Dr. Angelica Selim

The aesthetic appeal of skin tissue helped determine Dr. Selim’s career choice. She created this art wall in the DermPath sign-out room; the monitor shows tissue with lichen sclerosus.

THE ACTION OF LEARNING

by WHITNEY J. PALMER

Unlike most scientists or doctors, MARIA ANGELICA SELIM, MD didn’t have an “Aha!” moment when she knew, beyond a shadow of a doubt, that she would be a physician. Medicine was just simply around her—her father is an internist; her mother, a pediatrician. So, she grew up assuming being a doctor was her future. Identifying a specialty, though, was harder. To find what best fit her interests, Selim’s father coordinated times for her to shadow his colleagues who worked in areas of medicine most related to images—radiology, dermatology, and pathology. For her, pathology, with its opportunities to examine shapes and colors, hit the mark. “My father asked me if I felt I could be the person behind the microscope all day,” she said, recalling her excitement at what she saw on the slide. “I said yes. I found what his colleague did to be fascinating, and I could easily see myself in that role.”

Today, Selim, Professor of Pathology and Dermatology, serves as the Chief of the Division of Dermatopathology at Duke University Medical Center and is considered a leading international voice in vulvar pathology. She is also a highly respected and sought-after educator who has spent more than 20 years at Duke cultivating the next generation of pathologists.

“My career, for me, has been a journey. It has been something that never ends,” she said. “It is not something that is permanent, but rather filled with movement, action, and learning. At Duke, I have always felt that there was something next—it is what has kept me here at this institution.”

The Journey

After shadowing her father’s pathologist colleague, her trajectory was set. Following medical school graduation at the Universidad Nacional de La Plata in Argentina, Selim completed her residency in pathology at New England Deaconess Hospital, now Beth Israel Deaconess Medical Center, and her dermatopathology fellowship at The Harvard Medical School Dermatopathology program. It was the sheer volume of skin biopsies that caught her eye, and soon her colleagues were bringing her cases for evaluation. Thus, her expertise began to grow. “With so many cases, my co-workers would see me reading and trying to figure things out by myself,” she said. “They started to bring me cases to look over and help them. They naturally started to select me as the go-to person for asking skin biopsy questions.”

But her journey had just begun. The next stop on her career path brought her to Duke in 1999 when she accepted Assistant Professorships in Pathology and Medicine. For nearly two decades, she was integral to coordinating and supervising the combined dermatopathology residency education program from both the pathology and dermatology departments. In 2013, her work led to her promotion to dual professorships. One of Selim’s clinical contributions has been integrating multi-disciplinary study of vulvar disorders. Vulvar pathology has, historically, been a conundrum both for patients and doctors. The associated disorders are poorly understood, and there was little-to-no collaboration between specialties, leaving countless women to suffer without answers or treatment.

But for Selim, with her lifelong fascination with colors and images, diagnosing these disorders is like solving a puzzle. And with each puzzle she completes, another woman gets clarity for her painful questions. “The vulva is an organ with a very significant skin component. Both gynecologists and dermatologists are familiar with it, but at the time a multi-specialty approach was not a frequent practice,” she explained. “Then people started to understand that whatever skin disorder affects the body extra-genitally also has a high probability of also manifesting on the vulva.”

What followed was an explosion of knowledge, she said, with gynecologists, dermatologists, and pathologists all beginning to work together to provide better care for women. Not only did collaborations increase, but so did the number of vulvar dermatoses included in classifications. In the 1970s, lichen sclerosus was the only inflammatory process recognized in the ISSVD classification, but by 2011, dozens of dermatoses were recognized as part of the classifications for vulvar dermatologic disorders.

“Women with these conditions had been very, very upset because they were going from one specialty to another without receiving an answer,” she said. “I got involved because I saw there was a need for more interactions between the specialties—if we brought in skin pathology, we may be able to give these women better service.”

The Journey for the Next Generation

It is the quest for knowledge that pushed Selim to go beyond her clinical work. She wanted to make connections with others in her field and participating in international conferences was a prime avenue for having broader conversations and learning from others’ experiences. And Duke’s reputation as an international leader with its campus in Singapore helped open those doors for her. She likened it to standing on the shoulders of a giant. “Duke has a very large international presence, and for many people it creates the perception that the University doesn’t have boundaries,” she said. “It is an institution that welcomes other people, ideas, philosophies, and cultures.”

Attending these conferences fed Selim’s intense love of travel, and it also broadened her impact on the specialty. By learning, sharing ideas, and networking at these events, she cemented her own reputation as a leader and positioned herself as a valued teacher. Consequently, she was chosen as Duke’s Dermatopathology Fellowship Program director, a position she held from 2001 until 2019. During that time, she trained more than 20 fellows, giving her the opportunity to launch the next generation of pathologists on their own journey. Today, many of them work as her colleagues at institutions across the country. “I now have the pleasure of working with my friends that have trained with me when we go to conferences because they also embrace the idea of collaboration,” she said. “When you train, you pass your knowledge on to your fellows, and you connect people.”

It’s this approach that has earned her several accolades over the years. In 2017, she received the American Society of Dermatopathology’s annual Walter R. Nickel Award for Excellence in Teaching of Dermatopathology for contributions to education in the field. She is also the four-time recipient of Duke’s Dr. J. Lamar Callaway Teaching Award for outstanding contributions in teaching the art of dermatology, as well as a two-time recipient of the Bernard F. Fetter Teacher Award given by the pathology house staff to the faculty member whose skills, knowledge, and attitude have most influenced their education.

“Many of my fellows told me they knew my voice would be in their head, and I responded that I hoped it would only be for a short time.” Maria Angelica Selim, MD

COMING OUT FROM DRIVING THE 10-HEAD SCOPE TO TEACH Dr. Selim conceived the prototype for our sign-out rooms with multi-monitor computer and scope camera screens for group viewing.

She credits her success as an educator to her approach in selecting the fellows she trains. It’s not about only choosing individuals with the greatest technical skill—it’s about nurturing students who will add to the field in a variety of ways. “You are looking for individuals who you want to be your next colleague, someone who reflects what you want the specialty to be, someone who embraces the institution and has ethical standards for the specialty,” she said. “You want people who have the confidence to jump in, be leaders, and be someone you can be extremely proud of whether they opt for academic or private practice.”

Although she trained and provided guidance, it was never her intent to create cookie-cutter versions of herself. Her hope was that her fellows would internalize the experience and knowledge she imparted and parlay it into their own philosophy and approach to practice. “Many of my fellows told me they knew my voice would be in their head, and I responded that I hoped it would only be for a short time,” she said. “I only gave them the tools they needed to find their own voice and naturally develop their own style of practice.” Armed with those skills, they can not only serve patients and potentially teach others, but they can also enjoy their own lifelong learning pursuits. Doing so is something that continues to drive Selim on a daily basis. “I am still creating my style and discovering myself, and I am still able to share with my fellows and colleagues,” she said. “It is all about the action of learning. I am still on that journey.”

Fellows from the Duke Dermatopathology Fellowship program gather around Dr. Selim at the 2017 ASDP Annual Meeting.