The parent institution must assure the financial, technical and moral support, and provide the necessary space, facilities and supply of patients for the establishment and maintenance of an approved residency program in dermatology. Adequate exposure to both outpatients and inpatients is necessary, as are opportunities to do research, to teach and to become acquainted with administrative aspects of the specialty. A cooperative relationship with other disciplines in medicine will result in the most effective implementation of these activities. When the resources of two or more institutions are utilized for the clinical or basic science education of a resident in dermatology, letters of agreement must be approved by the institutional governing boards. Affiliations should be avoided with institutions that are:
At such a distance from the parent institution as to make resident attendance at rounds and conferences difficult.
Do not add to the educational value of the program.
Program director and staff
The program director and his or her supporting staff must have had the necessary training and professional experience to enable them to properly train residents in dermatology. Their dedication to this purpose is paramount and they must be both adequate in number and willing and able to devote the time and effort required to assure the implementation of the administrative, educational, patient-care, and research goals of the program. An instructor-to-trainee ratio of at least one-to-three is desirable, as is a minimum of two geographic full-time members of the clinical faculty, one of whom can be the training director. Faculty from any and all clinical and basic science departments can and should be utilized to provide a complete educational experience for the trainees.
The training program shall be organized to permit the acquisition of experience and knowledge of dermatology in a graded and systematic fashion. Didactic training should complement and when possible precede or parallel the clinical activities. Such education should be organized to follow a curriculum that will ensure resident exposure to the complete range of disorders encountered by the dermatologist.
Appropriate clinical direction and supervision are necessary throughout the training period. As the experience and confidence of the trainees grows, increasing responsibility for patient management should be assumed; however, the authority and supervisory role of the staff at all levels of training must prevail.
An equivalent of the training experience must be assured for all trainees. Teaching methods throughout the training period should include various combinations of lectures, conferences, seminars, demonstrations, individual or group study of color transparencies and histologic slides, clinical rounds, chart and record reviews, faculty trainee sessions in small groups and one-to-one settings, book and journal reviews and attendance at local, regional, and national meetings. Projection equipment and facilities for reviewing and taking clinical photographs should be provided. A library containing the essential texts, journals, and other learning resources should be an integral part of each training area. Space also should be made available for dermatology conferences, preferable dedicated for that purpose.
A vital part of the residency program is the structure study of the basic sciences related to dermatology, including allergy, anatomy, bacteriology, biochemistry, embryology, entomology, genetics, histology, immunology, mycology, oncology, parasitology, pathology, pharmacology, photobiology, physiology, serology, virology, and basic principles of therapy by physical agents. Particular emphasis should be placed upon dermatologic microbiology, dermatopathology, and immunodermatology. There should be a well-organized course of instruction and range of experience in these three disciplines. The dermatopathology training should be directed by a physician with special qualification, or its equivalent, in dermatopathology.
To facilitate clinical and laboratory teaching it is essential that the department have an adequate supply of properly classified anatomic and pathologic materials, including histologic and photographic slides, and that the resident participate actively in the interpretation of histopathologic sections. Clinical laboratory facilities for microscopic analysis of biologic specimens (e.g., fungal and ectoparasite scrapings, Tzanck preparations, immunofluorescence, darkfield examinations), culture for microbes (e.g., fungi, bacterial, viruses) and interpretation of histologic specimens by light and electron microscopy should be conveniently available.
The training should be sufficient to assure a knowledge of and competence in the performance of procedures in allergy and immunology, cryosurgery, dermatologic surgery, laser surgery, dermatopathology, clinical pathology, parasitology, photobiology, physiotherapy, topical and systemic pharmacotherapy, and microbiology, including sexually transmitted diseases. Among these disciplines, dermatologic surgery should be given special emphasis in the organization and implementation of the training program.The surgical training should be directed by faculty who have had advanced training in dermatologic surgery. Dermatologic surgical training should include electrosurgery, cryosurgery, laser surgery, nail surgery, biopsy techniques, and excisional surgery with appropriate closures, including small flaps and grafts when indicated.
The practice of dermatology is concerned with both ambulatory and hospitalized patients. It is essential that an active outpatient service furnish sufficient clinical material representing the broad array of diseases seen by the dermatologist. Suitable facilities which permit the use of modern diagnostic and therapeutic techniques in the care of these patients should be provided. Inpatient facilities are also essential so that residents have the opportunity to treat the more serious cutaneous diseases on a daily basis and observe the dermatologic manifestations of systemic diseases. Dermatology staff and residents must have primary rather than consultant responsibility for patients whom they hospitalize with dermatologic illnesses.
Properly supervised experience with appropriate follow-up in the provision of consultation to other services whose patients manifest skin diseases as secondary diagnosis also is necessary. The keeping of complete and accurate consultation records within the dermatology unit should be emphasized throughout this phase of the training. Space and equipment should be provided to permit instruction in dermatologic surgery, electrosurgery, phototherapy, cryosurgery, application of topical medicaments and dressings, physiotherapy, radiotherapy, appropriate epicutaneous and intradermal testing, phototesting, and other diagnostic procedures.
During training it is necessary for trainees to gain an understanding of many diagnostic procedures and therapeutic techniques even though they might not personally perform them. Furthermore, some of these procedures or techniques might not be available in their programs. Among these techniques are procedures that include hair transplantation, dermabrasion, Mohs micrographic surgery, and tissue augmentation. The physical modalities are specially notable, because an understanding of the basic properties of the electromagnetic spectrum is needed for the resident to become knowledgeable about the effects of various forms of this energy in the cause of disease, and about their use in dermatologic diagnosis and therapy. Electron beam, x-ray, grenz ray, and laser radiation are among these modalities. Even if some of these modalities are unavailable within a training unit, it is still the director's obligation to assure that the trainee has received appropriate instruction concerning the disease implication and therapeutic application of these energy sources.
Training must be provided in cutaneous allergy and immunology, and sexually transmitted diseases. Training also should be provided in appropriate aspects of environmental and industrial medicine, internal medicine, obstetrics and gynecology, ophthalmology, otolaryngology, pathology, pediatrics, physical medicine, preventive medicine, psychiatry, radiology, and surgery.
Experience in the teaching of dermatology to other residents, medical students, nurses, and/or allied health personnel is an important element of the residency program. In addition, trainees should, when possible, be given selected administrative responsibility commensurate with their interests, abilities, and qualifications.
Faculty members should be actively involved in clinical investigation, laboratory research, and/or related scholarly activity. Residents should be actively involved in clinical research and should be exposed to basic research activities. Appropriate research facilities must be available to support the activity of faculty and residents. Some of these research facilities can be in departments other than dermatology.
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