regarding the natural history of skin cancer and relevant treatment options.
  3. Work effectively under the supervision of the attending Mohs surgeon to efficiently manage skin cancer in the setting of multiple patient comorbidities.
  4. Become familiar with emergency patient management as it occurs in university settings such as cardiac, pulmonary and neurologic events.

Medical Knowledge:

  1. Develop competency in the early clinical identification of skin cancer, application of diagnostic techniques, and performing a preoperative clinical history and physical exam for patients with skin cancers.
  2. Become familiar and proficient with optimal wound reconstructions following the removal of skin cancers by Mohs surgery such as second intention healing, biologic dressings, full and split thickness skin grafting, flap repairs (advancement, rotation, transposition and interpolation flaps), with patients using local anesthesia.
  3. Become familiar with interpretation of Mohs horizontal frozen sections and tumor mapping in university settings.

Practice-Based Learning:

  1. Conduct reviews of surgical topics with the Mohs surgeon to discuss issues that arise during the care of Mohs patients in university settings.
  2. Bring complex patient management problems identified in the Mohs university setting (basal cell carcinoma, squamous cell carcinoma, melanoma, adnexal carcinoma, Merkel cell carcinoma, extramammary Paget's disease, atypical fibroxanthoma, sebaceous carcinoma and dermatofibrosarcoma protuberans), to WVU dermatopathology consultants.

Communication Skills:

  1. Demonstrate effective interpersonal and communication skills with patients, ancillary, and other professional staff in the university clinics and via electronic and telephone contacts.
  2. Maintain comprehensive, timely, and accurate electronic medical records.

Professionalism:

  1. Display professional responsibilities including respect, truthfulness and sensitivity to diversity.
  2. Accept responsibility for continuity of patient care.
  3. Maintain appropriate professional boundaries when providing care to patients.

Systems-Based Practice: 

  1. Learn to navigate the insurance-based challenges presented to patients so that they receive high-quality care.
  2. Work effectively with university office assistants and colleagues to coordinate comprehensive patient care.
  3. Utilize EMR for reviewing patient's record and pertinent data.

METHODS TO ACHIEVE OBJECTIVES:

  1. Review of journal articles relevant to patient cases/encounters.
  2. Lectures/handouts which may include but not limited to: Mohs surgery techniques, second intention healing, biologic dressings, full and split thickness skin grafting, flap repairs (advancement, rotation, transposition and interpolation flaps), histopathology concepts and various skin cancers that often require Mohs surgery.

EXAMINATION PROCEDURES AND EVALUATION CRITERIA:

Formative Assessment: 
Informal preceptor sessions with the student to review physical examination, history and other pertinent information related to each day's patients. Differential diagnoses, surgical approaches and microscopic examination features will be reviewed daily on a case-by­ case basis.

Summative Assessment: 
Student will present one topic related to Mohs surgery at the end of the 2-week rotation. This can be a case presentation or a literature review of a topic and should be no longer than 10 minutes in duration.

PRIOR TO THE FIRST DAY OF THE ROTATION:

Contact Ms. Bethany Guthrie, bethany.guthrie.m@wvumedicine.org at least 2 weeks prior to the start of the elective.