Residency Programs

Below you will find the essentials of accredited dermatology residencies. If you are interested in admittance into a residency training program, you may contact the National Resident Matching Program, 2450 N. Street N.W., Suite 201, Washington, D.C. 20037-1131, or call (202) 828-0676.

If you desire further information, please contact the American Board of Dermatology, Henry Ford Hospital, 1 Ford Place, Detroit, MI 48202-3450, or call (313) 874-1088. They have a pamphlet available that might be of interest to you.

Requisites of the Program | Resident Evaluation | Special Responsibilities of the Program Director | Training Programs in Dermatopathology | Definition of Dermatology | Nature of Residency | Advanced Training | Board Requirements

Essentials of Accredited Residencies

Special Requirements for Residency Training in Dermatology

OBJECTIVES AND CONDITIONS:

Approved training programs in dermatology shall be organized to provide trainees with the educational and practical experience that will permit them to deliver superior specialized care to patients with diseases of the skin. Such experience must be varied and broad, progressive and systematic, and of sufficient duration. Moreover, it must include instruction in the pertinent basic sciences and in all clinical areas that bear upon the specialty of dermatology, and training in research and teaching. Accomplishment of these objectives requires a suitable institutional environment, a cooperative and supportive administrative authority, a stable financial base, and enthusiastic, competent and available staff, and adequate patient population, modern efficient equipment and space, and satisfactory liaison with other disciplines that relate to dermatology.

DURATION OF TRAINING

A training program shall offer a minimum of three years of graduate medical education in dermatology. Trainees must have satisfactorily completed a broad-based clinical year of training (PGY-1) in an ACGME accredited program or a similar Canadian accredited program prior to entering a dermatology residency program.

A four-year program must provide a broad-based clinical experience during the first year and three years of dermatology education in the second through fourth years of the program.

About 75 percent of the resident's time spent in each year of dermatology residency training must be related to the direct care of dermatologic outpatients and inpatients; this includes consultations, clinical conferences, and inpatient rounds.

Dermatopathology, microbiology, and other basic science lectures, seminars, and conferences are essential components of the resident's training.

Exceptionally, accreditation of residency programs that are shorter than three years is possible, but only under the following conditions:

This training must represent an unusual and highly specialized experience, in research or in a selected major area of dermatology, in an institution with extraordinary capability in such fields and with multiple accredited training programs in other disciplines. Moreover, training under such conditions will provide the trainee with only one year of credit to be applied against the necessary three years of training in dermatology. This training may not be used in lieu of the first postgraduate year or the first year of residency training in dermatology.

REQUISITES OF THE PROGRAM

1) Institutional

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.

2) 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.

3) Content

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.

4) Research

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.

RESIDENT EVALUATION

Periodic in-training evaluation of trainees should be carried out to ensure that the trainee is making satisfactory progress. Both formal examinations and performance ratings by the faculty can be utilized and the trainee should be personally appraised of his or her strengths and weaknesses at appropriate intervals at least twice annually. Completion by the program director of resident yearly report forms, such as those requested by the American Board of Dermatology and other certifying boards, is an important part of this evaluation process.

One measure of the quality of a program is the performance of its graduates on the certifying examination of the American Board of Dermatology.

SPECIAL RESPONSIBILITIES OF THE PROGRAM DIRECTOR

Internal analysis of the training program by the program director and his or her staff is essential in addition to the regular surveys conducted by the Residency Review Committee for Dermatology. One measure of the quality of a program is the performance of its graduates on the certifying examination of the American Board of Dermatology.

The program director must notify the Secretary of the Residency Review Committee of any change in the program, staffing, affiliations or facilities which might significantly alter the educational experience.

At times of his or her absence, the program director must designate an interim director. If this period is for six months or longer, the Residency Review Committee should be notified. Appointment of an interim director should not exceed two years because it might have a detrimental effect on the program.

A log of surgical procedures performed by residents must be kept on file and provided upon request to the Residency Review Committee or the site visitor. Documentation of resident evaluation, institutional and inter-institutional agreements, resident agreements and departmental statistics should be kept on file and provided upon request to the Residency Review Committee or site visitor. The accurate and complete execution of application forms, progress reports and replies to other requests from the Residency Review Committee is the responsibility of the program director. The care and precision given to these responses will be taken into consideration in the assessment of the training program.

The program director must ensure that residents are adequately supervised by faculty at all times. Further, resident duty and on-call assignments must be made in a manner that ensures that neither education nor quality of patient care is jeopardized by inappropriate resident stress or fatigue. Physicians must have a keen sense of personal responsibility for continuing patient care, and must recognize that their obligation to patients is not automatically discharged at any given hour of the day or any particular day of the week. In no case should a resident go off duty until proper care and welfare of the patients have been ensured. Resident duty hours and night and weekend call must reflect the concept of responsibility for patients and provide for adequate patient care. Residents must not be required regularly to perform excessively difficult or prolonged duties. When averaged over four weeks, residents should spend no more than 80 hours per week in hospital duties. Residents at all levels should, on average, have the opportunity to spend at least one day out of seven free of hospital duties and should be on call no more often than every third night. There should be an opportunity to rest and sleep when on call for 24 hours or more. Trainees should be adequately supported to permit their undivided attention to educational and service responsibilities.

The program director should advise all residents planning to seek certification by the American Board of Dermatology to complete the Preliminary Registration Form of this Board and to communicate directly with the Executive Director of the Board to be certain that they are in full compliance with the requirements for certification.

Effective: January 1991
ACGME: September 1990

TRAINING PROGRAMS IN DERMATOPATHOLOGY

The training program in dermatopathology shall be an equal and joint function of the department of dermatology and of the department of pathology. The training period in dermatopathology shall be one or more years subsequent to the satisfactory completion of residency training in an approved program in either dermatology or pathology as outlined in the DIRECTORY OF RESIDENCY TRAINING PROGRAMS. For pathologists, the dermatopathology program must include a minimum of six months of training in clinical dermatology in a program accredited by the Accreditation Council for Graduate Medical Education or its equivalent. For dermatologists, dermatopathology program must include a minimum of six months of training in anatomic pathology in a program accredited by the Accreditation Council for Graduate Medical Education or its equivalent. In either instance, this experience may be either in block or integrated in the first year of the program.

The sponsoring institution must provide ample case material and supporting facilities to meet the training requirements in dermatopathology, clinical dermatology, autopsy pathology, and surgical pathology.

The dermatopathology training program must include both didactic instruction and practical experience in the clinical and microscopic diagnosis of skin disorders by means of direct inspection, appropriate microscopic techniques including light and electron microscopy, immunopathology, histochemistry, and the relevant aspects of cutaneous mycology, bacteriology, and entomology. The program should provide an environment in which medical research related to the specialty is actively pursued. The program must provide a sufficient volume and variety of dermatologic problems and other educational material for the trainee to acquire the qualifications of a consultant in dermatopathology. The program must provide the trainee with the training required to set up and to operate a dermatopathology laboratory and to supervise and train laboratory personnel.

The program must be directed and closely supervised by a physician possessing board certification or equivalent training and experience in either of the contributing specialties of dermatology or pathology. The program director must devote sufficient time to provide adequate leadership to the program and supervision for the trainees. The program director must evaluate the performance of trainees in accordance with the General Requirements of the ESSENTIALS OF ACCREDITED RESIDENCIES.

EFFECTIVE: July 1987
ACGME: 1986

DEFINITION OF DERMATOLOGY

A dermatologist is a physician who has expertise in the diagnosis and treatment of pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair, and nails, as well as a number of sexually transmitted diseases. Dermatologists have extensive training and experience in the diagnosis and treatment of skin cancers, melanomas, moles, and other tumors of the skin, contact dermatitis, and other allergic and non-allergic disorders and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. The dermatologist also has expertise in the management of cosmetic disorders of the skin such as hair loss and scars.

To be certified as a dermatologist, a physician must have had at least four years of post-graduate residency training accredited by the Accreditation Council for Graduate Medical Education. The first broad-based general clinical year is followed by three years of intensive training in dermatology, including dermatopathology and dermatologic surgery. In addition to the successful completion of the four years of required training, the certification process includes a comprehensive examination administered by the American Board of Dermatology.

With this background and knowledge, dermatologists are singularly qualified to diagnose and treat the wide variety of dermatologic conditions, as well as benign and malignant skin tumors. Dermatologists also have expertise in the care of normal skin and in the prevention of skin diseases and skin cancers.

Dermatologists perform many specialized diagnostic procedures including microscopic examination of skin biopsy specimens, cytological smears, patch tests, photo tests, potassium hydroxide (KOH) preparations, fungus cultures, and other microbiologic examination of skin scrapings and secretions. Treatment methods used by dermatologists include externally applied, injected, and internal medications, selected x-ray and ultraviolet light therapy, and a range of dermatologic surgical procedures. The training and experience of dermatologists in dermatologic surgery include electrosurgery, cryosurgery with the use of freezing surgical units, laser surgery, nail surgery, biopsy techniques and excisional surgery with appropriate closures, including flaps and grafts. Among some of the techniques used by dermatologists for the correction of cosmetic defects are dermabrasion, chemical face peels, hair transplants, injections of materials into the skin for scar revision, sclerosis of veins, and laser surgery of vascular lesions of the skin, including certain birthmarks.

Patients seeking a dermatologist may come directly or may be referred by another physician.

A certified specialist in dermatology may subspecialize and become certified for special qualification as follows:

DERMATOPATHOLOGY (Special Qualification in Dermatopathology)

All dermatologists have training and experience in dermatopathology, however, special qualification in dermatopathology, which signifies advanced competence, can be obtained by either a board-certified dermatologist or pathologist. Special qualification involves further extensive training and experience in the evaluation of tissue specimens submitted from dermatologic patients. These evaluations include the examination and interpretation of microscopic slides of thin tissue sections and smears, and scrapings from lesions of skin and related tissues. The dermatopathologist has expertise in light and electron microscopy, immunohistochemistry, and laboratory management.

IMMUNODERMATOLOGY (Special Qualification in Dermatological Immunology/Diagnostic and Laboratory Immunology)

An immunodermatologist is a dermatologist who, through additional special training, has developed expertise in the study of the cause, diagnosis, treatment, and outcome of skin diseases involving the immune system. These physicians have a basic understanding of such diseases from the perspective of anatomic and clinical pathology, along with the accurate interpretation of immunologic analyses of tissue cells and body fluids. The immunodermatologist is knowledgeable and experienced in utilizing many forms of immunological treatments.

NATURE OF RESIDENCY

Following the first post-graduate year of training (PGY1) , the resident is required to take an additional three years of full-time training as a resident in a dermatology residency training program accredited by the Accreditation Council for Graduate Medical Education (ACGME), or three years of full-time training as a resident in a dermatology residency program accredited by the Royal College of Physicians and Surgeons of Canada. Accreditation of dermatology training programs in the United States is the responsibility of the Residency Review Committee for Dermatology acting with authority delegated to it by the ACGME.

About 75 percent of the resident's time spent in each year of dermatology residency training must be related to the direct care of dermatologic outpatients and inpatients; this includes consultations, clinical conferences, and inpatient rounds. Dermatopathology, microbiology and other basic science lectures, seminars, and conferences are essential training components, and so are basic and clinical investigation. Residents are encouraged to participate in research during their training.

During or following the first year of dermatology training (PGY2), the training director may request prospective approval from the American Board of Dermatology for a special final two years for those trainees whose career plans involve a primary commitment to investigative dermatology.

Training must be completed within five years after the beginning of dermatology residency, except when military services or other compelling circumstances intervene.

Most residents complete all their dermatological training in one institution.

ADVANCED TRAINING

The American Board of Dermatology offers a special qualification certification in either dermatopathology or dermatological immunology/diagnostic and laboratory immunology. This requires an extra year of specific accredited fellowship training.

BOARD REQUIREMENTS

The certifying examination consists of two parts. Part one is a comprehensive written examination including the following topics: clinical dermatology, preventative dermatology, dermatopathology, cutaneous allergy and immunology, dermatologic surgery, cutaneous oncology, sexually transmitted diseases, internal medicine as it's related to dermatology, photobiology and cutaneous microbiology, as well as anatomy, physiology, biochemistry, radiation physics and therapy, physical therapy, pharmacology, genetics, and electron microscopy as it's related to dermatology. Considerable emphasis is placed on comprehensive knowledge of the literature.

Part two utilizes visual aids and histopathologic sections to assess the candidates, knowledge of the topics listed above but with special emphasis on clinical and laboratory dermatology, dermatologic surgery, and microscopic dermatopathology. In microscopic dermatopathology (250i of the part two examination), questions relate to histopathologic slides examined by the candidates. Candidates must furnish microscopes.

Candidates must pass both parts oneI and two to be certified. If a candidate passes one portion, only the failed portion and not the other needs to be repeated. The examination is given annually in the fall during a two-day period involving a total of about 10 hours.

Prerequisites for taking the board examination include:

1. Graduation from a medical school in the United States accredited by the Liaison Committee for Medical Education (LCME), an accredited medical school in Canada, or an accredited osteopathic school in the United States. Graduates from foreign medical schools are required to have the standard certificate of the Educational Commission for Foreign Medical Graduates (ECFMG).
2. One year of clinical training in one of the following types of board-based programs in the United States accredited by an Accreditation Council for Graduate Medical Education (ACGME) or a similar program in Canada accredited by the Royal College of Physicians and Surgeons of Canada: transitional year, flexible first postgraduate year, and first year residencies in internal medicine, general surgery, family practice, or pediatrics. A residency in a discipline that does not involve direct patient care, such as pathology, is not acceptable for first postgraduate year credit.
3. Must hold a currently valid, full, and unrestricted license to practice medicine or osteopathy in the United States or Canada. This is a prerequisite for taking the board examination, but many residents only have temporary licenses in their PGY1 and residency.