ADDENDUM 9

UEMS Dermatology/Pathology – ICDP Joint Meeting – Frankfurt 3.12.2007

Present: Cerio, Cerroni, Gollnick, Kerl, Kutzner, Lax (replaces Offner), Ruiter, Sangueza, Walsh, Wolter.
Absent: Bruun-Rassmussen, Cook, Cribier, Offner, Sanchez, Santucci, Smoller

At 9:00 Gollnick opens the meeting and welcomes all participants.

1) Organization of the Examination 2008
The Examination will take place in Frankfurt on Saturday, December 6, 2008. The Board will meet on Sunday, December 7.

As in 2006 and 2007, members of the Examination Committee will provide 20 multiple choice questions for part 1 (and eventually 2-3 immunohistochemical pictures for part 2) before August 1, 2008. The Secretary will integrate new questions and will send to Members of the Examination Committee for the 2008 examination 60 questions for review not later than October 31, 2008. The histopathologic slide set for part 3 of the examination will be prepared in Graz. Twenty slides will be changed with new slides. New slides have been already reviewed by Walsh and Kutzner in November 2007.

The registration fee for the examination in 2008 will be stable at 600 €. The amount will be the same for all candidates, including those who failed in previous years and wish to repeat the examination.

Upon a proposal of Cerio, the following policy has been discussed concerning refund of the fee for candidates who cancelled participation in the Examination: cancellation up to 2 weeks before the Examination: refund of 400 €; cancellation less than 2 weeks before the Examination or no-show: no refund. This policy has to be written on the application form.

A maximum of 40 candidates will be accepted for the examination. Application forms will be sent to Graz and will be checked by Kerl and Cerroni for evaluation of requirements to sit for the examination.

Upon a proposal of Cerroni two grants will be established: one grant of up to 1.500 € for candidates coming from countries listed in the low or middle-low income groups according to the world bank; a second grant of up to 600 € (refund of the fee) will be awarded to the candidate with the best overall score (including only candidates from countries listed in the low or middle-low income groups according to the world bank; if no candidate from such countries is present, then it will be awarded to the best candidate overall). The grants will be awarded only if the finances of the Dermatopathology Examination are deemed sufficient to cover for the costs. Applications for the first grant should be sent to the Secretary and be forwarded to the Board with a proposal for the award. Informations about the first grant will be posted on the web-site; informations on the second grant will be communicated to the candidates directly in Frankfurt.

As already approved in 2006, candidates coming from countries outside Europe where a Board Certification for Dermatopathology is already established should have passed the Board Examination in Dermatopathology of their Country in order to take the Examination organized by the ICDP-UEMS.

A Summary of the last 5 Examinations should be prepared by Kerl and Cerroni and published together with all Board Members in Virchow Archives, the American Journal of Dermatopathology and the Journal of the European Academy of Dermatology and Venereology.

2) Special qualification in Dermatopathology – Curriculum, Accreditation of Training Centers:
The proposal made by Kerl was accurately reviewed and integrated by proposals and corrections made during the discussion. A preamble will be written by Ruiter. The final document is attached to the minutes (Addendum 1). The application forms have been reviewed as well (Addendum 2 and 3).

Lax mentioned that the importance of intense collaboration between dermatology and pathology for increase of quality should be included in the preamble, and that the UEMS should intensify the collaboration between dermatology and pathology to armonize access to dermatological specimens in the various European countries. Lax also suggested that a training center may be directed by both a pathologist and a dermatologist as co-directors.Moreover, several institutions could join to form a training center.

For the moment, only European Centers will be accredited. Application fee for accreditation: 1.000 €. If a visit is deemed necessary to check facilities of the Center, all costs (for the visit of two representatives) must be carried by the applying Institution.


The meeting is closed by Gollnick at 12:00.

Addendum 1

Frankfurt, December 9, 2007

Special Qualification in Dermatopathology


Guidelines for Best Practice of Dermatopathology and for Accreditation of Specialty Training Programs in Dermatopathology

The UEMS Sections of Dermato-Venerology and Pathology have agreed on the installation of an international dermatopathology examination under the direction of the International Committee for Dermatopathology (ICDP). In this context the dermatopathology examination has taken place in 2006 and 2007 with broad international interest and good results. Both UEMS Sections applaud this examination and regard it as an excellent instrument to improve the quality of dermatopathology.
The UEMS aims at improving quality of medical cure and care by several means, including the assessment of training requirements, the formulation of guidelines for medical practice, and the accreditation of continous medical education in aggreement with the UEMS charters. As optimal input for medical practice is more and more multidisciplinary, a structured collaboration between the disciplines involved is therefore mandatory. Dermatopathology is an excellent example of a structured collaboration between Pathology and Dermato-Venerology. Currently a limited number of Dermatopathology Centers operate in some European countries and they stimulate the quality of medical practice, enable training of dermatopathologists and develop a best practice that can be followed by others. This will lead to a network of competent dermatopathologists in Europe that provides a critical mass for education, teaching and scientific development of this field, which should lead to improvement of its medical quality.
In order to optimize a structured collaboration between Pathology and Dermatopathology, to reinforce the existing network of Dermatopathology Centers and to enable new Centers to join this network the ICDP has formulated guidelines for Training Centers in Dermatopathology. The guidelines will be submitted for approval by the UEMS Sections of Pathology and Dermato-Venerology in 2008.
Participation in the network of Dermatopathology Centers is on a voluntary basis and will help to make the quality of such a Center more explicit. This network will create an informal self-regulatory system that continuously will stimulate improval of quality. In a formal sense, each Center has to adhere to the regulations of its own country.
In this Guidelines for Training Centers the structure of the Training Center and its Training Program are described and information is given on the ICDP-UEMS Dermatopathology Examination. Finally, application forms are included for the development and recognition of a Dermatopathology Training Center.

The following guidelines are used:
I. Training Centers
A) Program Director
The program director is a pathologist or dermatologist with special training in dermatopathology. The program director, together with the faculty, is responsible for the operation of the program. After 2012 she/he must be certified in dermatopathology by the ICDP-UEMS-Sections of Dermatology and Pathology (or the Royal College of Pathologists / United Kingdom or the American Board of Dermatopathology). Certification will be based on the Board-Examination. A program director must have at least 3 years of experience in dermatopathology (following residency in dermatology or pathology) in addition to the one and half year specialty training (see recommendations of length of specialty training).
Exception: Qualification on the base of experience (grandfather clause)
Not later than 2012, fulfilment of all pre-requisites will be necessary in order to take the examination. The time period from 2008-2012 should be related to the establishment of accredited training programs and designation of directors on prior experience. Approval of experience training will be the role of the UEMS-Review Subcommittee. Experience training should basically cover at least 5 years of past experience in the field of dermatopathology.
The International Board of Dermatopathology – UEMS-Sections of Dermatology and Pathology must be notified by the program director about the appointment of a candidate (fellow), who wants to specialize in dermatopathology.

B) Resources
Training in dermatopathology must be linked with a university clinic, hospital or a comprehensive dermatopathology center.
The number of dermatopathology specimens from within the institution and/or from outside must be at least 3000 per annum. In addition, study sets and other material (appropriate books, journals, and access to a library) to support service, teaching, and educational responsibilities should be provided.

II. Program - Curriculum
Candidates for specialty training in dermatopathology must have successfully completed their residency training in dermatology/pathology, as required by the various national licensing bodies.
It is expected that candidates will demonstrate after his/her training considerable skill, experience, and knowledge of all aspects of dermatopathology and laboratory technology.
Candidates must actively participate in the review and diagnosis of current dermatopathological specimens on a daily basis. Opportunity to sign out under supervision must be given in order to be able to offer a specialist opinion for clinical diagnosis. A multi-headed microscope should be available.
The program must provide organized education in all aspects of dermatopathology including didactic instruction and practical experience in the diagnosis of skin disorders including the following skills:
a) Routine histology (all fields of dermatopathology)
b) Special stains
c) Frozen sections and interpretation of micrographic sections
d) Immunofluorescence, histochemical, immunological, molecular, microbiological, and other related technics
e) Access to electron microscopy (facultative)
f) Lectures, tutorials, and clinico-pathological conferences must be regularly scheduled and held
g) An opportunity for fellows to participate in dermatopathology research is desirable
h) Laboratory management; quality assurance
It is expected that the Program Director provides a short yearly report of activities related to the Dermatopathology Examination, including names and length of stay of trainees.

Recommendations for length of specialty training (minimum requirements)
Satisfactory completion of one year of specialty training in dermatopathology. It is recommended to complete the year in a program accredited for such training. In addition to this year, dermatologists have to spend a minimum equivalent of a period of 6 months in a Pathology Department to gain experience in anatomic/surgical pathology and laboratory technics. Pathologists have to spend a minimum equivalent of a period of 6 months in a Department of Dermatology to gain insight into the range of clinical presentations of dermatologic disorders and to use the clinical knowledge in the field of clinico-pathological correlation and diagnosis.
The one year specialty training in dermatopathology can only be completed after the residency training in dermatology/pathology, whereas the 6 months training in anatomic/surgical pathology (dermatologists) or clinical training in dermatology (pathologists) can be accomplished before, during or after the residency time.

III. Examination – Diploma in Dermatopathology
After having completed the full requirements in an institutional training program, which has been accredited, physicians would be qualified to appear before the ICDP-UEMS-Examination Committee to take the examination for special qualification in dermatopathology.
Certification will be based on the examination, which consists of a written test and a practical part comprising histopathologic sections.
Candidates who have been successful in the examination will be awarded the ICDP-Diploma of Dermatopathology under the auspices of the UEMS-Sections Dermatology and Pathology.
Eligibility and accreditation of training programs will be accomplished by a Review
Subcommittee, which includes equal members from both, UEMS-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.
Accreditation of a Training Center in Dermatopathology requires filling out the application forms, which can be requested at www.icdermpath.org . Visits from representatives (on-site inspection) may be necessary and will include evaluation of the facility, interview with the lead of dermatopathology, teaching staff, and trainees. The program should have ongoing mechanisms of re-accreditation (re-evaluation after 5 years for continuing professional development). Re-accreditation will be also required if there is a change of the program director.
A Trainign Center can be a single Institution or an interdisciplinary group (University, Hospitals, Practitioners) fulfilling all criteria mentioned in these guidelines.
Training for special qualification in dermatopathology outside of Europe needs to be assessed by the Review Subcommittee on a case-by-case basis.

IV. Definitions
Special qualification in dermatopathology
All pathologists and dermatologists have training in dermatopathology during their residency. To achieve special qualification in dermatopathology additional training must be obtained as previously prescribed.
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 interpretation of cutaneous pathology. Candidates must fulfil specific minimum requirements of training in an approved training program and must have taken the examination for the ICDP-Diploma of Dermatopathology (exception: grandfather clause) held under the auspices of the UEMS Sections Dermatology and Pathology.
While there is no legal reason why a pathologist would need this special qualification for the ability to read skin biopsies, some might welcome the opportunity to be officially certified as dermatopathologists. For a dermatologist, passing the examination would represent recognition of competency in dermatopathology.
It is also important to recognise the distinction between several terms commonly used regarding speciality status. Accreditation has to do with approval of training programs. 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.

Addendum 2

Frankfurt, December 9, 2007

Special Qualification in Dermatopathology

Application for Development and Accreditation as Training Center

Applying Center
Name: ………………………………………………………………….
………………………………………………………………….
Address: ……………………………………………………………….
…………………………………………………………………
List of participating Institutions:
……………………………………………………………………
……………………………………………………………………
……………………………………………………………………
……………………………………………………………………
Does Institutions have an affiliation with medical school? …………………..
If yes, give name(s): ………………………….………………………………
…………………………………………………………………..
________________________________________________________________
Nominated Program Director
Family name / First Name ……………………………………………
Title ………………………………………………………………….
Address: ………………………………………………………………
…………………………………………………………..
…………………………………………………………..
Phone: …………………………………. Fax: …………………………..
e-mail: …………………………………………………………………

Dermatopathology-Certification / Date: ……………………………………
Number of years spent teaching dermatopathology: ………………………..
Is nominated program director also head of Institute? ……………………….
If no, chair's name: ……………………………………………………..
________________________________________________________________
Dermatopathology Service
No. of specimens / year: ……………………………………………………
No. of immunofluorescent specimens prepared / year: ……………………
No. of immunohistochemistry specimens prepared / year: ……………….
No. of molecular investigations (specify): ………………………………….
……………………………………………………………………………… ..
Describe educational resources (see guidelines):
………………………………………………………………………………… .
………………………………………………………………………………… .
………………………………………………………………………………… .
………………………………………………………………………………… .
………………………………………………………………………………… .
Date: ……………………………..
Signature: .………………………………………………………………
(Nominated Director of Dermatopathology Program)
……………………… ……………………… ………..…………..
(Center partners)
………………………………………………………………………………… ..
Chair(s) of Department(s) (if applicable)

Addendum 3

Frankfurt, December 9, 2007

Special Qualification in Dermatopathology


Candidate
Family name / First name: ………………………………………………………………
Title: …………..………………………………………………………………………..
Dermatologist / Pathologist ? ..…………………………………………………………
Address: ………………………………………………………………………………...
………………………………………………………………………………….
Phone / Fax: ………………………………………………………………………….
e-mail: ………………………………………………………………………………….
Date of completion of residency time in Dermatology or Pathology: ………………………….
Start of Specialty Training in Dermatopathology / Date: ………………………………………
Date of completion of dermatopathology training (minimum 1 year): …………………………

Institution
Name: …………………………………………………………………………..
………………………………………………………………………….
Address: …………………………………………………………………………
………………………………………………………………….……….
Phone / Fax: …………………………………………………………………….
Date: …………………………………
Signature: …………………………….. ……………………………………
(Candidate) (Director of Dermatopathology Program)

For Pathologists
Dermatology Service
Institution: ………………………………………………………………………
Name: ……………………………………………………………………………
Address: …………………………………………………………………………
……………………………………………………………………
Phone / Fax: …………………………………………………………………….
How many months / years has trainee spent at institution? …………………………….
Date of completion of training in clinical dermatology (minimum 6 months): ………….
Date: ………………
Signature: …………………………….. ……………………………………….
(Candidate) (Head / Institute of Dermatology)
___________________________________________________________________________
For Dermatologists
Pathology Service
Institution: …………………………………………………………..
Name: ………………………………………………………………..
Address: …………………………………………………………….
………………………………………………………….
Phone / Fax: …………………………………………………………..
How many months / years has trainee spent at institution? ………………………
Date of completion of training in anatomic/surgical pathology (minimum 6 months): …
Date: ………………
Signature: …………………………….. ………………………………
(Candidate) (Head / Institute of Pathology)