In dermatology, we are fortunate to have many of our profession’s innovators and great teachers still among us. This column was created so that we may gain insight from these practitioners and learn more about them. Some are bright stars in our special universe — others unsung heroes. All of these colleagues have much to share from wisdom to humor to insights into dermatology and life. Joseph B. Bikowski, Jr. MD, FAAD, is the Director of the Bikowski Skin Care Center in Sewickley, PA, the Director of Dermatologic Education for the Heritage Valley Family Medicine Residency Program, Beaver, PA, and a Clinical Assistant Professor of Dermatology at the Ohio State University in Columbus, OH. He has been in the private practice of medical dermatology for more than 30 years in Sewickley, PA. Dr. Bikowski earned his medical degree at The George Washington University School of Medicine and Health Sciences in Washington, DC, in 1971. He then served internships in both straight medicine and surgery at The Washington Hospital Center and The George Washington University School of Medicine and Health Sciences, respectively. After serving 2 years as a general medical officer in the U.S. Army’s 82nd Airborne Division, he completed his residency in dermatology at The Ohio State University Hospital in Columbus, OH, in 1978 and was certified by the American Board of Dermatology in the same year. Dr Bikowski has more than 80 publications in the medical literature, is a member of the editorial board of Cutis, Journal of Drugs in Dermatology, Dermatology Times, Cosmetic Dermatology, and is the chief medical editor of Practical Dermatology. He is the originator and director of the Pre-Board Slide Seminar. In the last 30 years, more than 85% of all diplomats of the American Board of Dermatology have taken “the pre-board” in preparation for the certification examination of the American Board of Dermatology. Q. What part of your work gives you the greatest pleasure? A. Teaching. The word “doctor” derives from the Latin “teacher” and the word “physician” derives from the Greek “healer.” My lifelong passion has been to teach patients what is wrong (and why) and to teach other physicians how to make it right (and why). Q. What are the greatest challenges facing dermatologic education? A. There are three. 1. Improving the quality and quantity of basic medical dermatologic education in dermatology residency programs. I believe that over the last 10 years there has been a marked decrease in teaching the basics — acne, rosacea, eczema, warts, etc. I think we need to return to the core of our specialty and teach the basics of diagnosis and therapy for these common medical dermatologic diseases. They are not always easy to diagnose or treat, and our expertise in managing them is crucial to the survival of our specialty. 2. Post-dermatology residency fellowships in major elective cosmetic and laser procedures. Just as further education is required for dermatopathology and Mohs micrographic surgery after 3 years of dermatology residency, I think that a minimum of at least 1 year additional training should be mandatory in major elective cosmetic/ laser procedures if one wishes to successfully and safely perform these and be considered on a “par” with plastic and reconstructive surgeons who have vastly more surgical experience prior to practice. 3. Educating physician assistants. At present, there are more than 1,700 physician assistants practicing with board certified dermatologists in the United States and it is projected that number will rise to 2,500 or more over the next 3 to 5 years. A number of these have been well-trained by their supervising physicians, but usually on the job and over a prolonged period of time. Unfortunately, the educational experience for many may be fragmented and haphazard. There is not available at this time a core medical dermatology curriculum to educate PAs in the basics of dermatology. It is my understanding that the American Academy of Dermatology is in favor of a medical dermatology core curriculum educational experience for all PAs who are supervised by a board certified dermatologist. In my opinion, it only makes good common, medical and moral sense that PAs have proven competency in the basics of medical dermatology that eventually leads to a “certification” in medical dermatology. As a physician looking for a PA to employ, I would appreciate an individual with a basic knowledge of dermatology who I could then train to practice the art as I do, and I believe that a physician assistant would more than appreciate the increased knowledge and increased opportunity for employment opportunities afforded by successful completion of such a core curriculum. _________________________
ONLINE EXCLUSIVE
Q. What is your favorite quote in medicine? A. I actually have three and, interestingly enough, they do not come from the medical literature directly. The first is attributed to Buddha: “Without health, life is not life.” Each day that I see patients I try to keep in the forefront of my diagnostic and therapeutic endeavors that my primary purpose as a physician is to improve the quality of life of others — physically, mentally and psychologically. I believe that dermatology is the specialty of skin, hair, nails, mucous membranes and the psyche. The second is by Sherlock Holmes in the “Sign of the Four,” where Sir Arthur Conan Doyle writes: “When you have eliminated the impossible, whatever remains, however improbable, must be the truth.” Doyle was a physician who trained under Sir Joseph Bell, a famous physical diagnostician of the time, who possessed remarkable powers of deductive reason. The detective skills of Holmes were patterned after the medical deductive reasoning abilities of Dr. Bell. At times I know for sure what the diagnosis is not, and what remains as a possibility, however unlikely, must be the diagnosis. And the third is by Sir William Osler: “If you listen carefully to the patient they will tell you the diagnosis.” After 30 years of clinical dermatologic practice, at times, I still feel inadequate in my diagnostic or therapeutic abilities, so it is not uncommon for me to ask the patient, “What do you think is the diagnosis?” Or, when there is more than one equally effective course of therapy, “Here are your treatment options, which do you prefer?” It is not infrequent that the patient knows the answer to the former and will invariably choose the appropriate therapy for themselves in the latter. Q. What do you feel is your dermatologic legacy? A. I would hope that I am able to leave one and I want that to be my collection of more than 200,000 clinical dermatologic images. Correct dermatologic diagnosis relies heavily on a visual memory store of previously seen clinical presentations. Verbal descriptions are of little use in making the dermatologic diagnosis. The dermatologic practitioner relies heavily on what is seen, not what is heard. Although they are quite prevalent on the Web, online searchable databases of clinical dermatologic images are of miniscule value in correctly diagnosing skin disease. It is most difficult, if not nearly impossible, to match the 3-dimensional presentation of a living human to one or two images on the 2-dimensional computer screen and arrive at a correct diagnosis. It is necessary for the clinician to see hundreds, if not thousands of patients in order to acquire a vast enough store of mental images to diagnose and differentially diagnose accurately. Even after 3 years of dermatology residency training, it still takes 3 to 5 years of active clinical practice to become a proficient practitioner of the dermatologic art. This period may be shortened and the quality of the learning experience can be enhanced with the use of a comprehensive, high-resolution, online dermatologic image library. This database would allow the student/practitioner the time and opportunity to see both the common (in their most frequent presentation as well as their variations) and not so common diseases. It is most important that this type of database be interactive with a structured written educational program (core curriculum) and is keyed to all available therapeutic options to include: mono and combination therapy, as well as, on and off-label indications for topical and systematic medications. It should also contain case presentations of pre-post treatment images to demonstrate visually the anticipated results. It is my hope that my legacy will be www.DermEdOnline.com, a basic core curriculum of medical dermatology illustrated by my more than 200,000 images of clinical dermatologic disease. Dr. Barankin is a dermatologist based in Toronto, Canada. He is author-editor of five books in dermatology, and is widely published in the dermatology and humanities literature. He is also co-editor of Dermanities (dermanities.com), an online journal devoted to the humanities as they relate to dermatology.
In dermatology, we are fortunate to have many of our profession’s innovators and great teachers still among us. This column was created so that we may gain insight from these practitioners and learn more about them. Some are bright stars in our special universe — others unsung heroes. All of these colleagues have much to share from wisdom to humor to insights into dermatology and life. Joseph B. Bikowski, Jr. MD, FAAD, is the Director of the Bikowski Skin Care Center in Sewickley, PA, the Director of Dermatologic Education for the Heritage Valley Family Medicine Residency Program, Beaver, PA, and a Clinical Assistant Professor of Dermatology at the Ohio State University in Columbus, OH. He has been in the private practice of medical dermatology for more than 30 years in Sewickley, PA. Dr. Bikowski earned his medical degree at The George Washington University School of Medicine and Health Sciences in Washington, DC, in 1971. He then served internships in both straight medicine and surgery at The Washington Hospital Center and The George Washington University School of Medicine and Health Sciences, respectively. After serving 2 years as a general medical officer in the U.S. Army’s 82nd Airborne Division, he completed his residency in dermatology at The Ohio State University Hospital in Columbus, OH, in 1978 and was certified by the American Board of Dermatology in the same year. Dr Bikowski has more than 80 publications in the medical literature, is a member of the editorial board of Cutis, Journal of Drugs in Dermatology, Dermatology Times, Cosmetic Dermatology, and is the chief medical editor of Practical Dermatology. He is the originator and director of the Pre-Board Slide Seminar. In the last 30 years, more than 85% of all diplomats of the American Board of Dermatology have taken “the pre-board” in preparation for the certification examination of the American Board of Dermatology. Q. What part of your work gives you the greatest pleasure? A. Teaching. The word “doctor” derives from the Latin “teacher” and the word “physician” derives from the Greek “healer.” My lifelong passion has been to teach patients what is wrong (and why) and to teach other physicians how to make it right (and why). Q. What are the greatest challenges facing dermatologic education? A. There are three. 1. Improving the quality and quantity of basic medical dermatologic education in dermatology residency programs. I believe that over the last 10 years there has been a marked decrease in teaching the basics — acne, rosacea, eczema, warts, etc. I think we need to return to the core of our specialty and teach the basics of diagnosis and therapy for these common medical dermatologic diseases. They are not always easy to diagnose or treat, and our expertise in managing them is crucial to the survival of our specialty. 2. Post-dermatology residency fellowships in major elective cosmetic and laser procedures. Just as further education is required for dermatopathology and Mohs micrographic surgery after 3 years of dermatology residency, I think that a minimum of at least 1 year additional training should be mandatory in major elective cosmetic/ laser procedures if one wishes to successfully and safely perform these and be considered on a “par” with plastic and reconstructive surgeons who have vastly more surgical experience prior to practice. 3. Educating physician assistants. At present, there are more than 1,700 physician assistants practicing with board certified dermatologists in the United States and it is projected that number will rise to 2,500 or more over the next 3 to 5 years. A number of these have been well-trained by their supervising physicians, but usually on the job and over a prolonged period of time. Unfortunately, the educational experience for many may be fragmented and haphazard. There is not available at this time a core medical dermatology curriculum to educate PAs in the basics of dermatology. It is my understanding that the American Academy of Dermatology is in favor of a medical dermatology core curriculum educational experience for all PAs who are supervised by a board certified dermatologist. In my opinion, it only makes good common, medical and moral sense that PAs have proven competency in the basics of medical dermatology that eventually leads to a “certification” in medical dermatology. As a physician looking for a PA to employ, I would appreciate an individual with a basic knowledge of dermatology who I could then train to practice the art as I do, and I believe that a physician assistant would more than appreciate the increased knowledge and increased opportunity for employment opportunities afforded by successful completion of such a core curriculum. _________________________
ONLINE EXCLUSIVE
Q. What is your favorite quote in medicine? A. I actually have three and, interestingly enough, they do not come from the medical literature directly. The first is attributed to Buddha: “Without health, life is not life.” Each day that I see patients I try to keep in the forefront of my diagnostic and therapeutic endeavors that my primary purpose as a physician is to improve the quality of life of others — physically, mentally and psychologically. I believe that dermatology is the specialty of skin, hair, nails, mucous membranes and the psyche. The second is by Sherlock Holmes in the “Sign of the Four,” where Sir Arthur Conan Doyle writes: “When you have eliminated the impossible, whatever remains, however improbable, must be the truth.” Doyle was a physician who trained under Sir Joseph Bell, a famous physical diagnostician of the time, who possessed remarkable powers of deductive reason. The detective skills of Holmes were patterned after the medical deductive reasoning abilities of Dr. Bell. At times I know for sure what the diagnosis is not, and what remains as a possibility, however unlikely, must be the diagnosis. And the third is by Sir William Osler: “If you listen carefully to the patient they will tell you the diagnosis.” After 30 years of clinical dermatologic practice, at times, I still feel inadequate in my diagnostic or therapeutic abilities, so it is not uncommon for me to ask the patient, “What do you think is the diagnosis?” Or, when there is more than one equally effective course of therapy, “Here are your treatment options, which do you prefer?” It is not infrequent that the patient knows the answer to the former and will invariably choose the appropriate therapy for themselves in the latter. Q. What do you feel is your dermatologic legacy? A. I would hope that I am able to leave one and I want that to be my collection of more than 200,000 clinical dermatologic images. Correct dermatologic diagnosis relies heavily on a visual memory store of previously seen clinical presentations. Verbal descriptions are of little use in making the dermatologic diagnosis. The dermatologic practitioner relies heavily on what is seen, not what is heard. Although they are quite prevalent on the Web, online searchable databases of clinical dermatologic images are of miniscule value in correctly diagnosing skin disease. It is most difficult, if not nearly impossible, to match the 3-dimensional presentation of a living human to one or two images on the 2-dimensional computer screen and arrive at a correct diagnosis. It is necessary for the clinician to see hundreds, if not thousands of patients in order to acquire a vast enough store of mental images to diagnose and differentially diagnose accurately. Even after 3 years of dermatology residency training, it still takes 3 to 5 years of active clinical practice to become a proficient practitioner of the dermatologic art. This period may be shortened and the quality of the learning experience can be enhanced with the use of a comprehensive, high-resolution, online dermatologic image library. This database would allow the student/practitioner the time and opportunity to see both the common (in their most frequent presentation as well as their variations) and not so common diseases. It is most important that this type of database be interactive with a structured written educational program (core curriculum) and is keyed to all available therapeutic options to include: mono and combination therapy, as well as, on and off-label indications for topical and systematic medications. It should also contain case presentations of pre-post treatment images to demonstrate visually the anticipated results. It is my hope that my legacy will be www.DermEdOnline.com, a basic core curriculum of medical dermatology illustrated by my more than 200,000 images of clinical dermatologic disease. Dr. Barankin is a dermatologist based in Toronto, Canada. He is author-editor of five books in dermatology, and is widely published in the dermatology and humanities literature. He is also co-editor of Dermanities (dermanities.com), an online journal devoted to the humanities as they relate to dermatology.
In dermatology, we are fortunate to have many of our profession’s innovators and great teachers still among us. This column was created so that we may gain insight from these practitioners and learn more about them. Some are bright stars in our special universe — others unsung heroes. All of these colleagues have much to share from wisdom to humor to insights into dermatology and life. Joseph B. Bikowski, Jr. MD, FAAD, is the Director of the Bikowski Skin Care Center in Sewickley, PA, the Director of Dermatologic Education for the Heritage Valley Family Medicine Residency Program, Beaver, PA, and a Clinical Assistant Professor of Dermatology at the Ohio State University in Columbus, OH. He has been in the private practice of medical dermatology for more than 30 years in Sewickley, PA. Dr. Bikowski earned his medical degree at The George Washington University School of Medicine and Health Sciences in Washington, DC, in 1971. He then served internships in both straight medicine and surgery at The Washington Hospital Center and The George Washington University School of Medicine and Health Sciences, respectively. After serving 2 years as a general medical officer in the U.S. Army’s 82nd Airborne Division, he completed his residency in dermatology at The Ohio State University Hospital in Columbus, OH, in 1978 and was certified by the American Board of Dermatology in the same year. Dr Bikowski has more than 80 publications in the medical literature, is a member of the editorial board of Cutis, Journal of Drugs in Dermatology, Dermatology Times, Cosmetic Dermatology, and is the chief medical editor of Practical Dermatology. He is the originator and director of the Pre-Board Slide Seminar. In the last 30 years, more than 85% of all diplomats of the American Board of Dermatology have taken “the pre-board” in preparation for the certification examination of the American Board of Dermatology. Q. What part of your work gives you the greatest pleasure? A. Teaching. The word “doctor” derives from the Latin “teacher” and the word “physician” derives from the Greek “healer.” My lifelong passion has been to teach patients what is wrong (and why) and to teach other physicians how to make it right (and why). Q. What are the greatest challenges facing dermatologic education? A. There are three. 1. Improving the quality and quantity of basic medical dermatologic education in dermatology residency programs. I believe that over the last 10 years there has been a marked decrease in teaching the basics — acne, rosacea, eczema, warts, etc. I think we need to return to the core of our specialty and teach the basics of diagnosis and therapy for these common medical dermatologic diseases. They are not always easy to diagnose or treat, and our expertise in managing them is crucial to the survival of our specialty. 2. Post-dermatology residency fellowships in major elective cosmetic and laser procedures. Just as further education is required for dermatopathology and Mohs micrographic surgery after 3 years of dermatology residency, I think that a minimum of at least 1 year additional training should be mandatory in major elective cosmetic/ laser procedures if one wishes to successfully and safely perform these and be considered on a “par” with plastic and reconstructive surgeons who have vastly more surgical experience prior to practice. 3. Educating physician assistants. At present, there are more than 1,700 physician assistants practicing with board certified dermatologists in the United States and it is projected that number will rise to 2,500 or more over the next 3 to 5 years. A number of these have been well-trained by their supervising physicians, but usually on the job and over a prolonged period of time. Unfortunately, the educational experience for many may be fragmented and haphazard. There is not available at this time a core medical dermatology curriculum to educate PAs in the basics of dermatology. It is my understanding that the American Academy of Dermatology is in favor of a medical dermatology core curriculum educational experience for all PAs who are supervised by a board certified dermatologist. In my opinion, it only makes good common, medical and moral sense that PAs have proven competency in the basics of medical dermatology that eventually leads to a “certification” in medical dermatology. As a physician looking for a PA to employ, I would appreciate an individual with a basic knowledge of dermatology who I could then train to practice the art as I do, and I believe that a physician assistant would more than appreciate the increased knowledge and increased opportunity for employment opportunities afforded by successful completion of such a core curriculum. _________________________
ONLINE EXCLUSIVE
Q. What is your favorite quote in medicine? A. I actually have three and, interestingly enough, they do not come from the medical literature directly. The first is attributed to Buddha: “Without health, life is not life.” Each day that I see patients I try to keep in the forefront of my diagnostic and therapeutic endeavors that my primary purpose as a physician is to improve the quality of life of others — physically, mentally and psychologically. I believe that dermatology is the specialty of skin, hair, nails, mucous membranes and the psyche. The second is by Sherlock Holmes in the “Sign of the Four,” where Sir Arthur Conan Doyle writes: “When you have eliminated the impossible, whatever remains, however improbable, must be the truth.” Doyle was a physician who trained under Sir Joseph Bell, a famous physical diagnostician of the time, who possessed remarkable powers of deductive reason. The detective skills of Holmes were patterned after the medical deductive reasoning abilities of Dr. Bell. At times I know for sure what the diagnosis is not, and what remains as a possibility, however unlikely, must be the diagnosis. And the third is by Sir William Osler: “If you listen carefully to the patient they will tell you the diagnosis.” After 30 years of clinical dermatologic practice, at times, I still feel inadequate in my diagnostic or therapeutic abilities, so it is not uncommon for me to ask the patient, “What do you think is the diagnosis?” Or, when there is more than one equally effective course of therapy, “Here are your treatment options, which do you prefer?” It is not infrequent that the patient knows the answer to the former and will invariably choose the appropriate therapy for themselves in the latter. Q. What do you feel is your dermatologic legacy? A. I would hope that I am able to leave one and I want that to be my collection of more than 200,000 clinical dermatologic images. Correct dermatologic diagnosis relies heavily on a visual memory store of previously seen clinical presentations. Verbal descriptions are of little use in making the dermatologic diagnosis. The dermatologic practitioner relies heavily on what is seen, not what is heard. Although they are quite prevalent on the Web, online searchable databases of clinical dermatologic images are of miniscule value in correctly diagnosing skin disease. It is most difficult, if not nearly impossible, to match the 3-dimensional presentation of a living human to one or two images on the 2-dimensional computer screen and arrive at a correct diagnosis. It is necessary for the clinician to see hundreds, if not thousands of patients in order to acquire a vast enough store of mental images to diagnose and differentially diagnose accurately. Even after 3 years of dermatology residency training, it still takes 3 to 5 years of active clinical practice to become a proficient practitioner of the dermatologic art. This period may be shortened and the quality of the learning experience can be enhanced with the use of a comprehensive, high-resolution, online dermatologic image library. This database would allow the student/practitioner the time and opportunity to see both the common (in their most frequent presentation as well as their variations) and not so common diseases. It is most important that this type of database be interactive with a structured written educational program (core curriculum) and is keyed to all available therapeutic options to include: mono and combination therapy, as well as, on and off-label indications for topical and systematic medications. It should also contain case presentations of pre-post treatment images to demonstrate visually the anticipated results. It is my hope that my legacy will be www.DermEdOnline.com, a basic core curriculum of medical dermatology illustrated by my more than 200,000 images of clinical dermatologic disease. Dr. Barankin is a dermatologist based in Toronto, Canada. He is author-editor of five books in dermatology, and is widely published in the dermatology and humanities literature. He is also co-editor of Dermanities (dermanities.com), an online journal devoted to the humanities as they relate to dermatology.
