GUIDELINES FOR COMBINED TRAINING
IN DERMATOLOGY AND PEDIATRICS

GENERAL REQUIREMENTS

Combined training in dermatology and pediatrics must include at least five years of coherent training integral to residencies in the two disciplines that meets the program requirements for accreditation by the Residency Review Committee for Pediatrics and the Residency Review Committee for Dermatology.

Combined training must be conducted under the auspices of the Committee on Graduate Medical Education within a single institution and its affiliated hospitals. Documentation of the unqualified commitment of the hospital/s and faculty to the institutional goals for the combined training must be available in signed agreements. Affiliated institutions must be located close enough to facilitate cohesion among the house staff, attendance of trainees at weekly continuity clinics and integrated conferences, and faculty exchanges relating to the curriculum, evaluation of trainees, administration of the program, and related matters.

Both training residencies must be accredited by the ACGME. Residents may not be recruited for combined training if either categorical program has provisional or probationary status.

Residents should enter a combined training residency at the first postgraduate year level. A resident may enter a combined residency at the second postgraduate year level only if the first residency year was served in a categorical residency in pediatrics in the same academic health center. Transitional year training will provide no credit toward the requirements of either board. Residents may not enter combined residency training and receive credit beyond the first postgraduate year level, nor may a resident transfer to another combined residency without prospective approval by both boards. A resident transferring from a combined residency to a categorical dermatology or pediatric program should seek specific eligibility information from the appropriate board.

While residents are on pediatric rotations, their training is the responsibility of pediatric faculty, and while they are on dermatology rotations, it is the responsibility of the dermatology faculty. Vacations, leave, and meeting time will be shared equally by both training residencies. Absences from training (vacation, parental, sickness) exceeding five months of the 60 months must be made up.

REQUIREMENTS FOR DERMATOLOGY

During the 30 months of dermatology training, 28 months (full-time equivalent) must be spent in clinical dermatology with the primary responsibility in patient care. This must include at least 25 months (full-time equivalent) of experience in clinical dermatology, which must be primarily in the care of outpatients but will include consultations and appropriate inpatient rotations as well. In addition, each resident must obtain 3 months of experience in dermatologic surgery under the supervision of a dermatologic surgeon or Board-certified dermatologist with surgical experience, and 2 months of dermatopathology under the supervision of a dermatopathologist who is Board certified in this subspecialty. Indeed, continuity of training in dermatopathology should be sustained throughout the dermatology residency, in lectures, conferences, and as residents follow their patients in clinics and in the hospital.

Residents must learn the basic sciences on which clinical dermatology is founded, including cutaneous pharmacology, molecular biology, genetics, immunology, epidemiology, and statistics. Effective time in one of these areas is encouraged and should be for a minimum of 2 months, which may be substituted for time in the 25 month segment of clinical dermatology.

Residents must regularly attend seminars and conferences in general dermatology. These must be clinical pathological conferences. Residents must learn about major developments in both the basic and clinical sciences relating to dermatology and must attend seminars, journal clubs, lectures in basic sciences, didactic courses, and meetings of local and national dermatologic societies.

REQUIREMENTS FOR PEDIATRICS

The development of the resident's skills in pediatrics will be fostered by rotations on general pediatric services, both inpatient and outpatient, with exposure to a wide spectrum of disease. The resident must be exposed to pathologic conditions ranging from mild to severe illness, including life-threatening conditions requiring critical care. Fifty percent of clinical training must be in ambulatory settings. The pediatric patient population served must encompass adequate numbers and extend from the newborn (including premature infants) through childhood and adolescence.

The training should be the same as described in the Program Requirements of the Residency Review Commtitee (RRC) for Pediatrics with the exceptions that follow.

Thirty months of training must be in pediatrics; the additional 6 months of credit is recognized through 6 months of dermatology training.

Ambulatory Service In keeping with the commitment to primary and comprehensive care, the 5-year combined residency must provide that 50% of the pediatric experience be ambulatory. This may include all assignments in continuity clinic, acute illness and emergency department, and community-based experiences, as well as the ambulatory portion of the normal newborn, subspecialty, behavior/development, and adolescent experience.

Emergency and Acute Illness Experience The experience in emergency and acute illness must constitute a minimum of 4 months. Two of these months should be in emergency medicine; at least 1 of these months must be a block rotation in an emergency department that serves as the receiving point for EMS transport and ambulance traffic and is the access point for seriously injured and acutely ill pediatric patients in the service area.

Inpatient Experience General inpatient pediatrics must constitute at least 5 months of a resident's overall experience, exclusive of intensive care rotations. Intensive care experiences must be for a minimum of 4 and a maximum of 6 months and must include at least 3 block-months of neonatal intensive care (Level II or III) and 1 block-month of pediatric intensive care. At least 2 months of supervisory experience must occur on inpatient services.

Normal Newborn Nursery At least 1 month must be spent in the care of the normal newborn infant.

Subspecialty Experience Time spent in training in the pediatric subspecialties, excluding adolescent medicine and intensive care experiences, must be a minimum of 6 months. The required and desirable subspecialty experience should conform to the RRC Program Requirements for categorical pediatric training.

Continuity Clinic There must be at least weekly experience in a continuity clinic throughout the pediatric months of training. The patients should include those cared for in the hospital, well children of various ages, and children of various ages with chronic diseases and developmental problems. It is desirable that these experiences continue every other week during dermatology training.

Supervisory Responsibility At least 5 months of supervisory responsibility must be provided for each resident during the 30 months of training in pediatrics. The supervisory responsibilities must involve both inpatient and outpatient experience.

Adolescent Medicine There must be a structured educational experience to train residents in the medical and psychosocial problems of the adolescent. This rotation must be for at least 1 month. During this time, experience in adolescent gynecology should be available.

Behavioral/Developmental Pediatrics At least 1 month of a structured, focused experience in behavioral/developmental pediatrics must be provided. The experience must be supervised by faculty with training and/or experience in the behavioral/developmental aspects of pediatrics.

CERTIFICATION

The residents in a combined training residency must satisfactorily complete the specific credentialing requirements of each board to be eligible for the examination of the Board. Clinical competence must be verified by both department chairs/program directors. Lacking this verification, the resident must satisfactorily complete 3 years of training in dermatology and 3 years of training in pediatrics to qualify for the examination in the respective specialty.

Upon successful completion of all requirements of the combined residency, the candidate is qualified to apply to take either or both the ABD and the ABPeds certification examinations. The candidate will be certified by each board upon successful completion of the certifying examination. Certification in one specialty will not be contingent upon certification in the other. It is the candidate's responsibility to complete the examination process in each specialty.

Residents who complete combined training must complete at least one year of pediatric dermatology fellowship in order to be eligible to apply for the subspecialty certifying examination in Pediatric Dermatology given by the American Board of Dermatology.