ESSENTIALS FOR TRAINING PROGRAMS IN

CLINICAL AND LABORATORY DERMATOLOGICAL IMMUNOLOGY (CLDI)

 

Goals of Training Programs in CLDI

The primary objective of training programs in CLDI is the development of dermatologists who will have the skills to become leaders in the rapidly expanding area of dermatological immunology and diagnostic laboratory immunology.  To this end programs shall provide training in immunological research, use of methods of immunologic diagnosis in the laboratory and clinic, and expertise in clinical dermatological immunology.  Graduates of CLDI training programs may be expected to seek careers in academic centers, research laboratories or in the practice of clinical dermatological immunology and diagnostic laboratory immunology.  They should be qualified to become expert consultants to dermatologists and other physicians and to regulatory agencies.

General Requirements

Trainees in approved programs in CLDI must have completed dermatology residency training in a program approved by the Residency Review Committee for Dermatology and the Accreditation Council for Graduate Medical Education and be certified by the American Board of Dermatology, or be eligible to sit for its certifying examination.  Those who enter training programs in CLDI immediately after completion of dermatology residency training must take and pass the American Board of Dermatology certifying examination at the first opportunity in order to be eligible for CLDI Special Qualification certification.  Training in CLDI will be for a minimum period of one year.  Training institutions must have the facilities and faculty to provide the necessary instruction and supervision in all aspects of CLDI training outlined below.  Directors of approved training programs will normally have been certified by the American Board of Dermatology as specially qualified in CLDI.  Other faculty for training programs in CLDI should either be members of the faculty of the Department of Dermatology or in Departments of Immunology, Immunopathology, or other specialties having expertise in medical immunology.  Training directors should establish and foster ongoing working relationships with other immunology and immunopathology programs within the training institution, its affiliated hospitals and laboratories.  In addition, trainees must have access to sufficient numbers of patients with immunologically related skin disorders to develop expertise in performing diagnostic laboratory procedures appropriate for these patients, and to develop skills as expert consultants to other dermatologists, allergists, rheumatologists, internists, pediatricians, pathologists, and other physicians.

Content of Training Programs in CLDI

Trainees should:

  1. Learn basic theory of immunology and immunopathology.
  2. Be trained in immunologic research methods and develop research skills suchthat they will be able to continue to contribute to the advancement of the field following completion of their training program.
  3. Become skilled in performing diagnostic immunological and immunopathological procedures relevant to cutaneous disease.
  4. Develop the requisite knowledge to set up and operate a diagnostic CLDI laboratory, to maintain appropriate quality controls, and to meet necessary regulations governing operation of such a laboratory.
  5. Become capable of acting as consultants to physicians who have patients with immunologically related skin disorders.
  6. Develop a working knowledge of immunotherapy and be prepared to care for patients or serve as consultants in this area.

Specific Methods of Training

Trainees should be exposed to diagnostic methods of immunopathology, including immunofluorescence and peroxidase labeled techniques, using appropriate controls.  They should be familiar with use of polyclonal and monoclonal antibodies for identification of tissue constituents, deposits of immunoreactants and identification of functional subsets of lymphocytes, other inflammatory cells and neoplastic cells in the skin.  Trainees should develop a working knowledge of use of laboratory equipment, including cutting sections by microtome and cryostat preparation and standardization of reagents.  They should also have a working knowledge of the preparation and interpretation of immunoelectron micrographs.  They should be familiar with methods for detection and quantitation of circulating antibodies in autoimmune disorders such as bullous diseases and collagen vascular disorders.  They should have familiarity with the complement system and measures of assay of its various components.  They should have the ability to carry out starch and agar gel electrophoresis and immunoelectrophoresis.  They should be familiar with quantitative immunodiffusion techniques and radioimmunoassay.  They should be capable of use of E-rosetting methods, and monoclonal antibodies for study of cell surface markers.  They should be familiar with assays for cytokines and cytotoxic and proliferation factors.  They should be familiar with immunogenetic markers, HLA associations and major and minor histocompatibility antigens.  Trainees should be familiar with cutaneous consequences of organ and bone marrow transplantation procedures. 

Trainees should develop competence in the care of patients with bullous diseases, collagen vascular disorders and other immunologic based dermatoses and be prepared to act as skilled consultants in this area.  They should be familiar with the evaluation of patients with contact dermatitis including historical and environmental evaluation, patch tests, photo tests, and photo patch tests.

Finally, trainees should be prepared for possible academic careers through experience in teaching students, dermatology residents and other physicians in the dermatological immunology and in dermatological laboratory immunology.  They should conduct seminars, give lectures and carry out bedside and clinical teaching of medical students, residents and other physicians.  They should regularly attend and actively participate in appropriate conferences in the departments of allergy, immunology, rheumatology, nephrology, pediatrics, pathology and basic science departments in their training institution, and develop productive ongoing working relationships with immunologists and immunopathologists in these disciplines.