Procedural dermatology fellows will soon have new requirements, including specifics about how many surgical cases they must perform.
The requirement is one of the changes put forward by the Accreditation Council for Graduate Medical Education as part of a regular review of the graduate medical education program requirements for procedural dermatology. This is the first revision to the program requirements since the subspecialty was first accredited in 2003.
The new requirements are scheduled to go into effect in July, but there may be some additional revisions before then as the group receives last-minute comments on the document, according to ACGME. The current requirements and revisions are posted online at www.acgme.org/acWebsite/RRC_080/080_prIndex.asp.
Under the revised document, ACGME is keeping the requirement that fellowship programs provide a sufficient volume and variety of surgical cases for fellows, specifically that at least 1,000 dermatologic surgical procedures per fellow are available and that at least 500 of that total must be Mohs micrographic surgery procedures. ACGME, however, is now also specifying case requirements for individual fellows. Fellows must perform, not simply observe, at least 400 surgical cases, of which at least 200 have to be Mohs surgery procedures.
ACGME is also adding requirements that frozen section slides for Mohs surgery must be reviewed and approved as part of an ongoing quality assurance program by an appropriate peer-reviewed organization. Facilities also will be required to have their frozen section laboratory and examination areas accredited by appropriate oversight bodies.
The biggest change in the document is the way it is organized, but much of the content is the same, said Dr. Randall K. Roenigk, professor of dermatology at the Mayo Clinic in Rochester, Minn., and chair of ACGME's Residency Review Committee for Dermatology. For example, the three major components of procedural dermatology fellowship training--Mohs micrographic surgery, reconstruction, and cosmetic surgery--remain the same, he said.
The regular revisions to the program requirements by ACGME are really a way to assure the public. "It's really an attempt to demonstrate to the public that we're doing our best to train the best doctors," Dr. Roenigk said.
But Dr. Lee S. Portnoff, a full-time Mohs surgeon in St. Louis and president of the American Society for Mohs Surgery, said that he is concerned about some of the changes ACGME has made.
The requirement to perform at least 400 surgical cases, of which at least 200 are Mohs procedures, would allow some fellows to complete the requirements without getting sufficient experience in non-Mohs surgeries, he said. If fellows are allowed to count Mohs-related repairs toward their overall surgical requirement, they could easily meet the requirements without doing much in the way of other types of procedures.
"This may be just a Mohs fellowship by another name," Dr. Portnoff said.