Hometown: Orlando, Florida
Name of Undergraduate Institution: University of Florida
Major(s)/Minor(s) in College: Major: Biology; Minor: German
Name of Medical School: George Washington University School of Medicine and Health Sciences
Residency Program: Dermatology Resident – University of Pennsylvania
Favorite Quote: “The size of your dreams must always exceed your current capacity to exceed them. If your dreams do not scare you, they are not big enough.” – Ellen Johnson Sirleaf
Contact Info: Instagram: @dr.dermatic
Where are you currently at in your career path and why did you decide to pursue this career path?
I am a first-year Dermatology resident at the University of Pennsylvania. I come from a medically-oriented family, the daughter of a Veterinarian and a Nurse Practitioner, and from an early age aspired to be like my parents and dedicate my life to the care of others. It was over for me the first time I rotated in a Dermatology clinic as an undergraduate – the complexity and variety of patients and problems, the ability to perform fast, minor bedside diagnostic procedures as well as surgeries, and the accessibility of the skin to provide important histopathologic correlation to what you are visualizing clinically all drew me in from the very beginning.
Dermatology is so much more than acne and Botox; dermatologists must be proficient in principles of anatomy, wound care/healing, infectious disease, rheumatology, cutaneous oncology, genetic syndromes involving the skin, aesthetics, as well as the “bread and butter” areas of general and procedural dermatology. We must have a keen eye to appreciate subtle differences in patterns and morphology to inform our diagnoses, the implications of which could mean the difference between sending a patient for full-body PET/CT scans versus simply prescribing one of many topical remedies in our toolbox. We require the ability to be critical of the literature, as dermatology and its use of technology and novel therapeutics is constantly changing and evolving. I cannot wait to immerse myself in this field for the next three years of training and beyond. I encourage anyone who is interested to be proactive early on in securing guidance, mentorship, and research opportunities. It is so worth it.
If you could go back and have a chat with your 1st year postgraduate self, what would you tell her?
I would tell myself to slow down. For many years, I found myself rushing to get to the next phase, and I believe many young people who aspire to professional careers find themselves having the same pattern of thoughts. How many of us go through the motions hoping that next phase will be everything we dreamed of? That this so-called “next chapter” will finally bring all the rewards, happiness, fulfillment, and satisfaction that we’ve been waiting for? In high school, I couldn’t wait to go to college and fulfill my dream of becoming a pre-med; then, in college, I couldn’t wait to finish the MCAT, graduate, and go to medical school. Then, in medical school, I couldn’t wait to be done already and start residency in my field of choice.
Even now that I’ve “made it” and started my dream residency, I find myself looking forward to being an attending and, at long last, completing my formal medical training. Part of me knows this is natural, and another part of me wonders what experiences I missed out on because in all that time, I never really took a break. I had tunnel vision and rushed, thinking that taking time off could be detrimental to my long-term goals. Knowing what I know now, I wish I had taken the time to travel and experience young adulthood after college and actually enjoy a year without studying (!!!). One year is a drop in the bucket, in the grand scheme of things, and would not in any way have set me back.
What advice would you give to a medical student looking to pursue a similar path as yours?
What helped me the most on my way to pursuing dermatology was mentorship. Dermatology is a rather small field, and having the support of someone at a higher level is incredibly valuable. It is not easy finding someone who is willing to invest in your success and views your wins as their wins. When you find that person, nurture that academic relationship: be on time, every time. Turn in the first draft of that manuscript early, before your deadline! Read about the patients you see in clinic with your mentor, and then ask thoughtful questions the next time. Show that person that you are not just intelligent, but dependable, qualities everyone wants in a resident but that not every individual possesses. These may seem small, but they do not go unnoticed. Make your mentor want to root for you!
I would also like to mention that a good mentor does not have to be a faculty member of a residency program; even someone who is only a year or two ahead of you has valuable residency tips and general “life hacks” they are more than willing to share. Take advantage of your peers who have been successful before you. No one should have to figure this all out on their own!
What is your favorite thing about your job?
I love the day-to-day variety in dermatology. The field is an incredible mixture of medical and surgical approaches to treatment. There are some patients who will be cured instantly, as when we cut out a skin cancer or bothersome cyst, and there are medically complex patients on systemic immune therapies that will require long-term, close follow-up whose disease may never be “cured,” just managed. We see the young and old and everything in between. Every new patient is a surprise; they could be here to discuss a cosmetic concern or they could be here with a history of an aggressive skin cancer that invaded the deep ear structures, requiring multiple surgeries by various specialists and ultimately resulting in loss of hearing. I can diagnose a superficial fungus with a simple skin scraping viewed under the microscope, and start treatment right away that will yield a favorable prognosis. In the very next case, I may diagnose a melanoma that has spread to lymph nodes and beyond – that patient has a longer road ahead and a less favorable prognosis, and I worry about them long after I’ve left for the day. I am kept on my toes and motivated to continue learning when a patient comes in with an unclear diagnosis, and have incredible resources at my disposal that I can use to help the patient even when a specific diagnosis remains elusive. There are uncommon presentations of very common conditions, as well as the occasional “zebra” you’ve only read about in textbooks. In such cases, it is helpful that the skin is so accessible, allowing dermatologists to easily correlate what we see on the clinical exam to what is happening under the microscope, leading us toward or away from a specific diagnosis.
Can you please walk us through a typical workday?
A typical morning for me starts between 7:00 and 8:00 am, with either patient care or didactic sessions in which faculty or upper-year dermatology residents give us lectures on a variety of topics. We see patients in many settings, including in attending specialty clinics, at the children’s hospital, at the VA Medical Center taking care of veterans for surgical and medical appointments, and also in our own weekly resident clinic that allows us to build relationships and continuity with patients we intend to follow over the course of the 3-year residency program under the supervision of attending physicians. Because it’s my favorite clinic, I’ll take you through a typical day in my resident clinic:
- 7:30 am: Walk into the hospital. Stop #1: coffee! They know me by name and order at the café outside of our clinic at this point.
- 7:40 am: Walk into the clinic. Pulling up the schedule, I see that none of my patients are here yet. This gives me time to peruse their charts and mentally prepare for the types of patients and problems I will likely see today.
- 7:45 am: First patient checks in, a new visitor I have never met before. Right on time! The medical assistant rooms the patient and takes vital signs while I start pre-populating a note.
- 7:50 am: Walk into the room and introduce myself to the patient. She is young, but used tanning beds frequently in her teenage years and has a family history of melanoma. She is here for a skin check because she has many moles and wants to make sure none of them are dangerous. She indeed has many moles scattered all over arms, legs, and trunk, and I have my dermatoscope at the ready to inspect them closely, looking for any atypical features that might prompt concern. There is one mole on her shoulder that is darker, larger, and more irregular than the rest; it stands out. I explain to her that I recommend taking a sample of the skin via a biopsy, which requires taking a photo of the spot for documentation purposes, a numbing injection, and then using a blade for remove the mole so it may be sent to out pathologists for microscopic inspection. I step out, present the case to my attending, and we re-enter the room together. My attending repeats the skin check and pauses to examine the mole I want to biopsy. My attending agrees with my plan and we begin to set up for the biopsy. During this time, I take the opportunity to counsel the patient that I am doing this because of its atypical appearance as well as her family history, noting that it is completely possible that the spot does not in fact represent malignancy. She agrees, signs the consent form, and I perform the biopsy. I promise to call with results within a week.
- 8:10 am – 12:00 pm: I am getting more efficient in clinic and have managed to stay on schedule for the remaining patients on my schedule. So far, I have seen and treated mild acne using topical medications in a college student, frozen a wart from the thumb of a young man using liquid nitrogen, referred someone for narrow-band UVB phototherapy for widespread psoriasis involving too large a surface area to be feasibly managed with topicals alone, biopsied one or two more suspicion lesions in an older gentleman with a history of multiple skin cancers, and seen a hospital follow-up patient who I saw and treated for a drug reaction so severe it required hospitalization. I am happy to see she is doing much better and her skin is no longer sloughing off.
- 12:00 – 1:00 pm: Grab lunch while I squeeze in a few patient callbacks/medication refills. I call to let one patient know her biopsy showed an early skin cancer requiring additional treatment. I schedule her in our resident surgery clinic where I will see her for definitive treatment. I call another patient back to let him know his liver function tests were normal and that he can now go ahead and start oral antifungal therapy for a stubborn nail fungus that has been bothering him for years. With callbacks done, I finish up notes from clinic.
- 1:00 – 4:00 pm: Head over to the VA for a surgical day, where I will see patients who have biopsy-proven skin cancers that require definitive treatment via wide excision. I team up with an upper-year resident, since I’m still fairly new at this, and map out how best to perform the excision keeping in mind the body location, thickness/laxity of the skin in those areas, and skin tension lines to ensure the scar heals under the most optimal of conditions. Once this is done, I ask my patient what music he would like to listen to while we operate. He chooses smooth jazz and promptly falls asleep while I am operating on his scalp. I take this as a compliment.
- 4:00 – 5:00 pm: Wrap things up! Finish my notes, clean up the rooms, more patient callbacks, and chat with my residents about the day as we walk to the parking lot.
- 5:00-7:00 pm: Me time. Walk the dog, make dinner, call my mom 😊
- 7:00 – 10:00 pm: I will typically try to fit in some reading before bed every night. There is so much to learn in dermatology, with very little of it taught in medical school, so independent study is very important as a dermatology resident. After that, it’s lights out – another full but gratifying day in my life as a dermatologist-in-training!
Wow, this is so amazing! Thank you so much for the extensive amount of helpful information that you shared with us Dr. Oliver! We absolutely appreciate you for all of this and for taking the time to share some wisdom and some insight into your specialty of choice! There are so many people out there who will benefit from this feature! Keep doing the wonderful work that you’re doing and we wish you the best of luck in your training and beyond!
Posted on December 26th, 2018