Evidence of Learning Assessment #5 (Primary)

Type of Assessment: ​Hands on Learning (Primary Learning)

Website: ​Online Dermatology Tech Program (Association Dermatologists Techs)

Source: ​Videos (each video is about 15-40 minutes long)

Date: ​February 16, 2018

Analysis:

For the past week and a half, I have had the tremendous opportunity of beginning an

online Dermatology Tech class alongside my ISM experience with my mentor. There is an

abundance of videos which are dedicated to teach Medical Assistants( MA), Certified Nursing

Assistants (CNA) and people like myself. This program educates MAs and CNAs how to

perform duties in Dermatology under the supervision of a Dermatologist. Here is a breakdown of

the things I have learned so far:

The first video I watched was over the ​Common Language of Dermatology. ​This is very

important area because, one must be able to use the correct terms and terms that are specific

to the condition the patient has. The first common language I learned about was about lesions.

There are four types of lesions: ​flat lesions, raised lesions, fluid-filled lesions and depressed

lesions. ​To begin with, a lesion is a ​region in an organ or tissue that has suffered damage

through injury or disease, such as a wound, ulcer, abscess, tumor, etc. So, a flat lesion is a

lesion that is smooth on the surface of the skin. There are two ways to identify a this type, a

macule which is a flat lesion that is no larger than .5 centimeter in diameter and a patch is a flat
lesion that is larger than .5 centimeter in diameter and also appears to be scaly and have a

slight texture to them. The second type of lesion is a raised lesion, which, like its name is, raised

above the surface of the skin. There are five types of raised lesions, a papule, nodule, cyst,

plaque, and wheat. Ones that are very familiar are, a cyst and plaque. A cyst is a spherical

lesion which is filled with semi-solid material, while a plaque is, a solid plateau like elevation

measuring at at least .5 centimeters in diameter. A common skin disorder with a plaque look/feel

would be psoriasis. The next type of a lesion is a fluid-filled lesion. There are three types of

fluid-filled lesions: A vesicle, which is a fluid filled cavity measuring less than .5 centimeter in

diameter. Next is a bulla, which is of fluid filled cavity measuring at at least .5 centimeter in

diameter and lastly, is a pustule, which is a thin walled pus-filled papule. Lastly, are depressed

lesions. The three kinds of depressed lesions are: erosions which are a defect of the skin

resulting from the loss or breakdown of the epidermis and this lesion heals without any scarring.

Then another depressed lesion is an ulcer and that is a defect of the skin resulting from the loss

or breakdown of the epidermis in at least the upper portion of the dermis, however, this type of a

depressed lesion heals with scarring. And lastly, atrophy. Atrophy is a loss of normal thickness

of the skin. Although this video had many other lessons to take away, the types of lesions were

something completely new to me and I only had a basic understanding of what a lesion was. I

had no idea there were other types of lesions. This video also included, the types of surface

changes in skin, common adjectives of color and shape and configuration of lesions. This video

taught me about common language in dermatology, which I have heard but did not know quite

that much about.

The next two videos addressed ​Collecting and Documenting Patient History. ​Collecting

and Document Patient History is a very important aspect of Dermatology because it ensures the

patient’s concerns are fully addressed, there will be no harm does to the patients by treatments
which may conflict with his or her preferences, allergies, or other medical conditions and the

physician can fulfill his or her duties in a timely, stress-free, and efficient manner. Any time with

any doctor is valuable and both the patient and doctor want to maximize that time and with that

in mind, there are stages of preparing the patient visit. The stages include: the physician looking

over the pre-visit chart review, determining the chief complaint, reviewing and clarifying past

medical history/family history, current medications, allergies, and social history and lastly

gathering the History of Present Illness (HPI). Some key points of a HPI that I learned were, it is

considered “subjective” in nature. What that means is that information relayed in the subjective

manner incorporates one's feelings, beliefs, perspectives and emotions. This is typically how a

patient will describe things. Then the way a physician wants to relay information is objectively.

Which is the opposite, it is fact-based and without consideration to feelings, beliefs,

perspectives, or emotions. I also learned that a physician typically wants/has to go through the

stages because it allows the patient visit to go smoothly and all issues/concerns to be

addressed. In part two of ​Collecting and Documenting Patient History, ​The video talked about

social habits. What social habits may influence the patient’s health, is it smoking, drinking,

tanning bed use, bathing habits? With the help of the review of systems, this technique helps

healthcare providers to elicit medical history from their patient, making their job a little easier

and the patient visit run smoother. Also in this video, I learned about the initial work up-up of

rashes/conditions and lesions and what to ask when you met a new patient. Then I learned

about the follow-up of rashes/conditions and lesions and what to ask to a patient who has been

to the physician. There was a lot of information to take away from this video.

The following video I watched was about ​The Anatomy In Dermatology. ​Knowing the

anatomy of the skin is extremely necessary, so that you can correctly and accurately chart a

patient’s skin conditions. To do so, one must use anatomical description. To get the anatomical
description, one must use a directional description, and location. Some of the key terminology

for writing the description of the condition include: right or left, proximal or distal, medial or

lateral, dorsal or ventral (volar) and anterior or posterior. Once identifying the skin condition is

done correctly, it is necessary to identify which part of the patient’s body where the skin

condition is located. Is it located on the face, or on the arm, on the scalp, on the neck? Under

these main body regions, there many other specific regions where the skin condition may be

found. Such as, the volar forearm, supraclavicular, tragus, alar crease, mcp joint, popliteal fossa

or even on the sole of the foot. There are so many and being this specific allows the patient to

get the right kind of treatment and having the correct anatomical description helps the physician.

The next video went somewhat along with the anatomical description, it was over ​The

Skin Structure and Function. ​Learning about the skin structure in the function of the skin is also

extremely important to do it because it helps answer the patients questions during the time

before the doctor comes into the room. I can now describe the types of layers of the skin to

patients and tried to answer basic questions when it comes to this topic. This video I learned

about three layers of the skin, subcutaneous tissue, dermis, epidermis (bottom to top). The

subcutaneous tissue is a layer of fatty tissue beneath the skin and contains the blood vessels

and nerves. The second layer is the dermis is the thick layer of living tissue below the epidermis

that forms the true skin containing blood capillaries, nerve endings, glands, hair follicles and

many other structures. The hair follicles in the dermis contain three stages of growth: Anagen, is

the growth phase, catagen which is the regression phase, and telogen which is the dormant

phase/preshedding phase. Some of the glands located in the dermis layer are sweat glands,

apocrine glands, eccrine glands and oil glands - sebaceous glands. And some of the other

structures located here are collagen and elastic which are both protein fibers. Collagen protein

fibers are those that provides strength and help the skin resist tearing, while elastin protein
fibers are those that allow the skin to stretch but then return to the position. Rhytids (wrinkles)

are aged in some damage elastin. Lastly, the epidermis is where skin cells are produced and

developed. The epidermis is home to a very few important types of skin cells, keratinocytes and

melanocytes. In the epidermis layer, the basal layer is the deepest layer and is the home to

melanocytes. Melanocytes are the cells which provide pigment to our skin (melanin). Cancer of

the melanocytes is called melanoma. Keratinocytes form a barrier against infect and help our

body retain water. These cells migrate upward through the stratum spinosum, stratum

granulosum, and stratum corneum. The protein keratin increases in concentration as the cells

migrate upward. Squamatization is when the process of the skin cell maturation. And then if skin

cancer forms it is known as, squamous cell carcinoma. This video gave me a better

understanding of the skin and how it functions, the way it functions and why it functions in that

way. I then began to watch the ​Introduction to Coding. ​I have not yet finished this video but, I

learned that coding is a standardized method of communicating to a patient’s insurance

company, using numeric codes to indicate which billable services were performed during a

patient office visit.

I am so grateful that I have the opportunity to go through with this program and earn my

Derm Tech certification. Once I have this certification I hope to put it to great use and learn so

much more and be hands on when I go to visit Dr Dharamsi. I am also extremely excited to

continue to learn more from this program and more about dermatology.