dermatology – CA Work Experience Program

Day 7: AE Dermatology

My last day at the clinic could not have been better! I had the privilege of spending today in the lab, which was a unique experience considering that many dermatologist offices do not have labs. I witnessed a whole plethora of things that the histologists (histology: study of tissue) do, and needless to say, I was very impressed. The day started off with a diligent recording of the temperature of every piece of equipment in the lab from the fridge to the water bath. Afterwards, some machinery had to be self-cleaned, so while they were cleaning, the cell fragments from the night before were carefully removed and placed in paraffin wax and set to cool. While they were cooling, we moved on to paperwork and to filing the new extractions that came in this morning. After getting all of the paperwork out of the way, I was introduced to a super cool printer that prints out customized slides for the cell slivers to be transferred on. After all of the slides were printed, the real fun began as we started to shave thin slivers of the extractions trapped in wax. Each block of paraffin wax containing slivers of skin extractions is shaved down and carefully placed into a temperature controlled water bath. From there, the specific patient slide is submerged in water and the histologist determines which shavings should end up on the final slide. Once all of the slides have been filled, the slides are transferred to an automated stainer and the process begins anew. I have included a picture of the shavings of skin in a water bath that were extracted using the method of punching. The method is exactly how it sounds with a device punching out a small cylinder of skin. Overall, the lab was super fun and I’m glad that’s how I ended my fun run!

Last day of Work Experience:(

Today was my last day at Cary Dermatology as well as the Work Experience. The WEP has been pretty fun as I feel i have gotten more out of the journey than I expected. Yesterday Hannah and I went into a surgery for the last time with Dr. Mangelsdorf. We captured our last moment by making a funny video of us taking off our protective equipment (known as PPE). All in all, the experience was fun because I really got to bond with people in two different places. Southern and Cary Dermatology really opened my eyes to what the work world of Dermatology looked like and I really enjoyed it. To all the doctors, I really appreciate them letting me learn in the midst of their busy days.

Day 6: AE Dermatology

Today was super cool! I was privileged enough to get to spend some time with the wonderful ladies at triage and at the front desk. They were all very welcoming and taught me the value of the work that is done behind the scenes. Triage was always working nonstop answering calls, reporting diagnoses, scheduling people, and following up on procedures. Their ability to multitask was incredible and I was definitely blown away watching the efficiency at which they answered calls while filling out extensive patient information forms. The women who worked at the front desk were amazing too! Aside from checking in patients, they also took and transferred calls, scheduled patients, sold cosmetics, and dealt with bills and the schedules for their specific providers. They have to juggle a lot, between phone calls and scheduling and forms and papers, but they graciously took the time to explain each process and their system of functioning. I was amazed to see the orderliness and specific schedule layout each provider has, and they really taught me the importance of crafting the perfect schedule. Their job may seem minuscule, but without them there would be no foundation for everything to run smoothly off of. I am very thankful that I got to spend my day with those wonderful women! I also got to do some interesting reading thanks to fact that they let me borrow some literature! I read up on the Pocket Atlas of Dermatology by Gerd Klaus Steigler and Howard I. Maibach, and I have to say that some of the things in that book were very intriguing. The book covers everything from acne to bacterial disorders and viral diseases. It is a brief book due to its small size, but still worth a read! I have included a picture of the book below!

Day 5: AE Dermatology

Day 5 went by super quickly! Today I was in the care of Dr. May again, and I could not be more grateful! She always takes the time to explain concepts to me and makes sure I am always included. Today we had more biopsies of moles and full body checks. In addition to those, we had a couple unique cases! There was a case of an autoimmune disease that manifested as a rash and flaky skin that would occur whenever the sun or heat was present. Another unique case was one of yeast overgrowth in response to moist environments, in this case caused by sweat. The yeast impacted the skin pigmentation, causing the white discolorations on the back. Another patient came in with a wart on the foot that had been over medicated with salicylic acid. As a result, a callous formed on the foot that had to be scraped off. Overall, today was a great day! Below is a photo of the yeast overgrowth called Tinea versicolor.

https://www.aad.org/public/diseases/color-problems/tinea-versicolor#causes

Learning days at Cary Dermatology!

Completing modules fashioned for med-students on 2 or 4 week rotations teaching about the basics of Dermatology.

Today I joined Hannah G. at Cary Dermatology where we complete our regular rounds of alternating going into a patients’ room with Dr. Mangelsdorf. Hannah and I talked a lot about all the different things we’ve been doing for the past few days that we hadn’t seen each other. I told her about the Mohs’ surgery that I witnessed, and she told me about the new information she learned through the teaching modules from the AAD. It was fun to start the day at 1:00 so the day went by very quickly. Hannah and I saw patients with psoriasis, warts, dysplastic nevus (atypical mole) and more. Besides that, we saw most of the same things I saw the first week I was there. It was really nice to be working with her as well as continue to reinforce my understanding of all the dermatology terms I have learned until this point with Dr. Mangelsdorf and the nurses throughout the day.

Day 4: AE Dermatology

Day 4 was super educational! I had the privilege of shadowing Dr. G, who is an amazing dermatologist! He was very patient and took every opportunity to explain and teach me new things! I appreciated the diagrams he drew and advice he gave me about dermatology and medical school in general. We saw a total of 8 patients with varying concerns. A couple of the patients just came in for general body checks, but others came in for irritant contact dermatitis in the form of a rash, discolored patches of skin, and biopsies. One of the biopsies was originally going to be an ED & C of previously biopsied areas but ended up being biopsies of new places. As a result, I got to witness some cool biopsies and also learn about the difference between biopsies and ED & Cs. ED & C “scoops” deeper into the skin, past the epidermis to the dermis, to remove the cancerous basal or squamous skin cells entirely. Biopsies, on the other hand, only scrape the surface layer, the epidermis, and take a sample of the skin tissue instead. This is because biopsies are used to obtain a sample of tissue to determine, most often, whether cancer is present. We also had a couple of people who got age spots treated with liquid nitrogen, and I got to look at skin cells treated with KOH under a microscope to check for bacteria. Today was a good day and I’m gracious for all of Dr. G’s help! Below is a picture of a basal cell carcinoma that would be removed with ED & C.

Picture 1: https://westcancercenter.org/cancer-type/non-melanoma/

Last Day at Southern Dermatology :(

Me, Dr. Boyse, Cary, and Priyanka (Dr. Boyse’s medical assistants)

An image of cancer affecting the skin blown up on a cellular level!

Today was my last day at Southern Dermatology where I worked with Dr. Boyse and her amazing co-workers which i have grown to really enjoy their company while working. I was able to shadow a dermatologist today who performed Mohs’ surgery and showed me how they remove cancerous sites on the skin and determine whether or not they have to continue to cut around the site to fully eradicate the cancer. The most common types of cancer I saw was invasive squamous cell (invasive meaning it reoccurs) and basal cell carcinoma. To be able to figure out whether or not the patient was cleared was a whole other process. Using Pathology, Dr. Wilmoth (the Mohs’ surgeon), would figure out whether or no the cancers were still in the tissues of the skin.

Dr. Wilmoth, would first cut the cancerous skin sample out of the patient’s existing cancer-targeted area to then be brought to the lab to be observed. When he arrived in the lab, he cut it so that the epidermis would be exposed and then handed it to his partner who would actually begin slicing the skin sample into thin layers for futher examination. Through a series of freezing the sample, shaving it, placing it onto slides, preserving it by dipping it in different chemicals, the skin samples of each patient went through that process and at the end of the day ended up in about 9 slides (or so) showing the skin sample its different edges. Dr. Wilmoth then walked me through what a basal and squamous cell carcinoma looked like. That morning however, he had many patients that all read positive on their cancer and had to have more of their skin removed. The coolest part about it was seeing how quickly and precisely Dr. Wilmoth could identify the cancers and continue on to view or “study” the next patients slide. I really loved being able to shadow Dr. Wilmoth the last day as he was under stress but did take the time to explain and show me what he was doing while executing it.

After all of that intense work, I returned back to the skin exams and cosmetic procedures on Dr. Boyse’s side of the clinic. Once again, I had a great time being able to help send labs down to triage, retrieve samples of cremes for patients to try and stand-in on skin exams one last time. I had a great lunch and it was a very fun last day with them! I hope to be able to come back and shadow with them or even work as a medical assistant before med school if I decide this is where I would really like to do!

Raleigh’s finest: Southern Dermatology!

An interesting cryotherapy demonstration… (liquid nitrogen spray!)

At Southern Dermatology today, I was put to the task as an intern by helping around with menial tasks around the office. This morning I helped send lab reports down to triage (where the workers would assess the patients problems and assign treatments to them), helped receive samples from the supply cabinet, and I even let patients know that Dr. Boyse was with another patient and that they’d be attended to in no time. I truly became familiar with the place that Dr. Boyse was happy I could participate in all the activity, making me feel like a true medical assistant. Throughout the day I stood in on many Botox procedures and skin exams; hopefully I will be able to see Mohs’ surgery with another Doctor. Once again, I had a lot of fun learning through modules, listening to Dr. Boyse explain common skin diseases, and eating the delicious Italian lunch we had today! Tomorrow is my last day at Southern Dermatology and I’ll be sad to leave because everyone was very inviting, willing to answer all my question no matter how confusing it may be. I can’t wait for the last day because I know it’ll be the best one yet, so I can’t wait for it!

Day 3: Audrey Echt, MD, PA Dermatology and Skin Cancer Center

Day 3 was a lot of fun! I was so honored to be in the care of Dr. May, who focuses on general dermatology! It was very fascinating to see the “general” side of dermatology such as the diagnoses of rashes and flare ups. We saw a total of 10 patients with ailments ranging from poison ivy to acne to allergic reactions. Watching Dr. May know which prescription to prescribe each time was very awe-inspiring. In addition, I got the honor of viewing full body check-ups and sun spot removals. It was interesting to see how the dark spots that people often discovered during their body exams could easily be frozen off. I learned from the body examinations that the spots we refer to as ‘dark spots’, are known as Seborrheic keratosis, and they are genetic benign marks. Two very interesting cases were one lady who had severe eczema on her hands, and had been prescribed faulty medication as a treatment, and a woman with a sun allergy. I was impressed by how quickly Dr. May was able to identify a faulty treatment and come up with a better alternative. As for the woman with the sun allergy, it was interesting to get insight on a situation that I have never had experience with. It helped me recognize the importance of sunscreen, not just for the patient, but for all of us. Overall, today was a great and exciting day! I have attached a picture of a sun rash below!

picture 1: https://www.makelifenatural.net/heat-rash-vs-sun-rash-know-difference/

More modules and a surgery!

machine used to cauterize skin during surgery!

Today at Dr. Mangelsdorf’s clinic I was able to witness more skin checks and then an exciting surgery towards the end of the day where my fellow intern Hannah and I wore surgery gowns. It was a typical 7:45 start and I saw a moderate amount of patients this morning. I saw more cryotherapy (the act of spraying liquid nitrogen to freeze off moles) being done on some benign seborrheic keratoses (moles). Later on in the afternoon, I got suited up to witness a basal cell being removed. It was a little bit intense and super cool. I also got to learn a lot more about parapsoriasis, urticaria (hives), atopic dermatitis (eczema) and all the other different medical names for everyday skin conditions. We also had lunch today at work so that was fun being able to talk to everyone and eat lunch with Hannah and Cristina who joined us! Overall, it was another full day of learning from Dr. Mangelsdorf, the modules from the American Academy of Dermatology (AAD), and the medical assistants/nurses.