The Procedural Dermatology Fellowship Program at New York Presbyterian Hospital, Columbia University Medical Center Campus is a two year program that provides a comprehensive experience in the clinical aspects of Procedural Dermatology and the opportunity to pursue intensive Procedural Dermatology training in an academic setting. Directed by Désirée Ratner, MD, the Fellowship Program is designed for the physician who aspires to a career in academic Dermatologic Surgery and emphasizes those elements of the discipline relevant to this career goal.

PROGRAM GOALS AND OBJECTIVES

Program Goals

• To promote the highest quality of Procedural Dermatology training through a combination of supervised hands-on experience and didactic learning
• To build surgical skills and judgment in graded and systematic fashion

Program Objectives

• To provide instruction in the three broad areas of:
1. Cutaneous Oncology, incorporating medical, surgical, and dermatopathological knowledge of cutaneous neoplasms, including the indications, and technical and laboratory aspects of Mohs micrographic surgery
2. Cutaneous reconstructive surgery, including the repair of skin defects resulting from surgical removal of tumors, or other skin disease, and scar revision
3. Cutaneous cosmetic surgery, incorporating medical, surgical, and dermatopathological knowledge of cutaneous disorders and aging of the skin, providing a broad exposure to and an appreciation of cosmetic dermatologic surgical procedures
• To provide instruction and experience in the preoperative and postoperative management (both short term and long term) of surgical patients in all three areas
• To develop proficiency in the above listed areas in a graded and systematic fashion, starting with the basic principles of delivery of local anesthesia, aseptic technique, preoperative evaluation, surgical equipment (including sterilization and maintenance), surgical anatomy, cold steel surgery, suturing materials and techniques, reconstruction of surgical defects and prevention and management of complications
• After a sound foundation in the basic principles and techniques of dermatologic surgery has been achieved, to expand the fellow's knowledge of related disciplines including: delivery of regional as well as local anesthesia, principles of and indications for conscious sedation and general anesthesia, the basic science and clinical aspects of wound healing, the use of specialized wound dressings appropriate to each clinical problem, and advanced reconstructive procedures, including staged reconstructions
• To develop advanced competence in the identification of patients whose conditions should be treated by minimally invasive dermatologic surgical procedures, and others, such as those requiring more extensive procedures or general anesthesia, who should be referred to other specialists such as ophthalmologists, otolaryngologists, plastic surgeons, or surgical oncologists, as well as those patients requiring additional management by medical oncology, radiation oncology or other subspecialists
• To develop experience in the multidisciplinary management of such patients
• To become familiar with the approaches and tools of modern clinical and basic research as they relate to the fields of cutaneous oncology, cutaneous reconstructive surgery, and cosmetic dermatologic surgery
• To develop effective interpersonal and communication skills with surgical patients, their families, and professional associates
• To develop professional attitudes consistent with being a physician, with an emphasis on responsibility, compassion, sensitivity to diverse patient populations, confidentiality, informed consent, adherence to ethical principles, and a commitment to excellence and on-going professional development
• To learn to use information technology to gather the most up-to-date scientific evidence to make informed decisions regarding diagnostic and therapeutic interventions for procedural dermatology patients; to find, assess, and assimilate the best evidence for clinical decision-making and continuously evaluate and improve patient care practices
• To develop an understanding of the different types of health care systems available; to advocate for quality patient care and assist patients in dealing with system complexities; to partner with professional associates to coordinate care; and to learn to practice in a cost-effective manner without compromising quality of care.
• To educate students and other healthcare professionals.
• To train the future academic leaders in Procedural Dermatology.

Fellow Practice Schedule

The fellow is scheduled to work two to three days per week (Mondays, Wednesdays, and/or Thursdays) participating in Mohs surgical cases, their associated repairs, other general dermatologic surgical procedures, and pre-and postoperative evaluations. Tuesday mornings are spent in the Multidisciplinary Melanoma Clinic with Drs. Ratner, Kaufman, and other specialists from Medical Oncology, Surgical Oncology, and Radiation Oncology. Tuesday afternoons are alternately spent teaching in the Resident Surgery Clinic (2nd and 4th Tuesdays) and in Dr. Ratner's surgical practice (1st, 3rd, and 5th Tuesdays). On Wednesday mornings, the Resident Cosmetic Surgery Clinic, directed by Dr. Gmyrek, takes place. The fellow will be scheduled to participate in this clinic on a monthly basis during the second half of the fellowship to gain experience in liposuction and other cosmetic surgical procedures. Friday mornings are spent with Dr. Ratner completing excisions, pre- and postoperative evaluations, and cosmetic surgical procedures in her surgical practice. Surgical lectures are held on Thursday mornings and Friday afternoons. If no surgical lectures are scheduled, the fellow is encouraged to observe and assist in outside repairs and adjunctive surgical procedures by oculoplastics, plastics, ENT, and surgical oncology as their schedule permits.

In the second fellowship year, Friday afternoons may be spent with Dr. Monica Halem in her cosmetic surgical practice, assisting in and gaining expertise in cosmetic dermatologic surgical procedures, including intense pulsed light treatment, microdermabrasion, laser treatment of vascular and pigmented lesions, laser hair removal, chemical peels, soft tissue augmentation, Botox injections, sclerotherapy, and other cosmetic surgical procedures.

Application Requirements

• MD Degree
• Completion of a Dermatology Residency
• 2 letters of recommendation
• New York State Medical License prior to the start date of the fellowship (July 1)