Walking on sunshine
UND medical students get hands-on dermatology education at the Fargo Center for Dermatology.
It’s really quite simple, said Dr. Rachel Ness from her office at the Fargo Center for Dermatology (FCD).
“If you want to protect your skin, the most economical, smartest thing you can do is just good sun protection,” explained the UND School of Medicine & Health Sciences (SMHS) alum, noting that even if we can’t alter our genetic profile, we can often control our exposure to the sun. “Whether it’s in the form of protective clothing – a hat or long sleeves – or sunscreen, all of that is going to reduce your chances of getting melanoma, squamous or basal cell carcinoma, and other types of skin cancers.”
Unfortunately, added Ness, even for those of us who don’t take our skin for granted, it’s easy to underestimate how damaging ultraviolet radiation can be. Although estimates vary – and hinge on the sun’s position in the sky, cloud cover, and the fairness of the skin in question – overexposure can occur in as few as 10 to 15 minutes for some skin types.
But natural sun isn’t the only problem, said Ness.
“I grew up in the era when the sun tanning industry really tried to convince us that a tanning bed tan was a healthy tan,” continued the physician who earned her M.D. from UND in 2003 and completed a dermatology residency in Wisconsin before coming back to North Dakota. “And now I’m seeing all those patients who lived in tanning beds developing melanoma.”
Skin cancer awareness
All of this is why Ness and her team of providers make community education as much of their goal as patient care. To that end, FCD has for more than a decade sponsored a free skin cancer screening each May that draws dozens of walk-in patients.
This past May, though, Ness handled the event a bit differently. After hosting a meeting with fourth-year UND medical student Mitchell Gullickson and some of his colleagues, Ness agreed to make the annual screening, which the clinic coordinates in recognition of Skin Cancer Awareness Month, an educational event for UND’s future physicians.
“Mitch came to me and said ‘we would love to do something with you,’” said Ness of Gullickson and his team of UND medical students. “This was the first year out of 15 that we’ve done such a partnership and it was a great community experience.”
According to Ness, on the day of the free screening, the dozen or so UND medical students welcomed incoming patients and helped them register. Showing the patients to an exam room, the students helped educate walk-ins on skin protection and the basics of skin cancer. Later, with a provider’s assessment in-hand, the students also helped explain to patients what the provider’s report might mean – if any skin lesions concerned the provider or if they appeared benign, giving the student a chance to improve their communication and teaching skills in the medical setting. If anything on a patient’s skin did concern the provider, students provided patients with a “next steps” form and a list of phone numbers, recommending that they schedule a follow-up appointment with any dermatology provider in the region.
In all, the event saw nearly 70 patients that day.
“I remember having conversations with relieved patients who traveled from a long distance or cited financial concerns as their main reason for attending the event,” said Gullickson, who hails from Fargo. “There was a deep sense of gratitude all around. Many of the medical students who volunteered their time with this event had a big exam the following day, so they showed real commitment to serving others by volunteering their time to help make this event a success.”
One of those students was Apple Valley, Minn., native Mckenzie Samson, who noted how she found the experience significant, even if she’s not necessarily interested in specializing in dermatology.
“No matter what area of medicine you’re in, I think it’s important to practice working with patients – and just having that general knowledge,” said Samson, who has her eye on anesthesiology. “Because you never know what kind of questions a patient might ask you. And the community engagement part of this is huge. We’ve been supported within our clinical rotations by area providers and patients, and I think it’s always a great thing to be able to serve and to give back.”
Six month wait
Encouraging students to understand dermatology better is especially important in a northern climate insofar as North Dakota, for example, both plays host to a predominantly fair-skinned population and is experiencing a major shortage of dermatologists.
“Right now, it’s usually four to six months minimum in the entire state of North Dakota to see a dermatologist,” Ness said, admitting that her screening event is both good community care and is vital for some people. “This is a way of capturing 70 to 80 people who might not otherwise have access to care but were worried about a spot on their skin. That way, we can at least help triage some of those patients, and be more efficient with our medical education because now we have students who want to help.”
As Ness described the situation, although interest in dermatology as a specialization is increasing among medical school graduates, the production of board-certified dermatologists is still slowed by the lack of dermatology residencies nationwide. The lack of residencies and dermatologists in most regions, including North Dakota, results in fewer rotations and dermatology-based electives for students, meaning fewer graduates get exposed to or seek out dermatology as a specialization and the cycle repeats.
And because most physicians end up practicing close to or in the community where they completed their residency, added Ness, the lack of a dermatology residency in North Dakota contributes to the loss of at least some specialists to other states every year.
“It’s also extremely competitive to get into one of the few residencies that do exist – there aren’t a lot of slots available,” she said.
For his part, dermatologist Michael Ebertz, M.D., founder of Skin Care Doctors, P.A., in Minneapolis, Minn., agreed, adding that while there is a shortage of providers, particularly in the upper-Midwest, he remains hopeful.
“Dermatology continues to be one of the most sought-after specialties in medicine,” said the 1992 SMHS grad, noting how there seems to be a greater interest in skin care today than a generation ago. “There is a high level of job satisfaction among dermatologists compared to many other specialties, which is a big reason for its popularity. The whole field of dermatology continues to grow and has been very exciting to be a part of. I can hardly wait to see what the next 20 years will bring in terms of advancements and the great opportunities for patient care.”
Filling the gap year
All of this is why Ness not only sponsors the free screening but lectures on dermatology for the SMHS. It’s also why FCD maintains a robust Gap Year Internship program for prospective or wait-listed medical students.
As Ness described her Gap Year program, which she began shortly after founding her Fargo clinic, undergraduates taking a gap year between their undergraduate and medical schooling – or those who have been waitlisted for medical school – can apply to intern at FCD. At the Center, interns are trained in everything from patient admissions, preauthorizations, and scribing to drug interactions, blood draws, and same-day surgery processes.
“In this way, future med students spend a year getting clinical experience to really build their resume, and also to get letters of recommendation from us,” said Ness of a program wrapping up its eighth year. “The whole point is to give all of these young, ambitious people some great experiences. Even if none of these people intend to go into dermatology, they still spend a year working in healthcare. Part of the idea is that we then help them through their med school application process.”
This program is actually how Ness and Gullickson first met. Joining the FCD as a Gap Year intern in 2019, Gullickson feels that the program put him ahead of many of his classmates during his first year of training at the UND SMHS.
“My passion for dermatology truly started during my time in the gap year program,” Gullickson admitted. “I felt much more prepared going into medical school following this position as I gained valuable experience with note writing, history taking, and dermatology-specific knowledge. Dr. Ness and the rest of the providers at the clinic do a phenomenal job of teaching, training, and mentoring the gap year interns. They understand that most of us will be providers one day as well.”