ARTICLE
Auteur(s) : Wolfram Sterry
Department of Dermatology, Charité Campus Mitte, Charité-
Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin,
Germany
Chairman of EDF Guideline CommitteeWolfram
SterrySubcommittee membersHelmut Kerl, Graz (Austria)Günther
Burg, Zürich (Switzerland)Rino Cerio, London (United
Kingdom)Lorenzo Cerroni, Graz (Austria)Bernard Cribier, Strasbourg
(France)Harald Gollnick, Magdeburg (Germany)Heinz Kutzner,
Friedrichshafen (Germany)Wolfram Sterry, Berlin (Germany)Members
of EDF Guideline CommitteeWerner Aberer, Graz (Austria)Martine
Bagot, Créteil (France)Lasse Braathen, Bern (Switzerland)Sergio
Chimenti, Rome (Italy)José Luis Diaz-Perez, Bilbao (Spain)Vladimir
Hegy, Bratislava (Slovak Republic)Lajos Kemény, Szeged
(Hungary)Gillian Murphy, Dublin (Ireland)Martino Neumann, Rotterdam
(The Netherlands)Tony Ormerod, Aberdeen (UK)Annamari Ranki,
Helsinki (Finland)Fenella Wojnarowska, Oxford (UK)
Special qualification (expertise) in dermatopathology
Special qualification in dermatopathology can only be achieved by
years of practice and experience.
Regulations and requirements for accreditation of speciality
training programmes in dermatopathology
Identification of accredited training programmes and eligibility
assessment for the examination could be accomplished by a Review
Subcommittee, which includes equal members from both Pathology and
Dermatology Boards. This subcommittee cannot function in a
licensing role (as this is governmental task), however, it would be
responsible for reviewing the performance (structure, program
design) of the teaching institution. Programmes wishing to be
accredited will have documentation as to requirements and on-site
inspection that will include evaluation of the facility, interview
with the director of dermatopathology and teaching staff and the
trainees. The programme must have ongoing mechanisms of evaluation
(re-accreditation).
Training for special qualifications in dermatopathology can also
be completed by European physicians in the USA when accepted by
Dermatopathology Centers with ACGME (= Accreditation Council for
General Medical Education)-approved training programmes.
The following guidelines could be used:
- – Training must be directed and closely supervised by a
pathologist / dermatologist with documented qualifications in
dermatopathology (International Board of Dermatopathology; Royal
College of Pathologists; American Board of Dermatopathology). The
trainee must be given the opportunity to “sign out” under
supervision.
- – Training in dermatopathology must be linked with a
university clinic, hospital or a comprehensive dermatopathology
center.
- – The programme must provide organized training in the
following areas concerning dermatopathology: routine histology,
special stains, immunofluorescence and immunoperoxidase techniques,
molecular techniques (PCR)1,
(electron microscopy, optional), laboratory management, quality
assurance.
- – A sufficient number and variety of dermatopathology
specimens – at least 3000 new accessions per annum – must be
available for the trainees to gain experience in diagnostic
dermatopathology. In addition study sets and other educational
materials should be provided.
- – Candidates for speciality training in dermatopathology
must have successfully completed their residency training in
dermatology/pathology, as required by the various national
licensing bodies. They should also confirm continuous and authentic
exposure to dermatopathology during their residency time.
- – Discussions, tutorial rounds, lectures, and
conferences must be regularly scheduled and held. Especially
clinico-pathological conferences, scheduled on a regular base
within qualified dermatological clinics, are important in this
respect.
Recommendations for length of speciality training
- – Satisfactory completion of two years of speciality
training in dermatopathology in a programme accredited for such
training.
- – Dermatologists would also be expected to spend a
minimum period of 6 months in a Pathology Department studying
anatomic and surgical pathology.
Organisation of a dermatopathology: laboratory and
requirements
The institution must provide for the practical service and training
in dermatopathology the following facilities:
Laboratories
Laboratories (within the training institution) with adequate space
and technical equipment for: routine histology, special stains,
immunofluorescence and immunoperoxidase techniques, molecular
techniques (DNA-PCR), (electron microscopy, optional), laboratory
management, quality assurance.
Personnel
A programme director who is responsible for the direction and
general administration of the laboratory. He must show documented
qualifications in dermatopathology (experience training; Diploma in
Dermatopathology) and be especially responsible for the training
programme. There must be a sufficient number of qualified
physicians (pathologists, dermatologists) with documented
experience and qualifications in dermatopathology. (In the USA for
dermatology there is a ratio of one full-time faculty member to 3
trainees.) Other staff: There must be a sufficient number of
qualified technicians and clerical staff to support practical
laboratory work and to meet the service responsibilities.
Dermatopathology specimens
The number of routine dermatopathology specimens from within the
institution and from outside (including referrals) must be at least
3000 per annum. This material must be available for examination to
residents and to trainees seeking special qualification in
dermatopathology. In addition slide sets should be provided.
Microscopes including a multi-headed microscope
Projection microscopes linked to a television video monitor.
Office facilities
Computers, computer medical databases and a multi-user network
system for input of data and generation of dermatopathology
reports, conference room to support teaching and educational
responsibilities, research space for scientific projects in
dermatopathology, library with journals, textbooks and other
teaching aids related to dermatopathology and pathology.
Examination – Diploma of Dermatopathology
After having completed the full requirements (see Section I and II)
in an institutional training programme, which has been accredited,
physicians would be qualified to appear before a Commission of
Pathologists and Dermatologists to take the examination for special
qualification in dermatopathology.
Certification will be based on the examination, which consists
of a written and oral test and a practical part comprising
histopathologic sections.
Candidates who have been successful in the examination will be
awarded the Diploma of Dermatopathology.
Definitions
Special qualification in Dermatopathology
All pathologists and dermatologists have training in
dermatopathology during their residency. To achieve, however,
special qualification in dermatopathology we must accept the fact
that dermatopathology cannot be practised as an avocation and
therefore additional extensive training leading to a Diploma in
Dermatopathology must be obtained.
A pathologist or a dermatologist with special qualification in
dermatopathology (“practising” dermatopathologist) is a pathologist
or dermatologist with special training and/or certification in
dermatopathology, who devotes a substantial portion of his
professional effort to the reading of cutaneous pathology.
Candidates must fulfil specific minimum requirements of training in
an accredited center and must have taken the examination for the
Diploma in Dermatopathology (exception: grandfather clause) held
under the auspices of the International Committee for
Dermatopathology.
While there is no legal reason why a pathologist would need this
special qualification for the ability to read dermatological
sections, some might welcome the opportunity to be officially
certified as dermatopathologists. For a dermatologist, passing the
examination would represent recognition of competency in
dermatopathology.
Experience training (grandfather clause)
This particular component is the most difficult to define. It is
suggested that an initial period of 5 years be allowed for approval
of training based on prior experience. This time period can be
adjusted and should be related to the establishment of accredited
training programmes. The specific details for the accreditation or
approval of experience training will be the role of the Review
Subcommittee (Board) for accreditation of dermatopathology
training. Experience training should basically cover past
experience with all of the various disciplines listed under
requirements for speciality training in dermatopathology.
It is also important to recognise the distinction between
several terms commonly used regarding speciality status2. Accreditation has to do with approval of
training programmes. Examination is a process whereby competence is
ascertained. Certification is attested by a certificate issued by
an official body. Certification may be regarding expertise,
training, or competence. Licensure is a function of states,
nations, and/or governing bodies regulating practice in geographic
areas.
At present there is a need for the definition of accreditation
of training programmes, of certification based on the examination,
and of maintaining the competence in dermatopathology (continuing
medical education and continuing professional development) in most
countries of Europe and many other states in the world outside of
the USA.
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Step
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Responsible
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Task
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1
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EDF Guidelines Committee (EDF-GC)
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Decision of topic of specific guideline
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2
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EDF Guidelines Committee
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Foundation of subcommittee for specific guidelines, nomination of
EDF members (50 %)
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3
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EDF Guidelines Subcommittee (EDF-GSubC)
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Identify all existing guidelines for the specific guideline (active
process: literature survey plus contact to Dermatological
Societies)
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4
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EDF Guidelines Subcommittee
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Select the guidelines with highest quality. Criteria for
selection:
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1. Availability of strength of evidence
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2. Availability of strength of recommendation
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3. Evidence of mechanics of literature review
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5
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EDF Guidelines Subcommittee
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Identification/nomination of additional 50 % EDF members for
the EDF-GsubC from amongst the authors of the best guidelines
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6
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EDF Guidelines Subcommittee
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Nomination of chairperson for EDF-GSubC from the GSubC members
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7
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Chairperson
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Consider involvement of other disciplines and patients’
organisations
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8
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EDF Guidelines Subcommittee
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Meet
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1. to decide the author of the first draft and to discuss the
present guidelines, their strengths and weaknesses
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2. 6 months later to discuss the draft (consensus conference)
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9
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Chairperson
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Circulate the guideline draft to national dermatological societies
for comments
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10
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Guidelines Subcommittee
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Circulate final version for approval among members of the guideline
subcommittee
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11
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Chairperson of Subcommittee
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Deliver final version to EDF guideline chairperson
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12
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EDF Guidelines Committee
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Review and comment guideline
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13
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EDF Guidelines Committee chairperson
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Send guideline for official approval to UEMS (formal approval)
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14
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EDF secretary
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Distribute guideline for in advance information to EDF members and
National Dermatological Societies
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15
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EDF
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Publication
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1. on EDF homepage
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2. in European Journal of Dermatology, British Journal of
Dermatology and Journal of Deutsche Dermatologische
Gesellschaft
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2 These definitions were prepared by Mark
Allen Everett, M.D., University of Oklahoma, USA.1 Procedures should be at least available in an
affiliated institution.
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