Guidelines

HKCP Higher Physician Training in Dermatology and Venereology Guideline (Chan et al 2017, p.88-93)

I) OBJECTIVES

To provide a broad training, in-depth and updated experience at a level sufficient for trainees to acquire competence and professionalism required of a specialist in Dermatology and Venereology.
To enhance knowledge, clinical skills and procedural competence in Dermatology & Venereology.
To provide an opportunity for postgraduate continuing medical education in Dermatology & Venereology.
To understand the various health care delivery issues concerning Dermatology & Venereology in the community.
To acquire professional competence in training future trainees in Dermatology & Venereology.

II) STRUCTURE

This period consists of a minimum of three years of supervised and accredited training in Dermatology and Venereology.
1. In the three years, the trainee should undergo a minimum of 24 months’ full-time dermatology training in a College accredited Dermatology & Venereology training institute and a minimum of 6 months’ full time venereology training in a College accredited Dermatology & Venereology training institute. The remaining six months are dedicated to full-time dermatology and/or venereology training or the training detailed in 1.2 below.
2. A maximum of 3 months may be accredited for full-time supervised training or research in a College accredited institute, or a local or an overseas institute considered by the Specialty Board to be of an equivalent standard, in Leprosy, Dermatopathology, Dermatosurgery, HIV medicine, Aesthetic Dermatology, Allergy, Occupational Dermatology or other specialties which are considered to be relevant by the Specialty Board of Dermatology & Venereology. Prior approval from the Specialty Board must be obtained by the Higher Physician Trainee in Dermatology & Venereology.
Apart from single specialty training in Dermatology and Venereology as stated above, the Higher Physician Trainees in Dermatology and Venereology may also undergo dual training together with a broad-based specialty, defined as either Advanced Internal Medicine (AIM) or Geriatric Medicine. In such dual training programmes, the training in the broad-based specialty ensures the acquisition of a broad-based training for those trainees.
The structures of dual training programmes approved by the College include the following and Trainees must clearly indicate the pathways chosen at the time of application to be registered as Higher Physician Trainee of the College:
1. Concurrent training: A minimum of five years of supervised training is required. The training programme comprises 36 months (cumulative) of training in Dermatology and Venereology and 24 months (cumulative) of core training in a broad-based specialty.
2. Sequential training: The training programme comprises 36 months of training in Dermatology & Venereology and 24 months in a broad-based specialty if it is chosen as a second specialty whereas 36 months in a broad-based specialty if it is chosen as a first specialty. A minimum of five and six years of supervised training is required depends on the training sequence.

III) CONTENTS

Medical Dermatology

Adequate opportunities are provided for the trainee, under the supervision, coaching and evaluation of trainers, to observe, manage, and deliver comprehensive care for patients with a wide variety of dermatological diseases.

The contents of training includes, but not limited to the following items
1. Fundamentals in dermatology: effective communication, history taking, valid informed consent, dermatological examination, investigations and interpretation, clinical diagnosis and decisions with evidence based treatment plans
2. Histopathology of the skin, focusing on histopathology report interpretation and clinical correlation.
3. Specialized topics
  
  Eczema, psoriasis, other papulosquamous disorders, exanthems, drug eruptions, erythroderma, urticarial, vasculitis, bullous dermatosis, emergency dermatology, developmental disorders, cutaneous oncology, cutaneous infection, pigmentary disorders, autoimmune conditions, hair and nails disorder, oral diseases, anogenital diseases, allergy, hypersensitivity and contact dermatitis, anogenital diseases, neutrophilic and eosinophilic disorder, histiocytosis, mastocytosis, non-infective granulomatous conditions, subcutaneous fat disorders, disorders of the vascular and lymphatic system, skin manifestation of systemic diseases, psychocutaneous diseases, paediatric dermatology, dermatoses of the elderly, dermatoses in pregnancy, aesthetic dermatology and leprosy.
Sexually Transmitted Infection

Adequate opportunities are provided for the trainee, under the supervision, coaching and evaluation of trainers, to observe, manage, and deliver comprehensive care for patients with sexually transmitted infections.

The contents of sexually transmitted infections training includes, but not limited to the following items:
1. Fundamentals of sexually transmitted infection: diagnosis and management of disease characterized by genital, anal or perianal ulcers (chancroid, genital HSV infections, granuloma inguinale, lymphogranuloma venereum), syphilis, diseases characterized by urethritis and cervicitis, chlamydial infections, gonococcal infection, diseases characterized by vaginal discharge (bacterial vaginosis, trichomoniasis, vulvovaginal candidiasis), pelvic inflammatory disease, epididymitis, human papillomavirus infection and its complications, proctitis, proctocolitis and enteritis, pediculosis pubis and scabies. Management of STIs patients’ sexual partners.
2. Specialized topics: special populations (pregnant women, adolescent and children, men who have sex with men, women who have sex with women, transgender), HIV infection detection and management of STI in the HIV infected, Hepatitis A, B & C, management of STI patients who have a history of drug allergy, clinical prevention measures, counselling of STI patients and their partners.
Procedural Dermatology

Adequate opportunities are provided for the trainee, under the supervision and evaluation of trainers, to observe and acquire the skills to deliver safe and effective dermatological procedure for diagnostic and therapeutic purposes.

The contents of procedure dermatology training includes, but not limited to the following items
1. Fundamentals of procedural dermatology: pre-procedural assessment, valid informed consent, anatomy, lesion and site selection, delivering local anesthetics, instruments, equipment and surgical materials, aseptic techniques, correct-patient and correct-site/lesion procedure, hemostasis, after-care and follow-up, complications of surgery.
2. Specialized topics:
  1. Investigatory procedure: Fungus scraping and microscopy, scabies scraping and microscopy, skin smear examination for leprosy, hair-pull test/trichogram, dark ground microscopy for spirochaete, Gram-staining and wet smear examination for pus cell, Trichomonas vaginalis and Gonococcus, specimen taking for sexually transmitted infections, cervical cytology smear, speculum examination, proctoscopy, prostatic massage, patch test reading and interpretation, Wood’s light examination, phototesting, patch test, prick test and intradermal testing, lumbar puncture.
  2. Dermoscopy on pigmented and non-pigmented lesions
  3. Therapeutic procedures: phototherapy, wet-wrap therapy, iontophoresis.
  4. Surgical procedure: punch incision/excision, elliptical incision/ excision, shave incision/excision, electrodessication, curettage, paring of corn, cryosurgery, intralesional steroid injection: needle/Dermojet, nail surgery, oral mucosal and genital skin surgery.
  5. Laser surgery: for pigment lesions, vascular lesions and ablative laser.
  6. Cosmetic procedures: Botulinum toxins, soft tissue augmentation, skin resurfacing.
Professional quality development

During the process of training, a professional quality must be developed in order to provide high quality care to patients
1. Be humanistic. To listen, to empathize and to gain patient’s trust.
2. Be ethical, legal and evidence-based in clinical practice.
3. Commitment to Continuing Medical Education and Continuing Professional Development.

IV) INSTITUTIONAL REQUIREMENTS

The accredited Dermatology/Venereology training institute of the training programme should fulfil the following criteria.

Dermatology training Institution should have the following features.
1. A day care center with out-patient clinics with accessible service which accepts referrals from a wide spectrum of health services. The volume of cases must be adequate; the range of cases type must be wide: from common dermatoses to rare dermatoses; from mild dermatosis to severe; from simple to complicated. Emphasis is given to the volume of cases with severe and complicated dermatosis.
2. The day care centre should be installed with facilities, equipment and materials to enable all the procedures in dermatology (Session 3) to be carried out. The facilities and equipment must be well maintained and operated to enable medical procedures to be carried out in a safe and high quality manner.
3. For a training institute not offer training in cosmetic procedures, arrangement must be made for trainees to be seconded to a College approved unit to receive training in cosmetic procedures.
4. The dermatology training institutes must possess a full range, updated and necessary pharmaceutical agents which enable comprehensive pharmaceutical management of patients.
5. The dermatology training institute must have ready access to a range of supportive service enabling comprehensive diagnostic and therapeutic activities to be carried out. Those supportive service will include, but not limited to: pathology (Histopathology, chemical pathology, haematology, immunology), radiology and microbiology.
6. The dermatology training institute must be affiliated with general hospitals with a full range of specialist services. This enables severe dermatoses to be taken care under in-patient environment and benefits from the immediate input from other specialties. This also enables acquiring of knowledge and experience in diagnosis and management of dermatoses in other specialties through the provision of inpatient dermatology consultation service. The trainee should work in the affiliated hospital for an adequate period under supervision to enable the acquisition of experience in hospital dermatology.
7. There must be adequate supporting facilities, equipment and material to enable academic, research and educational activities to be carried out: a library with full range of books, periodicals and other reference material which are made readily accessible physically or over the internet; space for seminars and meeting; computers and projection equipment.
The Venereology training institute, in addition to the features needed for a dermatology training institute, should have the following features.
1. A day care centre with out-patient clinics with accessible service which accepts patient self-referral and also referrals from a wide spectrum of health care services.
2. The volume of cases must be adequate; the range of cases type must be wide: from common to rare STI; from simple to complicated.
3. A laboratory attached to the clinic, to provide dark field examination, Gram stain smear microscope examination, and wet smear examination.
4. A counselling & contact training service supported by trained health nurses.
5. For a Dermatology training institute not offering the six months training in venereology, arrangement must be made for trainees to be seconded to an accredited Venereology training institute in order to complete the six months of training in venereology.
Supervision, coaching and evaluation
1. An accredited trainer is matched to a maximum of two trainees. Trainers are responsible for onsite supervision, coaching and evaluation of the performance of a trainee, reporting to the Specialty Board Chairman of the progress and advise the chairman on the individual need of a trainee.
2. On-site supervision, coaching and evaluation is essential. It requires the trainer to be of close proximity with the trainee in a significant proportion of the trainee’s training time, be present in the trainee’s clinical sessions and procedural session, and is readily accessible for consultation if not present.
3. Regular and frequent attendance and presentations in the format of journal club, case presentation, clinical-pathological conference etc. is required in the training programme. The trainee should carry out these activities in close consultation of his/her trainer.
4. The dissertation preparation should be prepared in close consultation with the trainer, from the proposal to carrying out study to the final write up.

For more information on the HKCP training guideline, please visit the below website: www.hkcp.org/hkcp/trainees.html

Or the below Guidelines on Postgraduate Training in Internal Medicine: Guidelines on Postgraduate Training in Internal Medicine, Sixth Edition, July 2018 (updated in April 2021).

Reference
Chan, T.M.D. and Li, K.T.P. (eds.) (2017) Guidelines on Postgraduate Training in Internal Medicine. Hong Kong: Hong Kong College of Physcians, p. 88-93.