Pediatric Dermatology

BACKGROUND

CERTIFICATION REQUIREMENTS
Prerequisites
Pediatric Dermatology Fellowship
Leave of Absence
Certification Examination
Examination Eligibility
Appeals Process
Continuing Certification Program

FELLOWSHIP CURRICULUM
Clinical Core Curriculum
Didactic Curriculum

LIST OF TRAINING PROGRAMS

 BACKGROUND

The American Board of Dermatology has established certification and continuing certification processes for the subspecialties of Dermatopathology, Pediatric Dermatology and Micrographic Dermatologic Surgery (MDS). These subspecialty certifications have been approved by the American Board of Medical Specialties and its 24 member boards. Surveillance and periodic reviews of the training programs are carried out by the respective RRCs, under the auspices of the Accreditation Council for Graduate Medical Education (ACGME).

Although all general dermatology residents receive comprehensive training in each of these subspecialties, candidates who pursue the additional year(s) of training in subspecialty fellowships will have met additional standards and qualifications that will prepare them for specialized careers in teaching, research, and/or the practice of these subspecialties.

It is emphasized also that the additional year(s) of training in Pediatric Dermatology and Dermatopathology must occur after the candidate has met the full training requirements for certification in the primary specialty of dermatology. Dermatopathology certification is also offered by the American Board of Pathology for physicians with a primary certificate in pathology.

ABD subspecialty certification is linked to primary certification in dermatology.

CERTIFICATION REQUIREMENTS FOR PEDIATRIC DERMATOLOGY

Maintaining subspecialty certification in Pediatric Dermatology is contingent upon maintaining certification in Dermatology.

Prerequisites:
All candidates for subspecialty certification in Pediatric Dermatology must meet the following requirements:
1. A currently valid, full and unrestricted license to practice medicine or osteopathy in the state or province of the candidate's medical practice in either the United States or Canada. The candidate may be denied certification if his/her license has been revoked, suspended, restricted, or surrendered in any jurisdiction - or if the candidate is subject to adverse licensure proceedings.
2. Primary certification by the American Board of Dermatology (ABD).
3. An additional one or more years of fellowship training in an ACGME accredited Pediatric Dermatology fellowship. The minimum amount of time in direct clinical care during fellowship will be determined in part from whether the candidate has had prior pediatric training. For candidates without one or more years of post-graduate pediatric residency, a minimum of 80% time in clinical pursuits is mandated.

Pediatric Dermatology Fellowship:

All applicants for fellowship training in Pediatric Dermatology must have satisfactorily completed the residency requirements for general Dermatology and be certified by or be eligible for certification by the American Board of Dermatology (ABD).

Residents not yet certified by ABD in dermatology may complete the fellowship, but are not eligible for pediatric dermatology certification until they are certified in general dermatology.

Leave of Absence:
Refer to the ABD Leave of Absence Guidelines page. 

Subspecialty Certification Examination:
Candidates who satisfy the Prerequisites and Pediatric Dermatology Fellowship requirements are eligible to apply to the ABD to take the subspecialty certification examination in Pediatric Dermatology.

When notified by the ABD office the enrollment is open for the Pediatric Dermatology Subspecialty Examination, interested candidates should log in to ABD website and go to the section entitled “Exams --> Subspecialty Exam Application.” 

Individuals who PASS an ABD certifying or subspecialty exam will automatically receive 60 AMA PRA Category 1 CME credits. The ABD has contracted with the AMA to provide these credits at no cost to diplomates. After the ABD releases the exam results, the AMA will send passing candidates a certificate for this credit. 

Examination Eligibility:

Certification in general dermatology is required prior to certification in Pediatric Dermatology. Candidates remain eligible for certification in Pediatric Dermatology for five years after completion of their fellowship. A pediatric dermatologist who has not been certified within five years of training may no longer claim to be “board eligible” unless the American Board of Dermatology determines that that physician has been prevented from taking the examination within the applicable five year period by military deployment or by catastrophic illness. 

Candidates remain eligible for certification in general dermatology for five years after completion of an ACGME accredited residency. A dermatologist who has not been certified within five years of training may no longer claim to be “board eligible” unless the American Board of Dermatology determines that that physician has been prevented from taking the examination within the applicable five year period by military deployment or by catastrophic illness. A pediatric dermatologist who is no longer eligible for certification in general dermatology will no longer be eligible for certification in pediatric dermatology. 

Appeals Process:

An appeals procedure similar to that described for the certification process in Dermatology is available for candidates for subspecialty certification in Pediatric Dermatology who were declared ineligible by the Board for Pediatric Dermatology or who failed the subspecialty examination. For details, see Appeals. Candidates submitting such appeals should contact the Board for additional current information.

Continuing Certification Program (CCP):
Certification in Pediatric Dermatology is time-limited for 10 years. When a candidate is certified in Pediatric Dermatology, he/she will enter into the Continuing Certification (Program (CCP) for the 10-year period. The subsequent CertLink segment will include the general dermatology module in addition to two pediatric dermatology modules. 

FELLOWSHIP CURRICULUM

The goal of this subspecialty training is to ensure expertise in the field of Pediatric Dermatology. A trained individual would be capable of providing tertiary outpatient and inpatient management for children with skin disorders as well as medical education for primary health care providers. Clinical subspecialty training will be under the direct supervision of pediatric dermatologists.

A. CLINICAL CORE CURRICULUM

Outpatient Experience:
Each fellow will participate in a minimum of 5 weekly outpatient half-day clinics under the direct supervision of a pediatric dermatologist. The focus in these clinics will be on the diagnosis and management of pediatric dermatologic disease. Specific disorders will include, but are not limited to:
1. All forms of dermatitis
2. Papulosquamous diseases
3. Bullous diseases
4. Viral, bacterial and fungal infections of the skin
5. Infestations of the skin
6. Drug reactions
7. Genodermatoses
8. Developmental anomalies
9. Neonatal skin disorders
10. Disorders of cornification
11. Hair and nail disorders
12. Acne
13. Skin malignancies
14. Connective tissue diseases
15. Granulomatous diseases
16. Vascular anomalies
17. Melanocytic lesions
18. Psychocutaneous disease
19. Child abuse
20. Skin signs of systemic disease
21. Photosensitivity disease

Fellows will utilize clinical time to develop and refine their skills in the management of acute pediatric skin problems and communication with children and parents.   Approach to the pediatric patient with emphasis on developmental and behavioral issues will be stressed. The impact of skin disease on the psychological well-being of the child and family will be addressed. Fellows will actively participate in the development of a therapeutic plan for children with both acute and chronic skin diseases. They will learn to educate parents in the management of these problems. They will have the opportunity for long-term follow-up of diseases in continuity clinics held throughout their fellowship.

Fellows will develop skills in pediatric diagnostic and therapeutic procedures in the clinic setting including, but not limited to:
1. Skin biopsy techniques
2. Potassium hydroxide examinations
3. Tzanck examinations
4. Mineral oil examinations
5. Hair mounts
6. Fungal cultures
7. Curettage and electrodesiccation
8. Cryotherapy
9. Laser therapy
10. Surgical excisions

Fellows will become familiar with the appropriate use of specialized laboratory studies, including but not limited to immunohistochemistry and molecular and genetic diagnostic techniques used in the diagnosis of pediatric skin diseases. Techniques in prenatal diagnosis and laboratory diagnosis of rare diseases including genodermatoses will be discussed.

Continuity Experience:
Fellows will provide tertiary care for pediatric patients with chronic diseases on an ongoing basis for the duration of their training during a weekly continuity clinic (a minimum of 1 half day per week). Fellows will be expected to function as the primary physician, formulating diagnostic strategies and therapeutic plans under the supervision of a pediatric dermatologist. The development of an ongoing relationship with families of children with chronic skin problems will be emphasized. All diagnostic and management decisions will be directed by the fellow in consultation with the attending pediatric dermatologist.

Consultation:
Fellows will actively participate in outpatient and inpatient consultation for all referrals to the service, including pediatric inpatients, patients in the normal newborn or intensive care nurseries, general or subspecialty clinic patients and pediatric patients in the emergency department. Appropriate history, physical examination, and diagnostic studies will be performed and final recommendations discussed with the referring physician after review with the attending pediatric dermatologist.

Departmental, Office Administration, and Systems of Care:
Fellows should have exposure to and training in utilizing systems of care.  This includes interactions with departmental and office administrative units to learn skills necessary for obtaining appropriate authorizations, facilitate coordination of care, and other facets of systems-based care.

Telephone Inquiries:
Fellows will be primarily responsible for handling patient telephone inquiries and inquiries from referring physicians and will receive appropriate instruction in these responsibilities. Telephone recommendations will be reviewed with the attending physician. Any problems that cannot appropriately be handled by telephone will be discussed with the attending physician or scheduled for emergency outpatient evaluation at the discretion of the fellow.

Community Based Consultation:
Fellows will accompany attending physicians to pediatric inpatient units, normal newborn nurseries and neonatal intensive care units at affiliated hospitals as referring physicians request consultation services for their patients.

Pediatric Dermatologic Surgery:
Fellows will be instructed in the evaluation and formulation of therapeutic strategies for pediatric patients referred for dermatologic surgery. Decisions as to the appropriate timing and type of surgical approaches to be used in pediatric patients will be emphasized with special attention to techniques and developmental issues that impact outpatient surgery in children. Fellows will participate in the preoperative assessment of patients, in the education and preparation of families for surgery, and in the post-operative management of surgical patients. The development of skills in outpatient pediatric dermatologic surgery using appropriate anesthesia will be emphasized. Fellows will learn the use of topical, local and regional anesthetic agents as well as the indications for and safe utilization of conscious sedation and general anesthesia. Procedures include excisional biopsy and full-thickness excision with appropriate simple or complex closures. Fellows will complete these procedures under the direct supervision of a pediatric dermatologist, dermatologic surgeon, plastic surgeon, or pediatric surgeon.

Laser Surgery:
Fellows will be instructed in the indications and use of the pulsed dye laser, and other lasers, as available, in the treatment of vascular and other skin lesions in children such as warts, keloids and striae. The limitations of laser therapy and the appropriate use of anesthesia will be emphasized. Fellows will learn the use of topical, local and regional anesthetic agents as well as the indications for and safe utilization of conscious sedation and general anesthesia. All laser procedures will be performed under the direct supervision of an attending physician with experience in laser techniques. Fellows will participate in the preoperative assessment and preparation of children and their families for laser surgery, including the importance of detailing pain management and obtaining informed consent. Postoperative management of these pediatric patients will be taught including techniques in child-friendly wound care and control of postoperative pain.

B. DIDACTIC CURRICULUM

Pediatrics:
Mastery of the basic principles of Pediatrics is essential to understanding the medical, developmental and psychosocial issues specific to children with skin disease. Fellows will participate periodically in didactic sessions of the Department of Pediatrics, including but not limited to, the following:
• Pediatric Grand Rounds
• Pediatric Morning Report
• Pediatric Teaching Conferences
• Chief of Service Rounds
• Morbidity and Mortality Conferences

Fellows will gain inpatient care experience via consultations on pediatric wards and in the newborn nursery. Outpatient care experiences will be gained via interactions with pediatricians in general pediatrics as well as subspecialty areas including Adolescent Medicine, Allergy, Immunology, Rheumatology, Oncology, Child Abuse, Genetics, and others as appropriate. Participation in at least one pediatric multispecialty clinic is required quarterly. 

General Dermatology:
Fellows will attend and actively participate in institutional Dermatology Grand Rounds as well as other regularly scheduled local conferences. Fellows will be expected to present pediatric patients with difficult diagnostic or therapeutic problems, and patients with rare diseases.

Dermatopathology:
Fellows will work closely with dermatopathologists and/or pediatric pathologists in clinical consultation. Fellows will be expected to review all biopsy specimens from patients seen during their fellowship and thus assure the clinicopathologic correlation of the findings in these patients and the establishment of the diagnosis and selection of optimal therapy.

Pediatric Dermatology:
Fellows will attend Pediatric Dermatology Divisional Meetings when scheduled. They will be expected to present clinical cases and give didactic summaries at departmental and divisional conferences. Fellows will be responsible for selecting appropriate subjects for presentation as well as for the organization of all data and materials pertinent to the discussion. Discussion will include diagnosis and management of cases seen in the preceding two week period.

Participation in formal journal review is required. Articles will be reviewed in advance, and discussed with the attending physicians, other fellows, residents and medical students on service. This review should include, but not be limited to, the following journals:
1. Pediatric Dermatology
2. JAMA Dermatology
3. Journal of the American Academy of Dermatology
4. Pediatrics
5. Journal of Pediatrics
6. Archives of Diseases of Childhood and Adolescence
7. British Journal of Dermatology
8. Journal of Investigative Dermatology

Educational Contributions by the Fellow:
Fellows will be responsible for clinical as well as didactic instruction of rotating residents and medical students, including the organization and presentation of basic lectures in Pediatric Dermatology. Lectures to the lay community will be encouraged as opportunity permits.

Collaboration with other physicians and the development of presentation and communication skills are a critical part of training in Pediatric Dermatology. In addition to presenting patients at Divisional Conference Meetings and Dermatology Grand Rounds, fellows should participate in regional and state Dermatology conferences. Fellows should submit 1-2 presentations per year at a national meeting including but not limited to the Society for Pediatric Dermatology, American Academy of Dermatology, American Academy of Pediatrics, American Society for Contact Dermatitis, Women’s Dermatology Society, Pediatric Research, Society for Investigative Dermatology. Preparation and review of these presentations will be directly supervised by the attending physician.

Training under direct supervision of the attending physician will include instruction and guidance in preparing posters, abstracts and manuscripts for presentation and publication. A minimum of two papers will be submitted to peer reviewed journals during fellowship training. Other publications including case reports, invited reviews, or chapters are also encouraged.

Photography:
Photography is central to dermatologic teaching and research. Fellows should be instructed in dermatologic photographic techniques. They will be encouraged to establish, develop and maintain a personal clinical slide collection for use in future teaching and publications.

Basic and Clinical Research:
In addition to supervised clinical training and teaching, fellows will receive exposure to or have experience in basic research and departmental or office administration.

Fellows should have the opportunity to participate in related basic research. This may be undertaken in collaboration with or under the direction of faculty from other disciplines. Programs should be designed based on individual interests and availability, and should range in length from 12 to 24 months, in addition to the clinical component of the fellowship as described above.

Trainees should engage in clinical research during their fellowship. Participation should include study design and implementation, protocol preparation, submission of proposals to an Investigational Review Board, analysis of data and manuscript preparation.

LIST OF TRAINING PROGRAMS