Beefs about benchmarks

April 1, 2007

National report - Changes to requirements for graduate medical education in dermatology have sparked protest by the American Society for Mohs Surgery (ASMS), even as some dermatologists say the society's concerns are unfounded.

According to a statement issued by the ASMS, changes approved by the Accreditation Council for Graduate Medical Education (ACGME) "are a threat to the specialty of dermatology and to our patients."

Most troubling to Dr. Cronin are these proposed changes:

Procedural standards

The section on procedural dermatology is especially troublesome to Dr. Cronin.

Following is the new three-category section as it appears in the ACGME's rewritten requirements:

1. During their training, residents should achieve competency in biopsy techniques, destruction of benign and malignant tumors, use of lasers for the treatment of superficial vascular tumors (e.g., port wine stains), and excision of benign and malignant tumors with simple, intermediate and complex repair techniques including flaps and grafts.

2. Significant exposure to other procedures through direct observation or as an assistant at surgery is required. Examples in this category include Mohs micrographic surgery and reconstruction of resulting defects, the application of a wide range of lasers and other energy sources, botulinum toxin injection, soft-tissue augmentation, sclerotherapy and chemical peel.

3. Program faculty must provide education relating to certain cosmetic techniques without necessarily affording direct exposure. Among these are liposuction, scar revision and dermabrasion. The program's experience in cosmetic surgery may vary depending on the nature and experience of the practice; however, didactic training in this area is required.