Evidence of Learning Assessment #1

Type of Assessment: ​Mentor Visit

Mentor: ​Dr. Jennifer Dharamsi

Profession: ​Dermatologist

Location and Business Name: ​Legacy Dermatology

Date of Visit:​ December 27, 2017

Time:​ 8:30 A.M - 5:00 P.M.

Analysis:

After the frustrating journey of looking for a mentor, I finally got one. Dr. Jennifer

Dharamsi ​is a board-certified dermatologist who practices medical, pediatric, surgical, and

cosmetic dermatology in the Dallas-Fort Worth Metroplex. ​When I first got there, I shadowed the

some of the medical assistants while the were setting up for Patrice, who is the physician’s

assistant. Later that morning, Dr. Dharamsi came in and I shadowed her the whole day.

The first patient I saw with Dr. Dharamsi was, an older man who had “an abnormal

mole”. I was unfamiliar with that term, but when I asked Dr. Dharamsi what she meant, she said,

that was a different way to say a developing melanoma. When she said that, a light bulb lit

above my head because I knew exactly what she was talking about. The procedure to remove

the mole was not more than 45 minutes. She began by, drawing on the patient’s back where

and how much she was going to remove the mole. During the procedure, she talked me through

every step and explained why did the things she did. While this was the first time seeing

something like this, everything she did interested me, especially when she was finishing the
procedure. She was finishing the procedure with sutures. She began by trying to match the skin,

like a puzzle so when the skin began to heal, it would heal properly and look natural. Once she

matched it up, she took absorbable sutures and sutured the skin together by using the

horizontal mattress suturing. Why absorbable sutures? Dr. Dharamsi used them because it is

they are used in the deep dermis and subcutaneous tissue to reduce skin tension. The ideal

absorbable suture material will retain tensile strength until collagen replacement is complete and

will remain non-reactive until fully absorbed. Then she informed why she chose to use ​horizontal

mattress suturing because it’s the most useful suture for high tension wounds especially when

the edges are fragile or frayed, like removing a chunk from the back. While continuing to

complete this, she explained what the dermis is. The dermis is the layer of skin that lies beneath

the epidermis and above the subcutaneous layer. It is the thickest layer of the skin, and is made

up of fibrous and elastic tissue. Thus it provides strength and flexibility to the skin. The dermis is

thickest on the palms and soles of feet and the back has a very thick layer of it. Now with those

sutures in, it looked as if the skin was being pinched, because it was raised. Dermatologists put

sutures in like that (looking like it has been pinched) because it forces the skin to repair itself

and come together better. And to make sure the sutures were in place, she used

non-absorbable sutures, which have to be removed in 7-10 days, to secure it. After this patient,

we talked about this “abnormal mole”. Although I knew about it, I wanted a better understanding

of melanoma. We spent almost 20 minutes talking about it. Dr. Dharamsi made the time tak to

me in between patients to explain why that person had what they had and how it happened and

I learned so much and I appreciated her effort.

The next patient was a middle aged man who had a skin tag that looked like a mini

scrotum on his inner right thigh. For this procedure, Dr. D, put local anesthesia around the area

and cut the skin tag off. Due to the bleeding, she cauterized (medical practice or technique of
burning a part of a body to remove or close off a part of it.)​ ​area where the skin tag was

removed and sutured it. I asked why skin tags appear on the skin and she said that skin rubbing

on skin could have played a large role in the development of that skin tag. After that we saw

patients who came for cosmetic procedures to patients who came for medical appointments (like

skin check ups). One of the cosmetic appointments, was a middle aged woman who wanted to

have fillers put into the temples of her head, under her eyes, her smile line area, cheeks and the

center of her head. This lady had fillers injected so that she would look more youthful. That was

her second treatment and she looked fantastic! From this procedure, I wanted to learn more

about the cosmetic side of dermatology because it’s very interesting. After that patient visit, we

saw other patients that were there for acne, warts, eczema and many others. When I sat in to

listen to the the patients with eczema and acne, I was familiar with what Dr. Dharamsi was

saying, however I still learned about it more. Lastly, the procedure that intrigued me because of

it was and the videos and I articles I’ve read about it was, a lipoma. A lipoma is a benign tumor

of fat that are generally soft, movable and painless. The gentleman with this, had it on his

shoulder and instead of having it surgically removed, he chose to have it terminated with fat

dissolvable injections. I found this interesting because, most of the procedure I watch, the

lipomas are removed surgically, so to see this, it was different and fascinating.Throughout the

day, I learned from watching Dr. Dharamsi doing procedures, explanations from her and the

staff and asking questions.

Spending the whole day shadowing Dr. Dharamsi, Patrice, the medical assistants and

nurses, I learned a lot of new things and I also knew a lot of what was being talked about (those

research assessments really helped). I saw the removal of harmful moles and basal/ squamous

cell carcinoma happen multiple times, but every time it was different and interesting. Each

procedure was in a different place, done on different skin types and different size, however not
once did I find it boring. I really enjoyed watching all of them because I learned something new

from the last time I saw the procedure. This visit showed me that all the work I put into the

research assessments paid off because I was not lost when the staff and Dr. D talked about a

patient and what they had. I was involved and I was very proud of myself. After shadowing Dr.

D, I want to see if I can get more hands on experience. How can I achieve this? I could take an

online course where I’ll learn more about dermatology and become certified to see patients.