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Spring 2014, Vol. 22 No. 1

Hong Kong J. Dermatol. Venereol. (2014) 22, 3-4


Editorial

Do we need our own independent College?

HHL Chan 陳衍里

Dermatology and Venereology is a recognised specialty within the Hong Kong College of Physicians (HKCP) and in the last decade, training has been well developed with Social Hygiene Service of the Department of Health being the main training centre and both teaching University hospitals carry a less significant role. Current training involves three years of basic physician training at the end of which, the trainees have to pass the intermediate examination (MRCP/MHKCP) jointly organised by HKCP and the Royal College of Physicians (United Kingdom). Afterwards, the trainees will undergo an additional three years of Dermatology/Venereology training. Trainees have to undertake an interim assessment during their training and at the end of which, they must pass the exit assessment.

The training of Dermatology and Venereology in Hong Kong differs significantly from most developed countries. In the United States of America (USA), trainees enter into a three-year Dermatology training programme (four years if they opt to spend a year in research) immediately after internship (housemanship) without the need to do any Internal Medicine. In Canada, trainees receive five years of residency training with the first two years being basic clinical training that must include a minimum of 12 months of Internal Medicine or Paediatrics, and must include specific rotations in Rheumatology and Infectious Disease. Rotations to other areas such as Plastic Surgery are recommended. This is then to be followed by three years of Dermatology training. In France, Germany and South Korea, training in Dermatology is similar to the USA and Internal Medicine is not a major or mandatory requirement. Japan and Brazil are similar to Canada whereby two years of basic training are required but apart from Internal Medicine, paediatric training can also be counted. In Singapore, there is a recent introduction of the Seamless Programme for Dermatology. Similar to Canada, two years of basic training is required, at the end of each, the trainees must pass the intermediate examination, this is then to be followed by three years of Dermatology training.

In Australia, after two years of internship, trainees enter a four-year training programme and at the end of the second year, they must pass the intermediate examination in Clinical Science and Pharmacology Examination (part 1) before proceeding to two further years of advanced training and then taking the fellowship examination.

It is therefore quite apparent that the training in Dermatology and Venereology in Hong Kong is not in line with the international trend and besides the United Kingdom (UK); North America, most of the Asian countries as well as other major European countries do not require their Dermatology/Venereology trainees to undergo such a prolonged duration of Internal Medicine training. Interestingly, even if a fully qualified dermatologist in the UK wishes to apply for specialist status in Hong Kong, his/her application is likely to be unsuccessful as the UK only requires two (not three) years of Internal Medicine training before further dermatological specialisation.

One of the major disadvantages in such a prolonged duration of Internal Medicine training is the prohibition of the development of subspecialties within Dermatology. There are now many well recognised subspecialties in Dermatology such as Dermatologic Surgery; Paediatric Dermatology; Dermatopathology and Photodermatology. For trainees who undergo Paediatrics as part of his/her basic training, it will be most useful and allow him/her to be better equipped to enter into Paediatric Dermatology fellowship upon completion of his/her Dermatology training. To illustrate, Dr. Ronald Moy, the former President of the American Academy of Dermatology, spent two years as an orthopaedic surgeon before entering into a Dermatology training programme. Upon completion of his Dermatology training, he then spent an extra year doing a Moh's surgery fellowship and is now a well renowned dermatologic surgeon.

For Venereology, while different countries have different directions of development, given the newly proposed two-year basic training, the expectant trainees in higher specialist training will likely be equipped with the knowledge for them to undertake the module in Venereology. Venereology can be a potential subject for subspecialty development.

Clearly it is now time to change, time to have our own college.

HHL Chan
陳衍里

 


Acknowledgement

The Editorial Board would like to thank the following who have reviewed original or review articles or have contributed articles to our Views and Practice section of the Hong Kong Journal of Dermatology and Venereology in 2013:

Dr Edwin Chan
Dr W Gulliver
Dr WY Lai
Dr PC Lau, Shirley
Dr SY Wong, David