The Case School of Medicine Dermatology Residency Program at the MetroHealth Medical Center Campus merged with its sister Case program at University Hospitals of Cleveland in July, 1996. The program director is Bryan R. Davis, M.D.

Residents

We currently have a total of thirteen residents, including one resident/fellow, who is on a four year National Institutes of Health dermatologist/basic scientist tract.

Goals

We intend to train superb dermatologists and physcian/scientists with the highest professional and ethical standards.

Background

The city of Cleveland has a population of 505,616 (1990 census) with 2,759,823 people in the metropolitan area. There had been three dermatology residency training programs in Cleveland until July 1996: the Cleveland Clinic Foundation with 12 dermatology residents, and the two programs of Case Western Reserve School of Medicine: University Hospitals of Cleveland (UH) with ten residents, and MetroHealth Medical Center with eight residents. An average of ten board eligible dermatologists were graduated each year, and many of them stayed in the Cleveland metropolitan area, joining the 135 present members of the Cleveland Dermatologic Society.

The merger between the two training programs of Case Western Reserve University (Case) School of Medicine had been contemplated for several years. This had been one of few U.S. medical schools with separate dermatology residency training programs at its major affiliated teaching hospitals. MetroHealth Medical Center, formerly Cleveland Metropolitan General Hospital, and University Hospitals of Cleveland (UH) are the two largest teaching hospitals in the medical school, each had its own dermatology training program for decades. There has always been a single academic faculty, with the academic chair traditionally sitting at UH in Dermatology, as well as in all of the other clinical departments with the exception of one.

The Three Hospital Systems

Three hospital systems make up the Case Department of Dermatology: MetroHealth Medical Center, University Hospitals of Cleveland, and the Veterans Affairs Hospital located in Wade Park, University Circle, Cleveland.

Each of the three hospitals and both of the programs have had their own personalities and strengths. In addition to the perceived need to reduce the number of graduating dermatologists, the merger was conceived to tap the strengths of the three hospitals and eliminate any relative weaknesses with a minimal loss of services.

MetroHealth is owned by Cuyahoga County and provides health care for the largest number of uninsured patients in the state. Approximately 5% of its budget comes from a county subsidy, 11% from Care Assurance, a federally funded program administered by the State of Ohio to provide care for the uninsured indigent, and the rest from private insurance and Medicaid. MetroHealth is located 9 miles from the main CWRU campus, close to downtown Cleveland. MetroHealth has nearly 14,000 outpatient visits each year, with a multiracial population including European-, Asian-, Latin-, and African-Americans. Approximately 15% of its outpatients are children. Private faculty patients are seen simultaneously with the residents' cases. Of the residents' cases, 20% are privately insured, including Medicare, 40% are Medicaid, and 40% are uninsured. The focus of the four full-time faculty is on patient supervision, teaching residents and students, and attendance at the dermatologic community activities such as city-wide grand rounds.

University Hospitals is a private, nonprofit hospital complex that is located near the center of the Case campus, although is not owned by the university. Most of its patients are covered by private insurance, but there is a large number of Medicaid and indigent, uninsured patients as well. University Hospitals has a strong scientific and laboratory framework of the its Department. It has 15 full-time faculty members, more than 10,000 square feet of laboratory space and is one of six national Skin Disease Research Centers (SDRC). The resident outpatient clinic at UH, has 3,100 outpatient visits each year, largely Medicaid, with an additional large number of faculty cases, again seen in the same setting, concentrating on patients with HIV related dermatoses, cutaneous lymphomas, and immunologic blistering diseases.

The Cleveland Veterans Administration Medical Center (VAMC) is closely affiliated with Case and with UH, and is situated within a 12 minute walk across University Circle Park, the heart of the Case campus, a beautiful walk past the Cleveland Orchestra and the Cleveland Museum of Art with its reflecting lagoon. The UH residency program had always used both UH and the VAMC for training. The VAMC's strength derives from its large, multiracial patient population. This provides more than 12,000 outpatient visits to Dermatology, virtually all of which are managed, with appropriate supervision, by the residents. The VAMC has two full-time faculty, including one whose career is dedicated to the ethical and social issues upon which dermatology impacts.

The Merged Program

The response of the Case academic department to the challenges of managed care and the change in graduate medical education funding was the merger of the two programs and the reduction of the number of residents, through graduation, from 18 to 12. Four positions will be sponsored by each of the three participating hospitals.

Didactic conferences, classes and seminars, attended by all residents, are concentrated into three mornings each week, one morning on the MetroHealth campus, and two mornings on the UH campus. Merging the two curricula was the easiest problem to solve. The subjects covered are weekly journal clubs, a core curriculum based on that of Cruz, (J Am Acad Dermatol 1993; 296:761-72), clinical photography slides shown for recognition and discussion, histopathology, and dermatologic surgery. By concentrating the didactic curriculum, by maintaining two full day clinical sessions each week on each campus, and by having the same proportion of conferences at each hospital as the number of residents there, the number of commutes across town average two trips each week for each resident.

Besides the didactic program attended by all residents, the residents rotate on various services: inpatient and consultation at the three hospitals respectively, histopathology, dermatologic surgery, specialty clinics and general clinics.

The merger changed the employment and benefit status of the residents. University Hospitals of Cleveland is the sponsoring institution for all residents. More information about the combined residency is available at the Dermatology Residency Program page on the University Hospitals' web site, although it is not kept up to date.

Application to the Program

Students interested in applying to this program should visit the web mode at http://www.uhcderm.com/residency%20program.html#application.