Training avenues in dermatopathology for an Indian dermatologist or pathologist

Sherina Laskar

 Department of Dermatology, Gauhati Medical College, Guwahati, Assam, India

Correspondence Address:
Sherina Laskar
Department of Dermatology, Gauhati Medical College, Bhangagarh, Guwahati - 781 032, Assam
India

Introduction

Dermatopathology is, in many ways, like algebra. One needs to recognize the clues on a histopathology section, fit in the unknowns and solve the equation to arrive at a diagnosis. Hence, many find dermatopathology intriguing and others, intimidating. For the pathologist or pathology trainee too, dermatopathology is equally interesting and challenging because of the sheer number and variety of diseases involving the skin and its appendages. There is a dearth of knowledge about training avenues in this subspecialty and this article aims to summarize the options available in India and abroad to an Indian aspirant.

Reasons to Train in Dermatopathology

Inadequate learning during the postgraduate training years

The dermatology and pathology departments of most medical colleges in India lack faculty members who are either trained or have a special interest in dermatopathology and hence, residents fail to learn enough practical diagnostic dermatopathology during their two or three years of postgraduate training.

Fascination for histopathology or dermatopathology

A dermatologist or pathologist may choose to subspecialize in dermatopathology due to interest garnered during the post-graduate training period.

To understand dermatology better

A better understanding of dermatopathology unarguably makes a dermatologist a better clinician. The ability to view and understand the pathologic processes underlying a disease would provide better insight into the disease and its management.

Affiliation to an academic institution

Being affiliated to a teaching hospital is a potential reason for a dermatologist to train in dermatopathology to teach residents better.

Economic benefits

Adequate formal training in dermatopathology is a sine qua non for a dermatologist who desires to take up formal reporting of skin biopsy specimens.^[1],[2] Although it is difficult to provide statistical data comparing the salaries of dermatologists, pathologists and dermatopathologists, it is easy to understand that the added subspecialization is likely to provide an economic advantage to both dermatologists and pathologists using their dermatopathology training professionally.

Factors to consider while choosing a program

1. Duration: 1 to 2 years is considered optimum for basic dermatopathology training
2. Location: for an early or mid-career professional, the deciding factor for selecting a program could be its location within India or abroad as it could imply significant financial, professional and personal life adjustments
3. Institute: the prestige of the institute hosting the program has potential long-term effects on one's career sketch
4. Program Director: the reputation of the course director as a dedicated teacher would be an important deciding factor
5. Volume of cases: higher number of slide accessions a year at an institute increases the exposure of a trainee to a variety of cases
6. Availability of stipend/scholarship: considered a bonus
7. Tuition fee: some centers abroad waive off their tuition fee which is otherwise a constraining factor for Indian trainees.

Training Avenues in India

The options for training in India are depressingly limited [Table - 1]. The Fellowship Course in Diagnostic Dermatopathology (FDD) under the directorship of Dr. Uday Khopkar is the only long-term (1-year) course in dermatopathology available in India. The salient features of this program include:

• Degree or diploma in dermatology (not open to pathologists) as a prequalification
• Training at Seth G.S. Medical College and K.E.M. Hospital, Mumbai
• Course fee: One lakh rupees for 1 year
• Awarded by Maharashtra University of Health Sciences (MUHS), but not Medical Council of India (MCI) recognized
• Advertisement issued during July–August every year, course usually commences in September
• Contact: muhs.ac.in.

Overseas Training Options

Of the multitude of options, the United States has the highest number and the best structured programs [Table - 2] for international medical graduates, who aim to return to their own countries after completion of training. The important considerations for the majority of these dermatopathology courses include:

• A postgraduate degree in dermatology or pathology as prerequisite
• Six months training in dermatology or pathology for pathology or dermatology trained doctors, respectively
• Test of English as a Foreign Language (TOEFL) score (usual minimum is 90 of 120 for the TOEFL internet based test)
• Two to three letters of recommendation, curriculum vitae and personal statement demonstrating interest in dermatopathology
• J-1 visa with defined minimum funding requirements [Table - 3]
• No board certification is provided and the training cannot be used to obtain a license to practice in any part of the United States
• The J-1 visa requirement [Table - 3] may be used as a rough guide for living expenses for the trainee in the United States, although this would vary depending on the location of stay. Housing classifieds websites such as craigslist, Airbnb and Bookings.com may be used to look up long and short stay accommodations.

Two of the most popular courses are profiled in brief.

Boston University School of Medicine: International Dermatopathology Fellowship

• Program Director: Dr. Jag Bhawan
• 30,000 specimen accessions per year
• Fellowship may be undertaken for 1 or 2 years
• All fellows must take up and complete a research project
• Tuition fee waived off on request
• Limited number of scholarships available (Subimal Roy, MD and Hari Tandon, MD, international dermatopathology fellowships)
• This program is very popular, therefore aspirants should apply 1–2 years before the intended training period.
• Contact: Ms. Cindy Yee-Lin; cinyee@bu.edu

Ackerman Academy

• Established in 1999 by the iconic Dr. Bernard Ackerman
• World's largest and most widely known training facility for dermatopathology
• Trainees may choose to train for 4–12 months
• Training fee: $1,000/month
• Affiliated to the SUNY Downstate Brooklyn Hospital, New York
• Contact: info@apply.ackermanacademy.org

Training Options in the United Kingdom

The year-long MSc in Diagnostic Dermatopathology offered by King's College London has been withdrawn by the university unfortunately. Short- or long-term (1–2 years) dermatopathology observerships may be undertaken at St. John's Institute of Dermatology, King's College London by writing to Dr. Eduardo Calonje, Head, Department of Dermatopathology, or the program coordinator, Miss Elena de Teran at jaime.calonje@kcl.ac.uk and derm-courses@kcl.ac.uk, respectively. The department also has a much sought-after 2-year fellowship that pays a generous stipend, but applicants need to be registered with the UK General Medical Council (GMC) in order to apply.

The department receives over 10,000 dermatopathology referrals a year.

The cost of living in the United Kingdom depends on a number of factors, but an average of 1,200 GBP per month may be considered adequate for an individual's modest living expenses.

Other Centers

• Mackay Memorial Hospital, Taipei, Taiwan
• • Program Director: Dr. Yu-Hung Wu
  • Duration of observership (for those not holding a Taiwan medical license): 3, 6, 12 months
  • Prequalification: board certified in dermatology or pathology
  • Fee: 10,000 New Taiwan dollars per month; scholarships available
  • Living expenses in Taipei are roughly 12,000–15,000 NT dollars per month
  • Contact: mmhedu@ms2.mmh.org.tw
• National Skin Center, Singapore
• • Program Director: Dr. Joyce Lee
  • Duration of fellowship: 1 year
  • ICDP-UEMS (see below) accredited training center
  • Accepts both dermatologists and pathologists
  • No tuition fee charged, but administration fee charged by National Skin Center (contact Mr. Naim at naim@nsc.com.sg for details)
  • Contact: joycelee@nsc.com.sg.

Short-Term Observerships

Most reputed dermatopathologists are known to take in international observers for one to several months once an applicant demonstrates adequate interest in the subject over email correspondences. Apart from the names mentioned above and in [Table - 2], examples of such short observerships include ones under Dr. Lorenzo Cerroni (Austria), Dr. Almut Boer (Germany) and Dr. Catherine M. Stefanato (United Kingdom).

Scholarships and Funding

Adequate time must be devoted to identify a scholarship suitable to one's needs. Registering on student help websites like Trialect.com, scholarship-positions.com, etc., for periodic e-newsletters provides not only information on scholarships and grants, but also courses, observerships, mentorship opportunities and clinical trials. The possible scholarships that may aid dermatopathology training are profiled in [Table - 4].

Author's Experience and Additional Comments

Given the dearth of trained dermatopathologists in India for teaching as well as for providing quality dermatopathology reports, there is definitely a vacuum that needs to be filled. There are a number of training options abroad, chiefly in the United States, however, the travel and living expenses apart from course fees often deter even serious aspirants. The Indian Association of Dermatologists, Venereologists and Leprologists has a scheme for four international observerships each year for its permanent members that waives off the programs' tuition fees and provides Rs. 1 lakh to each awardee. Although the sum would only cover a minor fraction of the costs involved, it certainly eases the liaising required to secure a place on any of these competitive programs. The decision to invest in such training has to be one's own, based on a clear vision of one's priorities and goals. Furthermore, a dermatologist desiring to train in dermatopathology needs to be aware that most pathology laboratories in India, government-aided or privatized, would be reluctant to allow them to sign out reports and hence, an initial struggle putting one's training to practice might be inevitable.

Although my own first choice was the Boston University program because of the great volume of cases and Dr. Jag Bhwan's reputation of being a dedicated teacher, I chose the MSc program at St. John's chiefly because of the prestige of the Chevening Masters Scholarship that I had been awarded by the UK government and my subsequent discovery that Dr. Eduardo Calonje, editor of Mc Kee's Pathology of the Skin, headed St. John's' dermatopathology department. Dr. Catherine Stefanato, the director of my program, ensured that I made the best of my training period and made arrangements for me to periodically attend the immunofluorescence, polymerase chain reaction (PCR) and fluorescence in-situ hybridisation (FISH) laboratories and participate in lunchtime slide discussions in general histopathology. While I had started out as unable to recognize even basic skin structures, a year's training, while not teaching me everything, took away my fear of histopathology and gave me the confidence to look at slides on my own, thereby continuing my learning back home.

The Frankfurt Exam

The European Union of Medical Specialists (Union Européenne Médecins Spécialistes [UEMS]) under the auspices of the International Committee for Dermatopathology (ICDP) conducts the International Board Certifying Examination in Dermatopathology (Diploma in Dermatopathology, ICDP-UEMS) in Frankfurt/Main, Germany, in December every year that most trained dermatopathologists from all over the world eventually aim to clear after their training.^[3]

Acknowledgment

The author wishes to thank the Chevening Organisation and the Foreign and Commonwealth Office, Government of the United Kingdom for the Chevening Masters Scholarship 2015–16 under the aegis of which she was able to undertake her Master's program in dermatopathology at King's College London and thereby also feel qualified to write this article.

Financial support and sponsorship

Institutional support.

Conflicts of interest

There are no conflicts of interest.

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