Medical Mission: Dermatological Residency Experiences from OC Skin Institute's Dr. Tony Nakhla

Annual MeetingSan Diego, California Sept.30 to Oct. 4, 2007see pages 20-23

Residents Join MedicalMission to the Amazon see pages 18-19

Resident ReceivesNavy Medalsee pages 14 & 15

Mohs MicrographicFellowshipsee pages 10 & 11

FALL

2007

Newsletter of the American Osteopathic College of Dermatology

CORPORATE SPONSORS

AOCD MIDYEAR MEETINGMarch 12-15, 2008Monterey, Calif.

Annual Meeting 2007San Diego, Calif.

Sept. 30 - Oct. 4check www.AOCD.org/meetings

for the latest updates

Upcoming EventsAmerican OsteopathicCollege of DermatologyP.O. Box 75251501 E. IllinoisKirksville, MO 63501Office: (660) 665-2184

(800) 449-2623Fax: (660) 627-2623Site: www.aocd.org

PRESIDENTBill V. Way, DO, FAOCD

PRESIDENT-ELECTJay S. Gottlieb, DO, FAOCD

FIRST VICE PRESIDENTDonald K. Tillman, DO, FAOCD

SECOND VICE PRESIDENTMarc I. Epstein, DO, FAOCD

THIRD VICE PRESIDENTLeslie Kramer, DO, FAOCD

SECRETARY-TREASURERJere J. Mammino, DO, FAOCD

IMMEDIATE PAST-PRESIDENTRichard A. Miller, DO, FAOCD

TRUSTEESBradley P. Glick, DO Karen E. Neubauer, DOJeffrey N. Martin, DO James B. Towry, DO

EXECUTIVE DIRECTORRebecca Mansfield, MA

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UPDATE CONTACT INFORMATION

Is your contact information current? If not,you may be missing need-to-know newsfrom the AOCD.Visit www.aocd.org/members. Click on thered box on the right side of the screen toupdate your info. Should you have trouble accessing yourprofile, you can fax the new information tothe AOCD at 660-627-2623. Send the faxto the attention of Marsha Wise, ResidentCoordinator.

http://www.aocd.org

Hello Fellow Dermatologists and Resi-dents,

This year has been passing by quickly.

Our AOCD Executive Director, BeckyMansfield, has been very busy repre-senting you with items at the AOAsummer meeting and getting us readyfor our upcoming convention.

The AOCD has now reached a newhigh of 90 dermatology residents. Wehave 21 AOCD Dermatology ResidencyPrograms across our great country.

I have recommended this year that weall strive to increase our ‘Excellence inDermatology’ in our offices, as well asin all of our dermatology residencyprograms, and I can say that I believe

Peter B. Ajluni, D.O., a board-certifiedosteopathic orthopedic surgeon fromBloomfield Hills, Mich., was installed asthe 2007-2008 AOA president on June22, succeeding John A. Strosnider,D.O., who passed away of pancreaticcancer on the previous day.

“In my over 35 years as an osteopathicphysician, I have seen this professionexperience immense success and havewitnessed the AOA grow into a nation-ally recognized medical association,”Dr. Ajluni said. “I am very proud toserve as president of this organizationand continue the work of Dr. Stros-nider.”

An avid hiker and jogger who hasparticipated in a number of marathonsand triathlons, Dr. Ajluni chose “D.O.s:Fit for Life” as his presidential theme,which conveys the importance ofosteopathic physicians serving as rolemodels for their patients when it comesto health and fitness. In addition, hewill extend that focus to make the AOAa healthier and more fit organizationfor its members and the US a betterhealth care system for patients.

Dr. Ajluni is currently on leave from hisposition as a senior orthopedic surgeonat Mount Clemens Regional MedicalCenter, part of the McLaren Health CareSystem, in Michigan where he alsoserved as former chief of staff. Hecontinues to serve as vice chair of theboard of trustees at Mount Clemens. Dr.Ajluni also held staff privileges atHenry Ford Bi-County CommunityHospital in Warren and St. John NorthShores Hospital in Harrison Township.

Serving as AOA president-elect for the2006-2007 term, Dr. Ajluni began hiscareer on the AOA Board of Trustees in1998 and was a member of the Execu-

tive Committee from 2000-2005. Inaddition, he served as chair of theDepartments of Business Affairs, Educa-tional Affairs, Professional Affairs, andGovernmental Affairs. Aside from hisinvolvement on the national level, Dr.Ajluni also has been an active memberof state and local osteopathic medicalorganizations. He served as presidentof both the Michigan Osteopathic Asso-ciation and the Michigan OsteopathicAcademy of Orthopedic Surgeons.

After earning his degree in 1969 fromthe Chicago College of Osteopathy,now known as Midwestern Univer-sity/Chicago College of OsteopathicMedicine in Downers Grove, Ill., Dr.Ajluni completed an internship andresidency at Mount Clemens GeneralHospital.

He resides in Bloomfield Hills with hiswife, Judy. They have three children,Noelle (Kurt) Cassel, Mark, andMatthew, as well as three grandchil-dren.

AOA Installs Dr. Peter B. Ajluni as 111th President

that this is being done. This fall, wewill be giving our residents a new typeof resident-in-training examination toevaluate both the level of accomplish-ments for the residents, as well as theindividual training program. Whateverthe results, we will gain knowledge toimprove all of our teaching programs.

Within the next few weeks we will,once again, gather as friends andcolleagues to enjoy a wonderful time inSan Diego at our AOCD AnnualConvention. Dr. Jay Gottlieb hasplanned an outstanding educationalmeeting. I do hope you will makeplans for you and your family to join usfor this event.

I have learned this past year that life isvery precious and may be short.

Message From The President

Remember to enjoy your work, but setaside more time to enjoy your familyand friends. See you at the convention.

Sincerely,Bill V. Way, D.O., FAOCDAOCD President, 2006-2007

Photo by John Reilly Photography

(831-372-4277), or reservations e-mail([email protected]).

The AOCD staff welcomes yourcomments and suggestions designed toimprove our organization.

Greetings from the “Windy City.” I amwriting this from the Chicago FairmontHotel where the summer meeting ofthe AOA Board of Trustees (BOT) andthe AOA House of Delegates (HOD) isbeing held. These two meetings estab-lish policy for the AOA, specificallyspecialty affiliates and state affiliates.Prior to the opening of the BOTmeeting several other smaller groupsmet to develop recommendations tothe Board members and House dele-gates. Dr. Robert Schwarze is ourdelegate to the Council of OsteopathicSpecialty Societies (COSS). All special-ties are represented and have a vote. Inaddition to reviewing the proposedresolutions and making recommenda-tions to the BOT and HOD, the COSSmembers can propose new policy. Dr.Lloyd Cleaver represents the AOCD atboth the BOT and HOD meeting. As avoting specialty delegate, he attends allsessions of the House and the refer-ence committee meetings. Anymembers interested in discussing anyissues related to the AOA shouldcontact me.

Annual MeetingDr. Jay Gottlieb has developed adiverse educational program that willbe of interest to our members. Iencourage all members to attend thelectures and all of the other activities inSan Diego.

Education Evaluating CommitteeThe Education Evaluating Committeewas scheduled to meet in St. Louis onSeptember 8 to review all residentannual reports and inspection docu-ments. They also were expected to

review the revised AOA educationdocuments that were approved at theAOA BOT meeting

Membership SurveyEarlier this summer we sent the 2007Membership Survey to all members. Ifyou have not returned your survey tothe national office, please send it to usby September 28. This survey allows usto determine the needs of all ourmembers (students, residents, fellows,and retirees). The responses we receivewill help the staff and ExecutiveCommittee plan the future of this greatorganization. A summary of theresponses will be included in the nextnewsletter.

Midyear MeetingDr. Leslie Kramer, 3rd Vice President, isthe program chair for the 2008 MidyearMeeting in Monterey, Calif. to be heldat the Hyatt Regency Monterey. Wehave reserved a block of rooms for ourconference (March 12-15) and Iencourage everyone to make theirreservations early. Reservations can bemade either by hotel telephone (831-372-1234), reservations fax

Executive Director’s Reportby Becky Mansfield, Executive Director

We are dedicated to helping patients

attain a healthy and youthful appearance

and self-image.

© 2007 Medicis Pharmaceutical Corporation MED 07-003 01/30/08

The National Psoriasis Foundation Walkfor Awareness is scheduled to be heldSeptember 29 in San Diego, the daybefore the AOCD Annual Meetingbegins.

The event is a nationwide programdesigned to generate awareness aboutpsoriasis and psoriatic arthritis and raisemoney for the National Psoriasis Foun-dation’s education, advocacy, andresearch programs, according toJonathan Richey, a fourth-yearKirksville College of Osteopathic Medi-cine medical student at Henry FordWyandotte Hospital in Trenton, Mich.,who is a volunteer participant at thisyear’s walk.

Living with PsoriasisA student member of the AOCD whoplans to apply to dermatology residen-cies for 2009, Richey was diagnosedwith psoriasis when he was 19 yearsold. He learned more about the chronicdisease and treatment options throughthe National Psoriasis Foundation.When the foundation began organizingwalks across the country this year tocreate awareness about the disease,Richey decided to get involved. “I wasalready set to go to the AOCD andAOA conventions, so this gives me theopportunity to do the walk and attendthe annual meetings,” he says.

Having the disease has not onlyaffected certain aspects of Richey’ssocial life, but also has impacted hiscareer decisions. Even though he haspatches of clear skin, the appearance ofthe disease especially on his arms andlegs has limited his activities such asswimming. “I haven’t gone swimmingfor a very long time,” he says, adding,“In summer, I never wear shorts.” Hisdiagnosis also motivated him to go intomedicine, and specifically dermatology,rather than become a dentist like hisfather. “I have an understanding of howpeople with psoriasis, and skin condi-tions in general, feel and I also have anunderstanding of the difficulty intreating it because of my personalexperience,” says Richey.

At the San Diego walk, he will servetriple duty as a committee member,team captain, and walker. As acommittee member, Richey has beeninvolved in the planning process toensure for a successful event. Theplanning began in the spring of 2006. “Ihelped recruit and motivate walkersand organized a team to raise moneyand walk in the event,” he says. Richeyalso will lead the organizing committeefor the Detroit Walk for Awareness in

June 2008. “If you cannot participate inthe San Diego walk, I encourage you tovisit the foundation Web site and lookfor walks occurring in your own state,”he adds.

Raise Awareness of DOs“This is a great opportunity to spreadthe word about DO dermatologists. Ifwe attend and walk together, we caninform people who have psoriasisabout osteopathic medicine and physi-cians,” notes Richey. “In addition, thenew AOA President Peter B. Ajluniplans to promote fitness and healthylifestyles throughout the year as part ofhis theme ‘D.O.s: Fit for Life.’ This is agreat way for DOs attending thenational convention to fulfill andpromote Dr. Ajluni's challenge.”

AOCD members can get involved eitherby walking or supporting a team orparticipant. Participants seek donationsfrom friends, family, and associates. Allfundraising is conducted prior to thewalk, eliminating the need to collectpledges after the event. Each walker is

asked to raise $100 in tax-deductibledonations.

Walk DetailsThe registration fee is based on an indi-vidual’s age and participation level. Thefees range from $10 for a youth who iswalking and raising funds to $25 for anadult (18+) who is only walking.

Individuals interested in joiningRichey’s team or contributing to it can

do so by e-mailing him [email protected] or visitinghis walk Web site atwalk.psoriasis.org/goto/pffp. The "pffp"stands for the team name "Physicians,Families, and Friends for Psoriasis.” Healso can be reached at (559) 359-8237.

Registration begins at 7:30 a.m.; thewalk begins at 9:00 a.m. The walktakes place at Mission Bay Park inNorth Mission Bay. There are tworoutes: the 1K is .62 miles and the 5K is3.1 miles. A brief warm-up and cool-down for all walkers will be provided.

Each participant will receive a specialgift bag after completing the walk, aswell as a T-shirt. Additionally, partici-pants will have several opportunities toenter a drawing for prizes. Live musicwill be provided by the band Grin'sEdge.

* Source: The National Psoriasis Foundation Website (www.psoriasis.org/about).

Psoriasis Awareness Walk Set for San DiegoStudent member volunteers

Fast Facts: Psoriasis*

As many as 7.5 million Americanshave psoriasis, according to theNational Institutes of Health.

Between 10% and 30% of peoplewith psoriasis also develop psori-atic arthritis.

Of the 5 types of psoriasis,plaque is the most common.

As the AOCD celebrates its 50th anniver-sary, we thought members would like tolearn more about the American Osteo-pathic Board of Dermatology (AOBD), thegroup responsible for administering thecertification examination for osteopathicdermatologists.

You may know that in order to receivecertification in dermatology, you mustpass an examination given by theAOBD. But did you know that theBoard has an integral role in the devel-opment of maintenance of certificationfor osteopathic dermatologists? Did youknow that the AOBD preceded theAOCD by more than a decade? Did youknow that the longest serving Boardmember has served for more than threedecades?

In 1945, five osteopathic dermatologistspetitioned the AOA to form the AOBD.The five—Drs. Edwin Cressman, CecilUnderwood, Anthony Scardino Sr.,Edward Brostrom, and RonaldMacCorkell—served for 13 years as theBoard. During their tenure, only sevenDOs were certified, and one was thebrother-in-law of a Board member.

In 1957, the AOCD was establishedprimarily to revitalize the AOBD. In thespring of 1958, the then AOCD presi-dent, Dr. A.P. Ulbrich, formed a newBoard in response to a request by theAOA. But according to James D.Bernard, D.O., FAOCD, who served as

an ex-officio member of the Boardwhen he was Secretary-Treasurer of theCollege, Dr. Ulbrich was having a diffi-cult time getting certified, so he calledupon a friend in the hierarchy of theAOA to form the AOBD. After theBoard members realized that the newlyformed College could nominate andelect new members to serve on theBoard, they all resigned.

A New CredibilityThe new Board consisted of threedermatologists: Dr. Scardino, whoserved as President; Donald Gardner,D.O., who was named Vice President;and Dr. Ulbrich who became the Secre-tary-Treasurer. That fall, the new AOBDgave its first exam in Washington, D.C.to eight individuals, all of whompassed.

In the 1950s, the AOA was trying togain credibility with regard to itstraining, explains AOBD ChairmanCharles G. Hughes, D.O., FAOCD. “Infact, all of the specialties in the AOAwere attempting to do that,” he says.The purpose of Dr. Ulbrich reorgan-izing the Board was to have a morestandardized approach to credentialingand certifying osteopathic dermatolo-gists. After Dr. Ulbrich stepped down,the Board had a number of memberscome and go, but the officers for manyyears included the late Dr. HarryElmets, as well as Drs. Daniel Koprince,Tom Bonino, and David Brooks Walker.

Growing ResponsibilityThe AOBD, then and now, is chargedwith defining the qualifications of acertified osteopathic dermatologist, saysDr. Hughes, who has served on theBoard for 24 years. The AOBDfrequently reevaluates these qualifica-tions based on AOCD membershipsurveys it sends out asking respondentsabout their scope of practice andtraining programs. “The surveys helpthe Board determine what ourmembers believe is important in thepractice of dermatology, what they’redoing, and how often they’re doing it,”he adds. The next step is to determinewho meets those qualifications.

“Serving on the Board is an awesomeresponsibility because we are given thetask of assessing graduates of thetraining programs to see if they havemet the criteria to be appropriate prac-titioners of their trade,” says LloydCleaver, D.O., FAOCD, AOBD Secre-tary-Treasurer.

That responsibility has increased five-fold since Dr. Cleaver first beganserving on the Board 13 years ago. Inaddition to analyzing the survey data todetermine the level of information thatneeds to be used for the exam and thescope of practice that should becovered, the Board assesses the trainingprograms to determine what thingsthey are teaching and what things theyshould be teaching.

Is all of this reevaluating of the examand training programs necessary?Absolutely, the Board members say.“Reevaluating the certifying exam’scontent ensures that it remains a validand reliable tool,” says Dr. Hughes.

Then there are the Certificates ofAdded Qualification (CAQs) indermatopathology and Mohs Micro-graphic surgery that the Board hasdeveloped. The latest CAQ in pediatricdermatology is expected to be availablein 2008.

Even writing the test has become acomplex process. “When I started, wegot together and each of us wrote ourportion of the exam,” says Dr. Cleaver.Now, individuals who want to writetest questions have to undergo psycho-metric training courses, which the AOAroutinely offers. In fact, one suchcourse is being offered on Sunday,Sept. 30 at the AOA Conference in SanDiego. He encourages AOCD memberswho are interested in being involvedwith the Board to attend this course.“These item-writing sessions are educa-tional and informative,” says Dr.Cleaver. “We’re looking for people tobecome involved with the Board andthis is an excellent way to do that.”

AOBD: Certification and Beyond

AOBDChairmanCharles G. Hughes, D.O. Vice ChairmanGene E. Graff, D.O.Secretary-TreasurerLloyd J. Cleaver, D.O.

MembersEugene T. Conte, D.O.James Q. Del Rosso, D.O.Cindy F. Hoffman, D.O.Stephen M. Purcell, D.O.Michael J. Scott, D.O.Edward H. Yob, D.O.

Maintenance of CertificationThe Board’s latest charge isdeveloping maintenance of certi-fication standards that must beimplemented by 2011 asmandated by the AOA’s Depart-ment of Education and theFederation of State LicensingBoards. The process of mainte-nance of certification will requirephysicians to recertify after acertain number of years, ratherthan being certified for a lifetimeas many were in the past. “They nowwant to have a higher level of assur-ance that people practicing medicineare doing so appropriately,” notes Dr.Cleaver. Physicians with lifetime certifi-cation will be encouraged to participatein the maintenance of certificationprogram.

With the extra work that the mainte-nance of certification will require, theBoard is contemplating expanding itsmembership, which currently stands atnine, in the future.

Down to BusinessCurrently, Board members serve three-year terms, while an officer serves aone-year term. This year, the methodfor electing AOBD members waschanged because the Department ofEducation wanted to ensure thatspecialty colleges were not dictatingBoard policy. Nominations for AOBDmembership now come from the Boarditself, whereas they used to come fromAOCD members. After Collegemembership approval at the annualmeeting, the nominations are sent tothe AOA Board of Trustees, who thenelect the AOBD members. Every year,three members’ terms expire andcurrent members are either re-electedor new members elected. Officers areelected annually. To become amember, an individual must be AOAboard certified, a practicing dermatolo-gist, and in good standing with theAOA. Board members usually serve asan officer of the AOCD prior to joiningthe AOBD.

The Board meets at least twice a year,at the annual and midyear AOCD meet-ings. If the five-year AOA audit isapproaching, it usually meets a thirdtime. The Board is evaluated by theAOA to ensure that it is meeting theAOA’s guidelines for certification. Thisis serious business, Dr. Cleaver says.Specialty boards that do not pass theAOA’s Standards Review Committeeaudit can be disbanded, which didhappen in another specialty.

Even though the AOBD and the AOCDmay have distinct purposes, they areboth affiliates of the AOA and consid-ered sister organizations that work welltogether. For example, three Boardmembers also serve on the College’sEducation Evaluating Committee andExecutive Committee. Some Boardmembers are residency program direc-tors, as well. The AOBD is an affiliateof the Bureau of Osteopathic Special-ists, which reports directly to the AOA.Dr. Cleaver serves as the AOBD repre-sentative to the Bureau.

You Should KnowWhat should AOCD members knowabout the AOBD?

For new members who have not yettaken the exam, Dr. Hughes says,“We’re on your side. Often times, weare seen as a gatekeeper, but we try tomake the process as fair as possible.For longer standing members, we needyour ongoing help, especially whenfilling out the surveys so we cancontinue to be sure our exams and

certification process are a true repre-sentation of what they should be.”

Dr. Cleaver concurs. “It used to be theBoard was something you worriedabout when you finished your resi-dency. But times are changing. We aretrying to deal with regulations that areimpacting us and at the same time,trying to protect AOCD members’ prac-tice rights and licensure. Our concern isthe practicing dermatologist, ourcolleague.”

Serving on the Board has been a laborof love, adds Dr. Cleaver. “We havesome very dedicated people whospend an unbelievable amount of timeon it. In addition, we rely heavily onconsultants, including Terry TenBrink,Ph.D., a psychometrician who hasprovided invaluable assistance over theyears,” he notes. “I would like to thankour predecessors for all of their hardwork to make this such a quality organ-ization.”

“It’s been an honor to serve on theBoard for twenty-something years,”adds Dr. Hughes. “It has allowed me tointeract with some of the best mindsand certainly the most dedicated indi-viduals in the College.”

How Well Do You Know the AOBD?

1. Who was the first osteopathic dermatologist certified by the AOBD?

2. Who has served as the AOBD Chair?

3. Who served the longest term on the AOBD, to date?

4. True or False: The AOBD grants certification for graduates.

5. To date, how many physicians have been certified by the AOBD?

(See bottom of page for answers.)

Answers: 1. Dr. Edwin Cressman. 2. Drs. Harry Elmets, Daniel Koprince, David Brooks Walker, and Charles Hughes.3. Dr.Thomas Bonino, Sr.who served as Secretary/Treasurer and the heart and soul of the Board for more than 30 years.4. False. The AOBD does not grant certification, but rather makes recommendations to the AOA Board of Trustees, whichis the body that actually grants certification. 5. Approximately 342 physicians.

Dermatologists have beencompounding since the specialtybegan, but the practice fell out of favorin recent years with the influx of pre-packaged pharmaceutical skin careproducts and cost containment effortsby insurance companies.

Still, compounding has many benefits.The primary benefit of compounding isthe ability to gear the diagnosis tomatch the vehicle. The vehicle is veryimportant with regard to penetration ofthe skin and aiding in the inflammationprocess. Additionally, compoundingprovides a larger quantity of topicalmedication at less expense over thelong haul.

The three main issues surroundingcompounding are as follows:

• the ability to assimilate or thinkthrough the disease;

• the bases that are used forcompounding; and

• the corticosteroids that are addedfor the treatment, the disease, andthe disease processes.

Understanding the spectrum of inflam-mation is essential when discussing theuse of compounding. That spectrumranges from an acute process to achronic one. In the acute process ofinflammation, wet dressings are recom-mended, followed by powders andlotions, aerosols, and sprays, and thencreams, oils, and gels. For chronicinflammation, ointments, water in oilemulsions, and then inert bases arerecommended in thatorder.

Acute InflammationOpen wet dressings workwell for acute inflammationas they cool the skinthrough evaporation. Theyaid in vasoconstriction bydecreasing the vasodilata-tion and augmentingblood flow seen withinflammatoryprocesses. They alsocleanse the skin.

Open wet dressings are ideal fortreating inflammatory conditions,erosions, and ulcers. Water is by far themost important ingredient in wet dress-ings. Usually one tablespoon of salt to16 ounces of water works well.Another option is acomponent of what isknown as a Dome-boro solution,which containsone part vinegarto four partswater.

Powders promotedrying by increasing skinsurface area. They arecommonly used for intertriginous areasto reduce moisture, friction, andrubbing.

Liquid lotions are essentially suspen-sions of powder in water. Tincturesalso fall into this category. Often, tinc-tures are alcoholic or hydroalcoholicsolutions. As the lotion and tincturesdry and evaporate, they leave auniform film of powder on the skinthat aids in the drying process. Aerosolsand sprays act in the same manner.

Chronic InflammationCreams are the compound of choicewhen moving lower on the spectrumtoward chronic inflammation. Creamsare basically emulsions of watercommonly called oil in water solutions.As the oil increases and the water

decreases, the mixturebecomes closer to aclassification of anointment.

Gels are transparent, semi-solid emul-sions that liquefy on contact with theskin, drying as a very thin, greaseless,non-staining film. Alcohols, such aspropylene glycols and acetones, are

usually found in these gels.

The greasiestcompounds are oint-

ments typicallyused for chronicinflammationprocesses. Theseconsist of a phase

of oil and smallquantities of water

commonly called water inoil solutions. The three major

types of ointments are soluble in water,emulsify in water, and insoluble inwater. Although pastes also are foundas a mixture of powder in ointments,they are not a mainstay of treatment.

How MuchIt is essential to have a working idea ofhow much of the topical medication isgoing to be used. The following chartprovides an estimate of the amountneeded:

Entire body (depending on individual’ssize): 30-60 gramsOne arm: 3 gramsHands: 2 gramsAnogenital: 2 gramsOne leg: 4 grams

CommonCompoundsMenthol, phenol,and camphor are

commonly usedcompounds. For anitchy eruption,

ABCs of Compoundingby Ronald C. Miller, D.O., FAOCD

“The final essential

ingredient for use in

compounding is good

communication

skills”

anywhere from 1% to 2% is appro-priate.

Regarding corticosteroids, hydrocorti-sone powder 1% to 2% andtriamcinolone powder 0.1% to 0.2% isrecommended. Liquor Carbonis Deter-gens also can be added. This is used asa purified tar for psoriatics. Anotheroption is precipitated sulfur, which is anextremely good compound added tomild corticosteroids for perioraldermatitis in anywhere from 1% to 4%solutions.

Lactic acid can be used in areas overthe feet and hands for cracking andfissuring, and for dryness of the skin.Although lactic acid works well, it canbe extremely sensitive when applied toareas with cracks and fissures.

The beta-hydroxy acid commonlycalled aspirin—salicylic acid—workswell for facial areas and provides goodpenetration of the keratin within theskin. In lotion form, strengths of 1% to2% triamcinolone powder are recom-

mended. In creamform, an addition suchas Diprolene creamworks well. A classicexample is 60 grams ofDiprolene cream added to Cetaphilcream, with a potential 1% mentholadded. If 240 grams of Diprolenecream is being used, then 2.4grams of menthol is appro-priate. Moisturel lotion also canbe added.

White petrolatum andSkin Barrier Repaircreams are used inmany compoundsfor psoriasis.

The final essential ingredient for use incompounding is good communicationskills when working with the pharma-cist. Having a pharmacy in theimmediate area that can handle all ofthe practice’s compounding needs alsois helpful.

The AOA has approved the first fellow-ship in Mohs Micrographic surgery(MMS) within the osteopathic profes-sion.

The fellowship is a full-time, paid posi-tion based at the offices ofDermatology Associates of Tulsa, whichis the practice of Edward H. Yob, D.O.The Fellowship is under the auspices ofthe Kirksville College of OsteopathicMedicine Osteopathic PostdoctoralTraining Institute and NortheastRegional Medical Center in Kirksville,Mo.

Program HighlightsThe subspecialty program emphasizestraining in MMS for the treatment ofspecific cutaneous malignantneoplasms where the procedure hasbeen documented to be of significantbenefit, according to Dr. Yob, who willserve as the program director.

The training program includes compre-hensive teaching in the principles ofthe following:

• cutaneous oncology,• cutaneous surgical anatomy,• appropriate diagnostic modalities,• proper patient selection,• preoperative evaluation,• proper procedural documentation,• surgical technique,• instrumentation for dermatologic

surgery,• field block and local anesthesia,• hemostasis,• surgical microbiology,• pertinent surgical

dermatopathology,• Mohs laboratory principles and

procedures,• surgical and laboratory biohazard

safety principles and procedures,and

• surgical wound managementutilizing recognized techniquessuch as secondary intentionhealing, primary closures, adjacenttissue transfer procedures (skinflaps), and skin grafting proce-dures.

Completion of theprogram also is expectedto enhance the knowl-edge, expertise, andexperience of the traineein standard dermatologicsurgery through compre-hensive training inexcisional surgery andrepair, electrosurgery,cryosurgery, cutaneouslaser surgery, dermabra-sion, scar revisiontechniques, and thera-peutic chemical peeling.

The training period is 12continuous months fordidactic and clinicaltraining, which involveslearning through observa-tion and direct patientexperience under thesupervision of competentphysician teachers, formaldidactic sessions, and anorganized readingprogram. The positionwill include a stipend,medical benefits, andmedical malpracticecoverage.

“The ultimate goal of theprogram is to allow thetrainee to evolve into aknowledgeable andskillful Mohs Micro-graphic/dermatologicsurgeon who has a sound under-standing of cutaneous oncology and athorough knowledge of the indicationsand methods of treatment of cutaneousmalignancy, as well as expertise insurgical technique and laboratoryprocedures,” says Dr. Yob.

After completion of the program, thetrainee will be expected to be preparedand eligible to complete subspecialtyboard certification examination in MMSgiven by the AOBD.

Dermatology Associates of Tulsa islocated in a suite on the campus ofSouthCrest Hospital. The practice has

an on-site, highly complex MMS labora-tory that is registered with CLIA, staffedby two full-time Mohs technicians. Italso has an extensive on-site library.Additionally, the fellow will collaboratewith other specialties includingdermatopathology, radiology, recon-structive surgery, general surgery,radiation oncology, and medicaloncology in the surrounding area.

Dr. Yob is certified in dermatology bythe AOA through the AOBD, and holdsa current Certificate of Added Qualifica-tion in MMS through the AOBD. He is amember in good standing of the AOAand AOCD and has served in various

New Mohs Micrographic Surgery Fellowship Approved

Page 10

positions including president of theAmerican Society for Moh’s Surgery. Dr.Yob has been in practice in derma-tology and dermatologic surgery for18-plus years and has completed morethan 7,000 cases of MMS. He also is anassociate professor at the University ofOklahoma–Tulsa.

Admission Requirements• The trainee must be a graduate of

an osteopathic medical schoolaccredited by the AOA.

• The trainee must have completedan internship approved by theAOA.

• The trainee must have satisfactorilycompleted a three-year derma-tology training program approvedby the AOA and the AOCD.

• The trainee must be board eligibleor board certified in dermatologyby the AOA and AOBD.

• The trainee must be a member ingood standing of the AOA andAOCD.

• The trainee must obtain medicallicensure in the state of Oklahomaprior to starting the training.

• The trainee must meet the programrequirements that are mandated oradopted by the program directorand training institution.

• Prior to admission into this subspe-cialty program, the trainee mustpresent a letter of recommendationfrom the Director of MedicalEducation at the hospital wherehe/she completed his/her AOAapproved internship.

• The trainee must present a letter ofrecommendation from the programdirector of the dermatology trainingprogram he/she completed.

For more information or to apply forthe fellowship, contact Cindy Wilson,the administrator at Dermatology Asso-ciates of Tulsa, at (918) 307-0215 [email protected].

If you’re among the physicians who didnot meet the May 23, 2007 deadline forcompliance with the National ProviderIdentifier (NPI) regulations, you’regetting a temporary reprieve providedthat you show you are attempting tocomply “in good faith.”

The Centers for Medicare & MedicaidServices (CMS) has implemented acontingency plan for covered entities(other than small health plans) that didnot meet the May 23 deadline for theNPI regulations under the Health Insur-ance Portability and Accountability Act(HIPAA) of 1996.

Providers will be allowed to use otherlegacy provider numbers (e.g.,Medicaid provider IDs, individual planprovider IDs, UPINs) on HIPAA transac-tions in order to maintain operationsand cash flow up until May 23, 2008.But only those providers who showthey have been making a good faitheffort to comply with the NPI provi-sions. In determining whether a goodfaith effort has been made, CMS willplace a strong emphasis on sustainedactions and demonstrable progress.Indications of good faith for a physi-cian might include having obtained an

NPI and having the ability to use it onHIPAA transactions. Meanwhile, CMSwill not impose penalties on coveredentities that deploy contingency plansin order to ensure the smooth flow ofpayments.

After it became apparent that manycovered entities would not be able tofully comply with the NPI standard byMay 23, CMS offered leniency on itsenforcement approach to protect fromfinancial penalties those who continueto act in good faith to come intocompliance, recognizing that transac-tions often require the participation oftwo covered entities and that non-compliance by one may put the secondcovered entity in a difficult position.

However, the enforcement process iscomplaint driven and if a complaint isfiled against a covered entity, CMS willevaluate the entity's good faith efforts.Each covered entity will determine thespecifics of its own contingency plan.Contingency plans may not extendbeyond May 23, 2008, and entities mayelect to end their contingency planssooner.

Meanwhile, Medicare will continue toaccept claims using legacy numbers ontransactions, accept transactions withonly NPIs, and accept transactions withboth legacy numbers and NPIs.However, as soon as Medicareconsiders the number of claimssubmitted with an NPI for primaryproviders sufficient, the agency willbegin rejecting claims without the 10-digit number. Physicians will have atleast one month of notice prior to theNPI-only requirement taking effect.

The NPI was established as the stan-dard unique health provider identifierto be used on health care claims andother HIPAA transactions.

For more information about the NPI,visit the CMS Web site atwww.cms.hhs.gov. The site alsocontains a document titled “Guidanceon Compliance with the HIPAANational Provider Identifier Rule.”

CMS Identifies Contingency Plan for NPI

Were you one of the first dermatolo-gists to participate in the PhysicianQuality Reporting Initiative (PRQI)when the Centers for Medicare &Medicaid Services (CMS) rolled it outthis past July?

Although the initiative is voluntary,providers who do participate areeligible for a bonus payment, subject toa cap, of 1.5% of total charges allowedby Medicare’s Physician Fee Schedule.

The program, developed by CMS toprovide a financial incentive bonus tophysicians for reporting best practicequality measures, officially begancapturing reported data on July 1.Dermatologists may report on qualitymeasures for services providedbetween July 1 and Dec. 31, 2007 toreceive the bonus payment in 2008

Of the 140 quality measures spreadacross 34 clinical areas approved foruse in 2007, three relate to melanoma.Dermatologists who report each of thethree melanoma measures in at least80% of the cases in which the measureis reportable are eligible to receive theincentive bonus.

The melanoma measures apply tocurrent melanoma patients and patientswith a history of melanoma. The CPT

category II codes refer to asking aboutnew or changing moles (Code 1050F);performing a complete skin examina-tion (Code 2029F); and counseling thepatient to perform a self-examinationfor new or changing moles (Code5005F). Exception codes were devel-oped to address situations in which itmay be inappropriate to complete themeasures. For example, if the patient isblind, the dermatologist would notadvise the patient to check for new orchanging moles.

CMS will capture the data for reportingphysicians by using their NationalProvider Identifier number. Claims mustbe submitted no later than two months(by Feb. 28, 2008) after the end of thereporting period. The lump sum checkfor the reporting period will be issuedin mid-2008.

For more information, such as how tocalculate the bonus cap, visit the CMSWeb site at www.cms.hhs.gov/PQRI/.An online tool kit designed to assisteligible professionals in successfullyintegrating the initiative’s measures intotheir practice can be downloaded. TheAmerican Academy of Dermatologyalso offers information about the PQRIspecifically with regard to dermatologyon its Web site at www.aad.org.

Dermatologists Report Quality Measuresfor CMS Initiative

The AOCD urges those members whohave not yet returned their 2007Membership Survey to do so as soon aspossible.

The survey, which was sent to allmembers in July, is a vehicle for theAOCD to determine the needs of all itsmembers, including students, residents,fellows, and retirees, says Becky Mans-field, Executive Director. “Theresponses we receive help our staff andExecutive Committee plan the future ofthis great organization,” she says. As anexample, including the resident annual

reports and the newsletter on the Website were done in response to feedbackreceived on the previous survey.

The surveys must be returned to thenational office by September 28 inorder to be reviewed by the ExecutiveCommittee meeting at the AnnualConference in San Diego. A summaryof the responses will be included in thenext newsletter.

Membership surveys are slated to besent out every other year.

Membership Surveys Due

Hi Everyone,

It’s a busy time here in the AOCDoffice.

There has been a steady stream ofannual reports coming in, details on theannual meeting are being finalized, andthe In-Training Examination Committeeis hard at work putting together thefinal exam questions, to which all theresidents and program directorscontributed. The In-Training Exam isscheduled for Sunday, September 30,starting at 7 a.m. Your 2007 AOCD duesmust be paid before you can take thisexam.

We also are working on the MidyearMeeting for March 2008 to be held atthe Hyatt Regency Hotel in Monterey,Calif. Intent-to-Lecture forms will beavailable in mid October. Residentlectures will be held from 1 p.m. to 5p.m. on Wednesday, March 12.

Recently, surveys were mailed out toevery AOCD member. Please take afew minutes to complete and returnthis survey to our office. We willcompile the results including allcomments for a report to the AOCDBoard of Trustees.

Since our last newsletter, we’ve had anaddition to our 2007-2010 Class of Resi-dents. Ali Banki, D.O., has joined Dr.Cindy Hoffman’s program. We nowhave a total of 90 residents for the2007-2008 training year.

Please be sure to let us know if yourhome or office address has changed sowe can keep you current on informa-tion sent from the AOCD office.

Residents who celebrated July birthdaysare Drs. Lyogov Avshalumova, JamesBriley, Jr., Christopher Buckley, AndreaCostanza (graduating), Mary Evers(graduating), Denise Guevara, Wade

Keller, David Roy, Matthew Smetanick,and Kevin Spohr (graduating).

Those who celebrated August birthdaysare Drs. Tracy Favreau (graduating),Johny Gurgen, Michael Holsinger (grad-uating), Karthik Krishnamurthy, KeoniNguyen, Ramona Nixon, Adriana Ros,Dawn Sammons, and Adam Wray(graduating).

Residents celebrating September birth-days are Drs. Brett Bender, MelissaCamouse (graduating), Tejas Desai(graduating), Marcus Goodman, JackGriffith, Ty Hanson (graduating),Patrick Keehan, Lela Lankerani, JohnMinni, Shaheen Oshtory, EvangelinePerez (graduating), Raymond Ramirez(graduating), Roger Sica, and BrianWalther.

Residents Updateby Marsha Wise, Resident Coordinator

Third-year resident Tejas Desai, D.O.,at the Western University/PacificHospital in Long Beach, Calif., hasaccepted a proceduraldermatology/Mohs MicrographicSurgery Fellowship in Loma Linda,Calif.

The one-year fellowship began thispast July under the direction of AbelTorres, M.D., J.D.

“I chose to do the fellowship at LomaLinda University Medical Centerbecause I wanted to obtain an in-depthperspective on dermatologic surgeryincluding Mohs Micrographic surgeryand cosmetic dermatology,” says Dr.Desai, who was a resident in theprogram run by David Horowitz, D.O.“More education and training are price-less.”

“Plus, I have the golden opportunity tohave Dr. Abel Torres as my program

director. He is well knownand respected in thedermatology commu-nity, having servedas Associate Clin-ical Professor ofDermatology atHarvard Univer-sity. In addition,his law back-ground andknowledge alsohave allowed me tolearn medical law andits relation to dermatologypractice.”

As part of the fellowship, Dr. Desai isserving as an attending physician,requiring him to teach dermatologyresidents at Loma Linda. “After they seepatients, they sign out to me, and Ioffer assistance as needed,” he says.

“I really enjoy teaching the LomaLinda dermatology residents

because I learn derma-tology concepts fromthem, as well,” saysDr. Desai. “Theseresidents go the extramile by researchingarticles andpresenting them tome for certain cases.”

“Finally, I thank Dr.David Horowitz who has

instilled in me a vast knowl-edge of dermatology. If it were not

for him, my fellow and attending statusat Loma Linda would not be possible.”

Resident Awarded Fellowship

Reagan Anderson, D.O., M.C.S..,M.P.H., first-year Resident at OakwoodSouthshore Medical Center in Trenton,Mich., recently received a Navy MarineCorps Commendation Medal from theDepartment of the Navy.

The medal was for meritorious servicewhile serving as the First Reconnais-sance Battalion Surgeon from June 2004to September 2006 in the Al Anbarprovince of Iraq.

“Getting this award is humbling,” saysDr. Anderson. “But at the same time, itis difficult because it is mixed in withpatients and experiences that I stilldream about nightly. When I look backat all the situations in which I wasinvolved and the hard decisions that Ihad to make, I look back and say I didthe best I could, but I wish I couldhave done more.”

Within 48 hours of arriving at CampFallujah, the lieutenant was doing morethan he expected as he was partici-pating in combat operations. Amongthem was the first combat airborneinsertion since Vietnam. “I was trainedto deal with medical situations overthere and how to handle physicalabuse, but not kicking down doors,clearing fields or houses, and holdinginsurgents at gun point,” he says. “Ilearned the other things quickly.”

“Luckily, I never fired my weapon intwo tours and for that I am exceedingly

grateful,” says Dr. Anderson. “Therewere many situations in which it wasclose. At least I don’t have those night-mares.”

During mass casualties, Dr. Andersonwas on call 24/7 for months on end.When he was not involved in directpatient care, he was facilitating blooddrives, managing medicalassets, and triaging combatwounded trauma patients.The latter allowed thesurgical specialists toquickly prepare and acceptpatients to the surgicalsuites for life or limb savingoperations. Dr. Andersonalso developed a mass casu-alty plan.

As part of the medical carehe provided, Dr. Andersonconducted daily “psych”rounds to keep the marinesand sailors mentally andspiritually healthy. As aresult, the battalion did notencounter one singlepsychological casualtyduring either deployment.He credits the psych roundswith keeping his battalionalive.

“Very few people in Iraq getinjured or die because theinsurgents are so skillful,”says Dr. Anderson. “The

reason they die is because compla-cency sets in. Something horriblehappens at home and people don’thave their head in the game. They’renot paying attention so they walk intoa trap, something they normally wouldhave spotted a mile away.” Because ofthe close bond he forged with the men

Dr. Anderson Receives Navy Medal for Iraq Duty

Dr. Anderson is loaded down minutes beforegoing on a combat mission.

Ryan Carlson, D.O., Chief Resident atOakwood Southshore Medical Center inWarner, Mich., received an honorablemention for a paper submitted to theMichigan Dermatologic Society.

He was presented with the MichiganDermatologic Society Scientific Investi-gation Committee Resident ResearchPaper Award for the case report enti-tled “Brooke-Spiegler Syndrome withAssociated Peg-Shaped Teeth” at the

annual meeting of the state dermato-logic society this past June.

“I was excited that my paper wasrecognized,” he says. “I spent a lot oftime working on it and to receiveacknowledgement of that was anhonor.”

Dr. Carlson just learned that the samepaper was accepted for publication inan upcoming issue of Cutis.

Resident Receives Honorable Mention for Paper

in the battalion, Dr. Anderson was ableto recognize when they were unfo-cused and was able to get them thecare they needed.

During his deployments, Dr. Andersoncoordinated several medical missions.Based on the purpose of the mission,he would either stay at the battalion aidstation, which was basically a clinic,that Dr. Anderson set up in what iscalled a moving operating base; go onpatrol with the battalion to providemedical coverage; or provide medicalcare to Iraqis. Oftentimes, the marineswould rent a house in which to set upthe clinic. “Usually the locals loved itbecause we paid them approximatelyone year’s salary to use their house forone or two weeks,” he says. “We left itcleaner than it was when they livedthere.” The clinic was basically a roomwith a stretcher where he would treatcasualties. “Having a walled structurewas good and bad because it wasstationary and that gave anyone whowanted to shoot at us a target. Beingthere one or two weeks gave them alot of time to plan an attack,” saysAnderson, adding, “We received rocketmortar and small arms fire every day.Luckily, they’re not great shots.”

On some missions, Dr. Anderson wenton night foot patrols to local medicalclinics and villages where he treatedmore than 100 Iraqis. On more thanone occasion, Dr. Anderson left behindmuch needed medical supplies andconducted classes on how to use them.These night patrols were conducted

under the constant threat of small armsfire.

During his second tour, Dr. Andersoncoordinated and/or participated inmore than 400 hours of medicalcoverage. Additionally, he managed sixcombat lifesaver courses whileproviding medical training for an elitebattalion of marines in preparation forcombat. Challenged with two combatdeployments, he worked 18-hour daysfor several months taking the battalionfar beyond its expected medical capa-bilities. Despite multiple engagements

and numerous wounds to his marines,he returned the battalion with no lossof life or limb. During this time, hecommanded and led 19 hospitalcorpsmen through more than 170 daysof combat preparation and combatoperations, shouldering responsibilitiescommensurate with those of a seniormedical officer in charge of a regiment.

The Navy said of his performance, “Lt.Anderson has demonstrated himself tobe a superior medical officer,unmatched by his peers, and admiredby his supervisors….Simply put, he isnot only an officer who provides morethan his rank would suggest, but he isalso a doctor who is unmatched amonghis peers in education, drive, accom-plishments, and clinicalacumen….Facing seemingly insur-mountable odds, technical and tacticalchallenges, uninterrupted combatdeployments, the inherent fog of war,and the stress of combat operations, hisservice, performance, and accomplish-ments have been nothing short ofmagnificent….He has served withdistinction and with honor. His devo-tion to mission accomplishment andsuperb medical care has been selflessand absolute.”

Dr. Anderson writes a dermatologic paper, which was published in Consultantmagazine in April 2007, while his battalion is under a mortar and rocket attack.

RESI

DEN

TSSPOTLIGHT

You could say that the residents atWellington Regional MedicalCenter/LECOM have 37 mentors, notjust Program Director Brad Glick, D.O.

That’s because the LECOM residencyprogram also has a Co-director, RichardRubenstein, M.D., and the residentshave access to the 35 dermatologiststhat belong to the same practice groupthat Dr. Glick does.

Expert Rotations“Our residents get exceptional out rota-tions on a week-to-week basis withinternationally recognized dermatolo-gists who are experts in their fields,”says Dr. Glick, who has been Directorsince the program was established in2002. “For example, Dr. Daniel Rivlin,M.D., is a multi-tasking, multi-talenteddoctor who performs Mohs Micro-graphic surgery and endovenous lasersurgery in addition to cosmetic derma-tology. When our residents spend a fullday with him, they get a lot of out ofthat day.”

Others who contribute to the residents’training include Carlos Nousari, M.D.,who specializes in immunobullousdiseases; Harold Rabinovitz, M.D., whoperforms cutaneous oncology,dermoscopy, and Mohs surgery; MartaRendon, M.D., who conducts researchon pigmentation disorders in additionto performing cosmetic dermatology;Francisco Flores, M.D., who is expert indermatologic surgery, including Mohs;Harold Bafitis, D.O., who is a skilledplastic surgeon; and Stella Calobrisi,M.D., who specializes in pediatricdermatology.

“Dr. Rubenstein and I lay the founda-tion on a one-on-one basis for theresidents’ dermatology training, butthen all of these amazing clinicianswho we happen to have here in southFlorida build on that foundation,” notesDr. Glick. “This array of clinicians andthe caliber of the clinicians we have setus apart from others and makes forsuch a great balance of rotation,covering all the bases for the residents.”

They even receive excellent training inhospital dermatology, which is harderand harder to come by these days,thanks to Francisco A Kerdel, M.D.,who is Chief of Derma-tology at CedarsHospital in Miami.“They get agood view ofthese patientsand many ofthe resi-dentsfollow-upin his officewhere theyget to tendto thesepatients, aswell,” Dr. Glickexplains.

Other ActivitiesIn addition to their hands-on patientcare, the seven Wellington LECOM resi-dents participate in weeklydermatopathology clinics at twodifferent labs—Ameripath and GlobalPathology.

On a monthly basis, they conduct ajournal club. Usually the residentslecture on dermatologic topics as aboard review and sometimes a guestlecturer is brought in.

Wellington Regional residents meet fora quarterly journal club with the NovaSoutheastern University, College ofOsteopathic Medicine/Broward GeneralMedical Center under the directorshipof Stanley E. Skopit, D.O., FAOCD. “Ireally enjoy the comradery betweenour two programs,” says Dr. Glick.“These residents really help each otherout and they even study for boardstogether.”

Then there are the Broward CountyDermatologic Society meetings that theresidents regularly attend. Recently,two LECOM residents were asked topresent grand round cases at ameeting.

Publish“We encourage our residents to go wellbeyond the norm of publishing,” saysDr. Glick. Many have received acco-

lades as a result. Third-year Resident Jon

Keeling, D.O., wasawarded the Alan

Scott, M.D Resi-dency Award bythe AmericanSociety ofCosmeticDermatologyand AestheticSurgery(ASCDAS) last

year. His paper,which he

presented at theannual ASCDAS

meeting, received firstplace among the research

papers submitted by MD and DOdermatology residents. The winningpaper was entitled "The Use of TopicalTherapies in Combination with Proce-dures for Treatment ofHyperpigmentation Disorders." In addi-tion, he won the Ferndale Laboratories’Caribbean Dermatology ResidentResearch Award from the CaribbeanDermatology Society in recognition ofhis paper entitled “Mequinol2%/Tretinoin 0.05% Solution for theTreatment of Melasma in MalePatients.” As part of the award, hepresented his paper at the CaribbeanDermatology Symposium held onGrand Cayman Island in January.

Although unrelated to a paper, Dr.Keeling was the recipient of an Amer-ican Society of Dermatologic SurgeryPreceptorship Award. As such, he spentone week in June with Leon Kircik,M.D., in Louisville, Ky., where hefocused on Mohs Micrographic surgery,as well as cosmetic procedures, such asBotox® injections, fillers, and laser treat-ments.

Second-year Resident Marianne Carroll,D.O., not only published a paper onthe utilization of Aldara® for the

Wellington Regional Medical Center Boasts Expert Rotations,One-on-One Training

“Our residents get

exceptional out

rotations on a week-to-

week basis with

internationally recog-

nized dermatologists

who are experts in

their fields,”

management of superficial skincancers, but she is beginning to berecognized as an expert on the topic.She and her mentor, Don Tillman,D.O., FAOCD, have spoken about it atseveral meetings and Dr. Carroll willeven be going to the World Congress inArgentina in October to present on thetopic.

Lynora Bassett, D.O., a third-year Resi-dent won the Daniel Koprince Awardfor her paper on tungiasis andpresented it at the AOCD meeting in2005.

Third-year Resident John Perrotto,D.O., co-authored a feature article enti-tled “Ulcers Masquerading asCutaneous Malignancies,” which waspublished in the October 2006 issue ofOstomy Wound Management, a peer-reviewed journal.

First-year Resident Keoni Nguyen,D.O., at Ohio University COM, O’Ble-ness Memorial Hospital in Athens, Oh.,was selected to present an originalstudy for the “What’s Hot: The PostersSymposium” at the summer AADmeeting this past August.

Dr. Nguyen presented his posterabstract entitled “Native AmericanDermatology: Does Percent TribalHeritage Influence Cutaneous Disor-ders?” as part of a new symposiumfeaturing the top 11 poster submissionsselected for presentation.

“As a first-year dermatology resident, itwas a great honor and pleasure to havebeen invited to speak on the topic ofmy original study about Native Amer-ican dermatology,” says Dr. Nguyen,who was the only resident selected topresent along with other prominentspeakers such as psoriasis expertKenneth F. Gordon, M.D., FAAD;immunodermatology expert Joseph L.Jorizzo, M.D., FAAD; and acne rosaceaexpert James Del Rosso, D.O., FAOCD.

Dr. Nguyen began collecting data forthis study when he was a third-yearmedical student rotating with EugeneConte, D.O., FAOCD. They decided itwas time to update the literature giventhat the first observational study of thiskind was done in 1958. Dr. Nguyencompleted this study during his intern-ship at Michigan State University, COM.

This observational study was conductedat the Phoenix Indian Medical Center inArizona. The study reviewed datacollected from 585 Native Americans ofNorth America seen at a first office visitfor a primary cutaneous disorderbetween June 2004 and December2006. “The analyses showed correla-tions between prevalence of certaindermatologic disorders and NativeAmerican percent tribal heritage(NAPTH), as well as refuted previousreports about the occurrence of psori-asis and polymorphous light eruptionwithin the Native American popula-tion,” says Dr. Nguyen. All subjectsincluded in the study had their derma-tologic diagnosis established throughexamination by Dr. Conte who is aconsultant to the center. The NAPTH of

each patient was verified through themedical record.

Statistical analyses showed the top sixdermatologic disorders in the 50% orless and the 100% tribal heritage groupsare dependent of each other. “Dr.Conte and I believe improved knowl-edge of cutaneous disorder prevalenceand the correlations with NAPTH willserve to improve the diagnosis of theseconditions,” he says, adding, “Thisstudy provided important insight intothe prevalence of dermatologic condi-tions among Native Americans andhopefully will stimulate further researchinterest in this area.” They plan to usethese data to create an educationalparadigm for dermatologists andprimary care physicians who serveNative Americans on a routine basis.

Not only was Dr. Nguyen honored bybeing asked to speak at the meeting,he found the didactics and symposiumsto be incredible, and he was inter-viewed by a reporter from DermatologyTimes for the October issue.

Resident Invited to Speak at AAD Conference

“Publishing, presenting, and conductingclinical research are crucial for thethree-year education of dermatology,”says Dr. Glick. “I feel comfortable in

saying that the residents are definitelygetting that experience here.”

The Journal of the American Osteo-pathic College of Dermatology (JAOCD)is now accepting manuscripts forpublication. Information for Authorsis available on the Web site atwww.aocd.org. Any questions maybe addressed to the Editor [email protected]. Member and residentmember contributions are welcome.

"The key to having a successfuljournal to represent the AOCD is inthe hands of each and every memberand resident member of the College,"notes Editor Jay Gottlieb, D.O. "Let’smake it great!"

JAOCD: A Call for Papers

VO

LUN

TEER

SPOTLIGHT

It wasn’t enough for the dermatologyresidents at Western University/PacificHospital in Los Angeles to crack openthe books when they had to learnabout tropical medicine. Instead, theyheaded to Ecuador.

Program Director, David Horowitz,D.O., co-Chief Residents Will Kirby,D.O., and Tejas Desai, D.O., plus first-year Resident Tony Nakhla, D.O.,joined the Nova Southeastern Univer-sity chapter of DOCARE Internationalon a nine-day medical mission. A totalof 11 physicians from various special-ties, physician assistants, medicalstudents, and volunteers comprised theteam.

Starting out in the city of Quito,venturing to the cloud forests on Tenaand eventually ending up in the rain-forest of the Amazon, the team treatedmore than 2,500 patients during thecourse of the April trip.

Among the unusual dermatologic disor-ders encountered were leshmaniasis,orf, myiasis, atypical mycobacteriuminfections, neurofibromatosis insiblings, urticaria pigmentosa, acroder-matitis enteopathica, perforatingneurotrophic ulcers, and a Marjolin’sulcer arising from a burn scar, as well

as numerous bacterial, fungal, andparasitic diseases.

“What impressed me the most, otherthan the variety of diseases we encoun-tered, was how appreciative thepatients were,” says Dr. Kirby. “Medicalcare in this part of South America issimply unaffordable and unavailable tothose who need it most.”

Dr. Desai concurs. “Dermatologists canmake a significant difference in thesepeoples’ lives by diagnosing a full

gamut of conditions that would other-wise go unnoticed,” he says. Whilethere, Dr. Desai enjoyed teachingdermatology to eager medical andphysician assistant students. Not onlywould he commit to another missiontrip next year, but Dr. Desai urges otherdermatology residents to join DOCAREor other missionary groups as part oftheir residency training.

Dr. Nakhla performed an excision of alarge congenital nevus located on thesubmental region of a 32-year-old

Residents Join Medical Mission to the Amazon

DOCARE International

Founded by an osteopathic physician in 1961, DOCARE International is anon-profit, tax-exempt organization whose primary objective is to bringneeded health care to primitive and isolated people in remote areas ofWestern Hemisphere countries. Its all-volunteer membership includes DOand MD physicians, nurses, dentists, veterinarians, pharmacists,optometrists, podiatrists, physician assistants, and interested laypersonswho contribute special skills.

Typically, missions occur during the Spring or Fall and last between sevenand 14 days, depending on the availability of members and their sched-ules.

DOCARE medical missions have concentrated on Central Yucatan to serveMayan Indians and to Ecuador, Guatemala, and El Salvador. However, inthe past they have gone to northern Mexico to serve the TarahumaraIndians. Areas of focus change as the need changes and also depend onthe improvement in availability of medical care locally.

To learn more about DOCARE International, visit its Web site atwww.docareintl.org or call (847) 836-8022.

female, who became overwhelmed atthe prospect of being rid of the lesion.“She explained how much she sufferedfrom the lesion, which was clearlydisfiguring,” he says. “When I offeredto remove it, she burst into tears ofjoy.” Using a cautery pen, disposablesurgical equipment, and a flashlight asa surgical lamp, Dr. Nakhla performeda modified M-plasty. “Although oursurgical environment was suboptimal,the outcome of the procedure provedexcellent,” he notes.

Dr. Horowitz was very impressed bythe enthusiasm of the residents and thegeneral medical knowledge of themedical students from Nova South-eastern University. With previousmission experience in Ethiopia, Mexico,and Africa, Dr. Horowitz is lookingforward to participating in futuremissions with residents.

“This medical mission truly gave me anew perspective on philanthropy,”concludes Dr. Kirby. “I’m hoping tomake our participation in this programan annual event.”

is aproud supporter

of theGraceway Pharmaceuticals

is a proud sponsor of the

American Osteopathic

College of Dermatology

The theme of this year’s Annual AOCDConvention is Take it Home!

That’s because each speaker has beenasked “to give pearls of wisdom thatwe may take back to our practices andresidency programs,” says Jay Gottlieb,D.O., FAOCD, Program Chair. “Atten-dees will walk away from this meetingwith a good idea of what it would taketo institute new concepts or proceduresinto their existing practices and/or resi-dency training programs.”

Keynote SpeakerSome of these concepts will come fromkeynote speaker, Dr. Anthony Dixon,who will be speaking about “Myths ofSkin Cancer Surgery Outcomes—Whichare True?” during the lunch lecture onTuesday. An Assistant Professor (Schoolof Medicine) at Bond University inGold Coast, Australia, and Fellow of theAustralasian College of Skin CancerMedicine, Dr. Dixon is a nationally andinternationally recognized authority onskin cancer surgery. He runs compre-hensive training programs andeducation workshops to assist doctorsin their skills managing skin cancer inAustralia and overseas. Dr. Dixon alsois involved in cutting edge research inskin cancer management. In particular,he is involved in progressing new tech-niques in reconstruction followingtumor excision. He also is Vice Presi-dent and Censor of the AustralasianCollege of Skin Cancer Medicine andDirector of Research for Skin Alert SkinCancer Clinics in Australia.

Guest SpeakersGuest speakers are slated to speak onMonday and Tuesday.

Speakers (listed with their topics)scheduled to present lectures onMonday between 9:30 a.m. and 1 p.m.are as follows:

Ramsey Mellette, M.D.Moh’s Reconstruction

Simon Warren, M.D.Bullous Diseases: What’s New

Edward Yob, D.O.Incorporating Moh’s Surgery into aDermatology Practice

Gregory G. Papadeas, D.O.CLIA Quality Assurance Test

Speakers (listed with their topics)scheduled to present lectures onTuesday between 7:00 a.m. and 4:45p.m. are as follows:

Cindy Hoffman, D.O.Great Cases from Osteopathic TeachingPrograms

Hilary Baldwin, M.D.I-Pledge Update

Sandy Goldman, D.O.Endovenous Laser Treatment

Shelly Friedman, D.O.Hair Restoration: What’s New and How toGet Started

Michael B. Morgan, M.D.Deadly Diseases in Dermatology

Nathan Uebelhoer, D.O.Lasers and Lights

Robert Greenberg, M.D.Psoriasis Update

Resident SpeakersResident speakers (listed with theirtopics) scheduled to present lectureson Wednesday between 8:00 a.m. and3:10 p.m. are as follows:

John Perrotto, D.O., 2nd Year Wellington Regional Medical Center,West Palm Beach, FLXanthochromia Striata Palmaris

Billie Casse, D.O., 2nd YearSt. Joseph Mercy Health System,Clinton Township, MIAnnular Elastocytic Giant Cell Granu-loma

Julie Malchiodi-Jacobs, D.O., 3rd Year Oakwood Southshore Medical Center,Trenton, MIOral Erosive Lichen Planus

John Coppola, D.O., 2nd YearBotsford Hospital, Farmington Hills, MICryptorchidism in a Patient with X-Linked Recessive Ichthyosis

Jon Keeling, D.O., 3rd Year Wellington Regional Medical Center,West Palm Beach, FLMequinol 2% Tretinoin 0.01% Solutionfor the Treatment of Melasma in MalePatients

Joseph Schneider, D.O., 3rd Year Pontiac Osteopathic Hospital, Pontiac,MICutaneous Leishmaniasis

Karthik Krisnamurthy, D.O., 2nd Year St. Barnabas Hospital, Bronx, NYClinical Dermatologic Applications ofIntralesional Bleomycin

Lawrence Schiffman, D.O., 2nd Year St. John’s Episcopal Hospital, Linden-hurst, NYAtypical Pyoderma Gangrenosum

Patricia Klem, D.O., 2nd Year Wellington Regional Medical Center,West Palm Beach, FLSclerodermoid Reaction to InfiltrateChemotherapeutic Agent Nevantrane forMS

Danica Alexander, D.O., 2nd Year Columbia Hospital, Palm Beach, FLManagement of Perioral Dermatitis

Brian Feinstein, D.O., 3rd YearNSUCOM/N Broward Hospital, Ft.Lauderdale, FLLinear Focal Elastosis

Heather Higgins, D.O., 2nd YearOakwood Southshore Medical Center,Trenton, MIAcrodermatitis Continua

Tony Nakhla, D.O., 2nd Year Western University/Pacific Hospital,Long Beach, CACerclage Technique for Repairing LargeCircular Defects of The Trunk: CaseReport of a Staged Excision of a PlexiformNeurofibroma

Annual Meeting Takes it Home!

Kevin DeHart, D.O., 3rd Year NSUCOM/Sun Coast Hospital, PortRichey, FLFormaldehyde Induced Allergic ContactDermatitis

Kevin Spohr, D.O., 3rd Year Wellington Regional Medical Center,West Palm Beach, FLA Case of Curious Axillary Freckling

Sanjay Bhambri, D.O., 2nd Year Valley Hospital Medical Center, LasVegas, NVEpidermal Growth Factor Inhibitors:Dermatologic Implications

Brian Stewart, D.O., 2nd Year St. Joseph Mercy Health System,Clinton Township, MIPyoderma Gangrenosum

Lela Lankerani, D.O., 2nd Year Frankford Hospital, Allentown, PAEosinophilic Pustular Folliculitis

Kristen Aloupis, D.O., MPH, 3rd Year NSUCOM/N Broward Hospital, Holly-wood, FLDissecting Cellulitis of the Scalp TreatedSuccessfully with Adalimumab

Brian Walther, D.O., 3rd Year Frankford Hospital, Allentown, PARecurrent Abscesses: Underlying Immun-odeficiency?

Angela Leo, D.O., 2nd Year Frankford Hospital, Allentown, PACutaneous Rosai-Dorfman Disease

David R. Bonney, D.O., 3rd YearNSUCOM/N Broward Hospital, Holly-wood, FLGriseofulvin Induced Photoallergic Reac-tion

Lunch lecturer: Timothy Kilpatrick,M.D.Mycosis Fungoides: Clinical Presentationand Laboratory Evaluation

Matthew Smetanick, D.O., 3rd Year Frankford Hospital, Allentown, PAAcrodermatitis Chronica Atrophicans

Mollie Jan, D.O., 2nd Year Frankford Hospital, Allentown, PA

Erythema Annulare Centrifugum Treatedwith PUVA

Adriana Ros, D.O. 3rd Year St. John’s Episcopal Hospital, Linden-hurst, NYCase Report and Review: Bilateral Micro-cystic Adnexal Carcinoma

Kristy Gilbert, D.O., 3rd Yr Northeast Regional Medical Center,Kirksville, MOPDT in the Treatment of Acne

William Kelly DeHart, D.O., 3rd YearUniversity Hospital/Case MedicalCenter, Cleveland, OHEczema Herpeticum in a PostpartumWoman

Elliot Love, D.O., 2nd YearUniversity Hospital/Case MedicalCenter, Cleveland, OHNodular Amyloidosis

Todd Kreitzer, D.O., 2nd Year University Hospital/Case MedicalCenter, Cleveland, OHEruptive Xanthomes

Kaija Hanneman, D.O., 3rd Year University Hospital/Case MedicalCenter, Cleveland, OHCutis Marmorata TelangiectaticaCongenita with Macrocephaly

Roger Sica, D.O., 2nd Year Sun Coast Hospital, Port Richey, FLChildhood Dermatomyositis

Daniel Marshall, D.O., 2nd Year Northeast Regional Medical Center,Kirksville, MOFlaps for Nasal Reconstruction

Christopher Buckley, D.O., 2nd Year NSUCOM/N Broward Hospital, Holly-wood, FLToxic Shock Syndrome in a Patient withHidradenitis Supporitiva

Brian Kopitzke, D.O., 3rd Year Genesys Regional Medical Center,Grand Blanc, MIA Case Report: Merkel Cell Carcinoma

Evening EventsThe welcome reception will be heldbetween 6 p.m. and 8:30 p.m. on

Sunday evening. The President’s Recep-tion and Banquet will be held from 6p.m. to 10 p.m. on Monday evening.

Welcome AOCD Fellows, Residents,Corporate Sponsors, and Guests:

As the program chairman for the 2007Annual AOCD Meeting, I lookforward to seeing all of you inglorious San Diego! The theme of thisyear’s meeting is Take it Home! Eachspeaker at this meeting has beenasked to give pearls that we may takeback to our practices and our resi-dency programs. New concepts,procedures, and thoughts will beintroduced. We will walk away fromthis meeting with a good idea of whatit would take to institute a newprocedure or procedures into ourexisting practices or residencytraining programs.

I encourage everybody to attend allof our lectures, visit with all of oursponsors, and attend all of our socialevents. There will be the welcomereception Sunday evening and ourPresidential Reception and BanquetMonday evening.

We have an exciting lunch lecture onTuesday with our entertainingAustralian keynote speaker, Dr.Anthony Dixon. He will be discussingMyths of Skin Cancer SurgeryOutcomes—Which are True?

Our AOCD residents have preparedpresentations on a multitude of veryinteresting and educational topics. Itwould be great to see all of ourmembers, resident members, andstudent members at these lecturessupporting the residents.

Welcome to San Diego. Live, Laugh,Learn…and Take It Home!!!

Jay S. Gottlieb, D.O, FAOCDProgram ChairmanJAOCD Editor President Elect AOCD 2007-2008

The second largest city in California,San Diego comprises several charmingand distinct neighborhoods to enjoywhile attending the 2007 AOCD AnnualMeeting slated for Sept. 30-Oct. 4.

Charming NeighborhoodsThe eclectic Gaslamp Quarter is a 16.5block historic district located aroundFourth and Fifth Avenues. The quarteris filled with grand Victorian-era build-ings that are home to more than 100 ofthe city’s finest restaurants, 40 night-clubs, and 100 retail shops, as well astheaters and art galleries. Cuisines to besavored include Afghan, Brazilian,Chinese, Indian, Italian, Mexican,Persian, Spanish, Thai, and more.

Downtown’s largest neighborhoodencompassing 130 blocks, the EastVillage burst into life in the pasttwo years. The revitalization of thisonce blighted warehouse districtwas fueled primarily by thebuilding of PETCO Park, the SanDiego Padres’ state-of-the-art base-ball stadium that opened in 2004.Today, scattered throughout thevillage are restaurants, rooftopbars, cafes, boutique shops,galleries, and live music venues.

Located along Broadway andstretching toward the BroadwayPier on San Diego Bay, Columbiais composed mostly of commercialdevelopment interspersed withresidential condos. However, it

also is home to the Museum ofContemporary Art San Diego. Explorethe rich Navy heritage of the cityaboard the USS Midway Museum or thefloating Maritime Museum of San Diegofeaturing one of the finest collections ofhistoric ships in the world.

A multi-level, outdoor shopping andentertainment center, Horton Plazaoffers 130 specialty shops, restaurants,a movie theatre, and performing artstheatre. Well known for its whimsicaland vibrantly colored design, it wascreated to resemble a European marketplace and function like an amusementpark with colorful pathways, bridges,and staggered levels.

Around TownAlthough downtown San Diego is bestexplored on foot as it has short cityblocks and most streets running oneway in a grid pattern for easy naviga-tion, alternate modes of transportationare available. The most popular are theSan Diego Trolley light rail system,pedicabs, San Diego Tour Coupes’ andGoCar Tours, and converted Britishdouble-decker buses.

Although a Kayak tour won’t get youaround town, it will get you a view ofthe amazing San Diego sunsets. Enjoypaddling in the La Jolla Sea Caves andwitness the many sea lions sunning onthe cliffs late in the day as they feed.

Places to GoIn addition to the 70 miles of beachesand one of the most beautiful naturalharbors in the world, San Diego offersseveral attractions for those on the go.

The San Diego Zoo is one of thelargest, most progressive zoos in theworld with more than 4,000 animals of800-plus species on 100 acres of park-land in Balboa Park, just north ofdowntown San Diego along ParkBoulevard. Don’t miss the newest andmost ambitious exhibit at the zoo,Monkey Trails and Forest Tails.

SeaWorld San Diego is cele-brating America’s musicalheritage with the Sea to ShiningSea Music Festival, Sept. 29-30and Oct. 6-7. Ongoing showsinclude Journey to Atlantis,Shamu’s Happy Harbor, andBelieve. Venture beyond thepublic exhibits for a unique inter-active experience with the park’sarctic animals, including an in-pool personal encounter withbeluga whales, as part of WildArctic Interaction.

Take a guided tour throughremote Africa and Asia and seeexotic animals in expansive habi-tats at the San Diego Wild AnimalPark. The 1,800-acre wildlifesanctuary is home to more than

San Diego: From Natural Harbors to a Dazzling Downtown

3,500 animals representing 429 species,including the largest crash of rhinos inany zoological facility and one of theonly California condor exhibits in theworld.

LEGOLAND California offers more than50 rides, shows, and attractions. Newthis year, a recreation of the city of LasVegas built out of more than two-million bricks and Captain Cranky’sChallenge, a ride that will testanybody’s sea worthiness.

The region boasts a variety of vineyardsand large wineries that feature guidedtours and gift shops. Most wineries arelocated off Interstate 15, approximatelya 45-minute to an hour’s drive north ofdowntown San Diego. These includethe Bernardo Winery, Falkner Winery,Fallbrook Winery, and Orfila Vineyards.If you don’t want to leave the area, visitthe San Diego Wine & Culinary Centerlocated in the heart of downtown. Thecenter offers tours that feature anexplanation of the winemaking processalong with a barrel tasting.

Things to DoWith sunny skies (Don’t forget thesunscreen!) and temperatures in the70s, the city is hopping the week of theAnnual Meeting. The following is asample of events.

The annual Fleet Week Parade of Shipsis Sept. 30 on the Bay. Watch theparade of aircraft carriers, U.S. & inter-national ships, Navy SEALS, Navysubmarines, Coast Guard cutters,harrier jets, and helicopters. Tickets are$25.

Adams Avenue StreetFair on Sept. 29 and30 is Southern Cali-fornia’s largestfree musicfestival. Itfeatures morethan 80musical actson sevenoutdoorstages. Thefair that takesplace onAdams Avenue,betweenBancroft and35th streets, alsohas more than 400food, arts and craftvendors, and carnivalrides.

The 6th Annual San Diego FilmFestival to be held Sept. 27-30 in theGaslamp Quarter are four days filledwith 100 award-winning films, intimategatherings with filmmakers and celebri-ties, high-powered industry workshops,and four nights of the city’s most glam-orous parties. Tickets range in pricefrom $10 to $250.

The AFC West Division Champion SanDiego Chargers host division rivalKansas City at QUALCOMM Stadium at1:15 p.m. on Sept. 30.

As part of the Old Globe Theatre’srenowned summer ShakespeareFestival, you can catch Measure forMeasure, Hamlet, or The Two Gentlemenof Verona. If the Bard is not your taste,

see the world premiere musical, ACatered Affair, by Tony Award-winnerHarvey Fierstein at the three-venuecomplex in Balboa Park.

For more information on San Diegoevents, visit the Web sitesandiego.org/event.

Dr. Balazs Welcomes Baby GirlCongratulations to Kathy Balazs, D.O.,and her husband, Brian Coffee, on thebirth of their daughter Madison Eliza-beth Coffee.

Madison was born on March 12th. Sheweighed 7 pounds, 8 ounces, and was19.5 cm long.

Dr. Balazs is a practicing dermatologistat Beavercreek Dermatology in Ohio.She graduated in 2000 from Dr. EugeneConte's program at Grandview Hospitalin Dayton.

Recently I met a dermatologist at adermatology meeting who mentionedthat his office had a high staff turnoverthat was resulting in pecuniary penal-ties. His situation reminded me of ahuman resources book that I onceread. It discussed several reasons for ahigh turnover rate, including lowsalary, insufficient benefits, lack of timeoff, restrictive vacation policies, andpoor physical working conditions.However, the book emphasized theone reason that is sometimes invisible:office human dynamics. This dermatol-ogist said that he left those issues up tohis only long-time employee, his officemanager. The book described a situa-tion in which after an office managerhad retired, the entire tone of the officebecame lighter. People worked moreeffectively, the patients felt morecomfortable, and the office incomeincreased.

According to Jennifer Forgle, managingpartner of the On Point Consulting Website (www.onpointconsulting.org),many managers are unable or unwillingto deal with performance problemsoften posing issues that cut across alltypes of businesses. Likewise, manybosses are slow in dealing with

performance issues, which sends asubtle signal to employees that theseissues are unimportant. Other leaderssimply ignore such issues hoping thatthey will disappear.

In reality, not addressing performanceproblems evokes a negative reactionamong co-workers whose behaviorreflects company values. Typically, theygrow increasingly resentful of peoplewho “get away with” poor performanceand attitudes. These poor performersare viewed as not doing their fair shareof work.

All performance issues should be dealtwith immediately. Managers who donot address them right away will live toregret their non-action, as will the otherworkers.

Employees leave their jobs because ofthe office culture, not because ofcompensation or benefits. The latter

Seeking a dermatolo-gist for a busy practice in

Tampa, Fla.Position offers many oppor-

tunities for MohsMicrographic surgery andcosmetic services along

with general dermatology.Please send CV to

[email protected] or call1-800-488-7336.

merely serve as hiring attractants. You’renot going to retain the best people iftroublemakers create an unsavory work-place atmosphere and possibly even legalreprise.

The most common reasons for notformally identifying bad behavior,according to Forgle, are as follows:

1. It is easy to check the “meet expecta-tions” box as part of the annualreview. Although this may seemeasier, it makes confronting an indi-vidual’s bad behavior more difficultin the long run.

2.Great revenue generators are diffi-cult. My question is: But are thedisruption and other employees’resentment worth it?

3. Leaders can be vague on whatdefines bad behavior. My recommen-dation is to define it concretely andvisibly so that all staff members knowwhat constitutes bad behavior.

Finally, all human resource books indi-cate that poor behavior often escalates.Nipping it before it blooms will create ahappier work environment for youremployees, which will result in decreasedanxiety and an increased bottom line.

Increase Income by Improving Office ‘Human’ Dynamicsby Robert Schwarze, D.O., FAOCD

AOA President John A. Strosnider,D.O., age 60, passed away of pancre-atic cancer on June 21.

His presidential theme, “Back to theBasics,” exemplified his dedication tothe proposition that DOs educated in arural environment would remain in thatenvironment, providing essential,quality health care to those in need.

“The osteopathic medical professionwas built on a primary care philosophy,and we need to get back to thosebasics so that our patients in theseareas have access to the distinctivehealth care promised by osteopathicmedicine,” Dr. Strosnider said afterbeing installed as AOA president lastJuly.

As the founding dean of the PikevilleCollege School of Osteopathic Medicine(PCSOM) in Kentucky, Dr. Strosnidermodeled the school with his “back tothe basics” concept in mind. His visionthat the school would produce primarycare doctors committed to providinghealth care in underserved communi-ties in Appalachia has become a reality.Since 2001, 93% of the 280 graduateshave chosen to enter internships andresidencies in primary care and 79% arepracticing in underserved areas.

“He was deservedly proud of his workat PCSOM in bringing an underservedcommunity’s dream of a first-classmedical school to reality,” says John B.Crosby, J.D., AOA Executive Director.

To honor his memory, AOCD PresidentBill Way, D.O., who referred to Dr.Strosnider as “a friend, classmate, andcolleague,” suggests that osteopathicdermatologists provide graduatingosteopathic medical students morequality training in dermatology. “Volun-teer at our schools to teach a fewlectures in dermatology and ask tohave trainees come to your office andlearn some dermatology,” he says.“Remember that physician meansteacher. Let us all do our part by givingback to our profession and help fulfillDr. Strosnider’s dream of improvingosteopathic medicine by getting backto the basics, which in our case isteaching dermatology to ourcolleagues.”

Dr. Strosnider was equally aspassionate about helping the AOAbecome a great organization. With thislofty goal in mind, he launched theAOA’s Greatness Campaign to get moremembers actively involved in helpingto shape AOA policy; to record histo-ries of living pioneers who madesignificant contributions to the profes-sion; and to fund the association’smajor goals such as a national adver-tising campaign or a campaign toimprove health care for all Americans.

Dr. Strosnider’s career as an osteopathicphysician gave him an opportunity toserve the profession in many ways: as aprovider for his patients; as a leader forthe Jackson County OsteopathicMedical Association in Missouri and theMissouri Association of OsteopathicPhysicians and Surgeons, as well as theAOA; and as an educator at what isnow the Kansas City University ofMedicine and Biosciences College ofOsteopathic Medicine and at PCSOM.

Dr. Strosnider is survived by his wife,JoAnn, and three children, John Adam,Alisha, and Paul, as well as his mother,Dodi.

In lieu of flowers, the family requeststhat a donation be made in Dr. Stros-nider’s honor to the AOA GreatnessFund. These donations can be made by

check (payable to the AOA with JohnA. Strosnider, DO, in the memosection) or throughwww.DO-online.org.

Sondra Darlene Way, the wife ofAOCD President Bill Way, D.O., passedaway unexpectedly on May 27, her 51stbirthday.

Mrs. Way was active in local and TexasDO organizations. She also was amember of the Auxiliary of District 5.She loved her Yorkie dogs and horses,and enjoyed horseback riding, cooking,and gardening. But her greatest enjoy-ment in life was her family as Mrs. Wayspent a great deal of time with her chil-dren and grandchildren.

She was a loving wife, mother, grand-mother, daughter, and sister. Mrs. Waywas preceded in death by her mother,Ethel Woods. She is survived by herhusband of 21 years; daughter, JulieRowe and husband Lance; son, ChrisRoss and wife Vanessa; three grandchil-dren, Taylor Ross, Levi Rowe, andNathan Ross; father, Herman Woods;two brothers, Jason and Clayton Woodsand family; and an extended family,wonderful friends, and osteopathicfamily.

Donations to the Foundation of Osteo-pathic Dermatology may be made inmemory of Mrs. Way.

Dr. Way wishes to express his utmostappreciation for all the prayers andcaring that individuals have providedduring this difficult time.

In Memoriam

Photo by John Reilly Photography

The American College of Mohs Micro-graphic Surgery and CutaneousOncology has changed its name to theAmerican College of Mohs Surgery(ACMS).

The primary reason for the namechange is to make it more user friendlyfor the public, according to ACMSCommunications Manager Erik Ebarp.

“ACMS is just easier to remember,” headds.

Although the ACMS membership andBoard of Directors approved the namechange at the annual meeting held thispast May, it will not become officialuntil October.

In order to prepare future physicians tomeet society’s health needs, leaders atcolleges of osteopathic medicine(COMs) and osteopathic graduatemedical education programs mustmove “beyond the barriers” to effectcurricular reform.

That according to an article publishedin a recent issue of the Journal of theAmerican Osteopathic Association(JAOA).

The article discusses several barriers inboth curricular and extracurricular areasof osteopathic medical education,beginning with the skeptics. These areindividuals who cite excellent boardscores, anecdotes of residencyprograms “loving our graduates,” andsurveys of graduates and residencyprogram directors as indications thatosteopathic medical education is doingits job well.

Faculty resistance resulting fromcompeting priorities, inertia, and theundervaluing of faculty development isanother barrier to reform.

Ongoing reliance on the FlexnerReport*, which the author contendslacks credibility due to decreptitudeand Flexner’s lack of clinical experi-ence, is another barrier. Although somecall for students to have clinical expo-sure earlier in their training, whileothers call for more basic science intheir later years, neither offer the inte-grated approach recommended bymany of today’s experts. Shorter

lengths of stay, advances in outpatientcare, and hospital closings have dimin-ished the value of quality medicaleducation programs through hospitals.Therefore, the author asserts thatmedical schools should consider deem-phasizing hospital-based training, whileforging partnerships with ambulatoryclinical training sites, assisted livingfacilities, and community healthcenters, among others.

Educators who do not integrate andbuild on the curriculum taught in otherdepartments serve as a barrier toeducation reform. Along those lines,the teaching of osteopathic principlesand practice are often fragmented incoursework, clerkships, and residencyprograms. An increase in osteopathicresearch at COMs in areas that comple-ment their missions (e.g., osteopathicmanipulative treatment, informatics,and interdisciplinary teams) wouldbenefit the curriculum, as well.

Although the mission of COMs is totrain compassionate physicians who arecommitted to service, and specificallyto the practice of holistic medi-cine, very few osteopathicmedical schools requirestudents to takebehavioral sciencescourses in which theycan learn those attrib-utes. This barrier tiesinto another one related tothe unspoken culture of medicine,which tends to be competitive, unemo-tional, hostile to human error, and

contradictory to the notion of compas-sionate caring and healing. To relay thesense of compassion and redefine theculture of medicine, educators mustexpand humanities requirements andrestructure learning environments, theauthor notes.

In order to move “beyond the barriers”to effect curricular reform, the authorconcludes that COMs and osteopathicgraduate medical education programsneed to do the following:

• Allow curricular evolution andfaculty development

• Expand clinical learning andteaching

• Break down departmental walls• Integrate osteopathic principles and

practice• Reevaluate admission requirements

of COMs• Eradicate the unspoken culture of

medicine

The article appeared in the July 2007 issueof the JAOA, Vol. 107, No. 7.

* The Flexner Report written by Abraham Flexner, ateacher and principal, is credited with triggering much-

needed reforms in the standards,organization, and curriculum of

medical schools inthe early 1900s.

A Call to Reform Osteopathic Medical Education

Additionally, the ACMS will introduce anewly designed and restructured Website later this fall. The Web site remainsthe same: www.mohscollege.org.

The College, named after FredericMohs, M.D., who developed the proce-dure, was established in 1967.Currently, there are approximately 800members.

Mohs College Changes Name

COR

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SPOTLIGHT

Malcolm McCoy, Vice President of Salesand Marketing at PharmaDerm, Duluth,Ga., who has been in the pharmaceuticalindustry for 30 years (six with Pharma-Derm), talks about the AOCD’s continuedgrowth and greatest impact in light of theCollege's 50th anniversary.

Why is it important that specialtycolleges, such as the AOCD,continue to grow strong?

Right now, if you look at the demo-graphics, there are not enoughdermatologists to meet patient demand.This shortage is reflected in the averagewaiting time to see a dermatologist,which is approximately six weeks orlonger. According to long-term projec-tions, it’s going to be hard to shore upthe dermatologist supply with patientdemand. The continued growth ofspecialty colleges, such as the AOCD, iscritical to meeting patient demand nowand in the future.

It’s important for the College tocontinue to grow to have a cadre ofosteopathic dermatologists who arequalified to train future DO dermatolo-gists. As the College grows, so does thenumber of osteopathic dermatologyresidents graduating. I understand thatthe number of residents is now at 90,and that’s even up from a few monthsago.

During the last half century, theAOCD has grown to become astrong and influential specialtyCollege. What is the College’sgreatest impact?

The AOCD’s greatest impact has beenon patient care and education. Itsmembers continue to inform the Amer-ican public about diseases of the skin,particularly skin cancer, and the needto have an annual full body scan.

Regarding resident education, theCollege’s greatest impact has been its’emphasis on the one-on-one trainingwith individual dermatologists that itsresidents receive across the board.

PharmaDerm is a Diamond CorporateMember, and sponsor of the WelcomeReception at both the Midyear andAnnual meeting in 2007.

Page 27

AOCD’s Greatest Impact: Patient Care, One-on-One Training

Like our counterparts at the AmericanAcademy of Dermatology, the AOCDhas a dermatology foundation knownas the Foundation for OsteopathicDermatology (FOD).

The FOD was founded in 2002 with theintent of improving the standards of thepractice of osteopathic dermatology byraising awareness, providing publichealth information, conducting chari-

table events, and supporting research(e.g., for residents in training) throughgrants and awards given to these appli-cants under the jurisdiction ofosteopathic dermatologists.

As FOD President, I urge you to givegenerously to build our Foundation toa level that provides much to both theosteopathic dermatology communityand the public at large.

In the coming months, be on the lookout for more information about theFOD.

Don’t Forget the Foundationby Brad P. Glick, D.O., MPN, FAOCD

American Osteopathic College of Dermatology1501 E. IllinoisKirksville, MO 63501

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PERMIT # 1556

ORLANDO, FL

Join us in

San Diego, California for

The American Osteopathic Association’s 112th Annual Meeting

September 30, 2007 to October 4, 2007Welcome to San Diego, California's second largest city.Where blue skieskeep watch on 70 miles of beaches and a gentle Mediterranean climatebegs for a day of everything and nothing. Bordered by Mexico, the PacificOcean, the Anza-Borrego Desert and the Laguna Mountains, San Diegocounty's 4,200 square miles offer immense options for business andpleasure.

Relax, soak in San Diego. Let your surroundings dictate a new appreciationfor all the good things San Diego has to offer. From thrilling ocean adven-tures to chilled-out siestas under the shadow of a palm tree, your San Diegoexperience will teach you a new way of life - full of fun, relaxation andbeauty.

San Diego is also home to such world-famous attractions as SeaWorld, theSan Diego Zoo, the Wild Animal Park and LEGOLAND California, as well ashistoric cultural gems Balboa Park and Old Town.

Medical Mission: Dermatological Residency Experiences from OC Skin Institute's Dr. Tony Nakhla

Health & Medicine

Transcript of Medical Mission: Dermatological Residency Experiences from OC Skin Institute's Dr. Tony Nakhla