Minimum duration of training, work based competency assessment will provide flexible pool of candidates-Amjad Khan


 Training in Paediatric Dermatology

Minimum duration of training, work based
competency assessment will provide flexible
pool of candidates - Amjad Khan

MCPS in Paediatrics or Dermatology followed by three to
four years Training should lead to FCPS in Paediatric Dermatology

LAHORE: An interesting presentation during the recently held SARCD and PADCON at Lahore was on Training in Paediatric Dermatology by Dr. Muhammad Amjad Khan on Training in Paediatric Dermatology which also aroused lot of discussion. He pointed out that issues related to skin are widely recognized illnesses seen in children who are looked after by a variety of healthcare professionals in different settings. Most often they are looked after by dermatologists but more recently in some countries paediatricians are also being trained to provide this specialized service.

Dr. Amjad Khan who is a Consultant Paediatric Dermatologist at Barking, Havering and Redbridge University Hospitals in London further stated that in United Kingdom Paediatric Dermatology as a specialty was recognized in 2007 with the start of dedicated Out Patients Departments but there was no separate Fellowship in Paediatric Dermatology. Paediatric dermatology in fact needs multidisciplinary approach including paediatricians and dermatologists while psychologists also help them. In USA there were twelve posts of paediatric dermatologist and almost 50% of them remain vacant. There are two hundred twenty Paediatric dermatology clinic but young dermatologists most often opt for other specialties. Now the paediatric dermatology posts in USA have increased to thirty five and they offer twelve months training programme. Canada was the first to start Fellowship programme in paediatric dermatology which is a two years programme and they established fifty specialty clinics in a year. In UK there are twelve months and twenty four months programems which are competency based. Singapore offers one year fellowship. India has a twelve months training programme while Bangladesh has just started. In Spain they have paediatric case based discussions,

Paediatric dermatology, Dr. Amjad Khan said is a unique specialty and the idea of formal training is quite novel. Pakistan has a population of over two hundred million but it has no training programme for paediatric dermatology so far. It is very specialized subgroup of paediatics as well as dermatology. It deals with birthmarks, genetic skin conditions, allergies, skin infections, and hair and nail disorders besides all types of common and rare skin conditions. Practice of paediatric dermatology covers not only traditional consultation but various procedures as well like skin biopsy, shave excisions, phototherapy, patch testing, topical immunotherapy and laser surgery. A study from India reported that skin diseases accounted for 38.8% of all paediatric problems. They have started three to five clinics a week and also do twice weekly ward round by paediatricians and dermatologist each week.

In Pakistan we have Fellowship in Dermatology and Fellowship in Paediatrics. Usually training in paediatric dermatology consists of prolonged residency or a sub-specialty fellowship after completing a formal Fellowship. Some countries have allowed dermatologists and encourage applications from paediatricians as well as offer two years Fellowship. The whole training programme is either time dependent or focused on the competencies achieved during the fellowship. He was of the view that for a country like Pakistan, we should opt for a mixed programme of British to increase the basic pool of interested candidates. This will result in better competition and varied choice of candidates. It should consist of a combination of minimum duration of training and work based competency assessment which will result in flexible training which many potential candidates will find attractive.

Dr. Amjad Khan further stated that during his stay in Pakistan he had detailed discussions with paediatricians and dermatologists. What we can opt for is MCPS in dermatology followed by three to four years training to earn Fellowship in Paediatric Dermatology. Another approach could be to start Fellowship in Paediatric Dermatology which can be MCPS in Paediatrics followed by a three years training programme in Paediatrics and Dermatology which will lead to Fellowship in Paediatric Dermatology. His presentation was followed by lively discussion. Chairperson of the session also referred to the campaign initiated by Dr. Yasmeena Khan who has asked the CPSP to start Fellowship in Paediatric Dermatology. It was further pointed out that it will still take some time for the paediatric dermatology to develop in Pakistan. Patients come with ugly scars, patients are very poor, treatment is very expensive, and hence not many are at presented attracted to this specialty.

Dr. Amir Ejaz from CMH Rawalpindi talked about the use of chloroquine in the treatment of cutaneous leishmaniasis. He pointed out that there are about three thousand five hundred cases in Paksitan, treatment is expensive and it has lot of side effects. Search is on for an alternate therapy. At present chloroquine is easily available. He then referred to an RCT for which software was used to select the sample size. One hundred fourteen people collaborated in that study which showed that intralesional chloroquine has some effect in cutaneous leishmaniasis but this disease still effects thousands of people. We need to find a new safe and effective treatment for these patients. Dr. Manzoor Memon participating in the discussion highlighted their own observations. They have so far organized 629 camps in the province of Sindh to create awareness in the community.

Earlier Dr. Anil Kumar from Nepal talked about eHealth initiative which they have been practicing in Nepal reaching the un-reached in the far flung areas. This is an e Health initiative by Nepal Medical College wherein they use integrated services in the community with dermatological services. The project is known as CHEST Nepal which stands for Community Health Education Services by Tele Health. It was started in 2009. It consists of eHealth service, Skill development and Training, Public Awareness besides providing clinical health services. During the last eight years, this service has benefitted six hundred dermatology patients. This is a community dermatology service. Dr. Dinesh Pokhrel talked about Leprosy Post elimination era. He referred to nodular type of leprosy and gross disability due to leprosy. He questioned have we eliminated the leprosy in totality? This is the oldest disease known to mankind. In India more than 50% new cases of leprosy are detected. Numbness of hand and feet should be enough to suspect leprosy. The patient complains of weakness of hands, eyelids, feet, they are painful and tender. India has almost 59% of global and 81% of the regional cases of leprosy. Challenges in the post elimination era, he said, include clustered endemic areas; and contagious leprosy is an issue which is not addressed by diagnostic criteria. We need to revise diagnostic criteria and enhance new case detection.