During the specialization in Dermatology and Venerology, no real separation can be made between the 5 years. The knowledge, problem-solving ability, and specific skills that are tied to each domain and are taught from the basics to the final objectives when the ASO is active in this domain.
The frequent general dermatopathology is reviewed during level 2 of the training.
At the end of the training, the doctor-specialist has acquired the competencies within the area of focus listed below to provide effective, high-quality patient care. The ASO independently provides science-based, comprehensive and effective diagnoses and treatment for patients with skin conditions. The detailed objectives describe the minimum standards and in no way obstructs the nee to learn additional knowledge, skills or attitudes for the most effective treatment of patients with skin- and venereal diseases.
The ASO is given the opportunity to practice a wide range of domains within the specialization during its training. The ASO acquires specific knowledge and skills during these internships and applies them in the practice. The ASO does an internship and learns the relevant activities for the service ‘the specialty dermatology’.
Overview of knowledge and skills
- the scientific fields at the base of dermatology and venereology as already offered during the basic training to doctor (anatomy, embryology, histology, microbiology, biochemistry, genetics, physiology and immunology);
- the embryonic development of the skin, and how congenital disorders and abnormalities arise during this process;
- the anatomical and physiological basis for normal skin examination considering the effects of age. This includes the anatomy of the skin in terms of location of blood vessels, nerves, muscles / tendons, skeletal reference points, lymphatic drainage, sites susceptible to complications during surgery, direction of incision, and the importance of the cosmetic units of the face;
- clinical genetics as known by the basic physician and the application to genodermatoses;
- clinical epidemiology in relation to skin diseases
- the function and dysfunction of the immune system with a emphasis on the consequences for skin diseases.
- clinical skills in systematically diagnosing skin disease (skin and skin adnexa, subcutis and adjacent mucous membranes) using anamnesis, physical examination and the necessary additional examination methods
- clinical characteristics, including presenting symptoms, natural course and prognosis of inflammatory, bullous, vascular, infectious, benign and malignant neoplastic, degenerative and congenital disorders of the skin and of sexually transmitted diseases;
- manifestations of skin diseases in elderly and children and all ethnic groups;
- skin manifestation of systemic diseases in patients of all ages;
- the skin abnormalities that can arise from drugs;
- the psychosocial aspects of skin diseases and of the diagnosis and treatment / guidance of disorders in this field. In doing so, insight should also be obtained into the possibilities that organizations such as social services, psychological and psychiatric services can offer;
- the basic principles underlying the main clinical skin and mucosal examinations, including microscopic examination, skin cultures, Woods lamp examination, dermatoscopy, diascopy, photodiagnostic possibilities, plaque tests and photoresist tests, and prick testing and intracutaneous testing; given the indications for and the potential value of, and the limitations and contraindications for, the above-mentioned studies in each clinical situation where their use is being considered;
- the relevant chemical, serological and cytological blood parameters in dermatological and venereal diseases;
- the formulation of an appropriate, differential and preliminary diagnosis;
- requesting appropriate laboratory tests;
- acquiring technical skills needed to conduct dermatological practice, including microscopic examination, Woods lamp examination, adhesive testing, intracutaneous testing and dermatoscopy; given the indications for and the potential value of and the limitations and contraindications for the above-mentioned investigations in any clinical situation where their use is being considered;
- the therapeutic possibilities in dermatology and venerology (percutaneous resorption, pharmacology and side effects of local and systemic medication) and the application and complications of physical treatments and surgery;
- the indications, mechanisms of action, side effects, dosages and precautions according to current guidelines of the main treatment modalities for local and systemic application in dermatology;
- the possible drug interactions and the teratogenic effects of the most important drugs used in dermatological therapy;
- the normal phases of wound healing, as well as the necessary conditions that are necessary for normal wound healing to take place;
- the indications and contraindications of wound care technologies available for acute and chronic wounds;
- the setup and implementation of an appropriate care plan taking into account issues such as the age of the patient, general state of health, indications, and costs of additional research, opportunities and costs of therapeutic interventions and epidemiology and natural course of the disease;
- setting up and implementing a treatment plan for local and systemic therapy.
The following components build on the knowledge and skills described in I 'General dermatology'.
II. Venerology, other infectious diseases, and import dermatoses
1. Basic knowledge
- microbiology applicable to infectious diseases of the skin and mucous membranes;
- the basic principles of clinical epidemiology, specifically for venerology, other infectious diseases and import dermatoses.
2. Diagnostics
- the microbiological methods and thereby being aware of the appropriate relevance;
- the relevant chemical, serological and cytological blood parameters in dermatological and venereal diseases;
3. Therapy
- the epidemiology, registration, contact tracing and case holding of sexually transmitted diseases;
- being able to apply the various treatment options that can be set for sexually transmitted diseases, infectious diseases, and import maturations.
III. Allergology and environmental dermatology
1. Basic knowledge
- the clinical presentation of allergies of the immediate and delayed type
- skin changes caused by working conditions;
- social legislation relating to problems with allergic dermatoses and environmental dermatoses
- The skin changes as allergic reactions to medication
2. Diagnostic
- performing cutaneous (prick test, intradermal test, patch test) and serological tests;
- performing photobiological tests;
- being able to interpret the results of allergy tests in relation to the skin abnormalities and working conditions
3. Therapy
- independently draw up a plan for carrying out and assessing the aforementioned tests and drawing up a policy plan (preventive and therapeutic) based on the results found
IV. Dermatopathology
1. Basic knowledge
- the histology of normal skin;
- the histopathological picture of frequent dermatoses;
- adequate removal of histopathological material.
2. Diagnostic
- know which diagnosis matches which test (choice of material and fixative) and thus knows to what quality the material must comply for good histopathological examination;
- to know whether a biopsy should be taken lesional or perilesional;
- clinicopathological correlations and relevance can be made by the pathologist on the basis of the result;
- to use current histopathological techniques such as H & E staining, (in) direct immunofluorescence, immunohistochemistry;
- a.d. dermatopathology incl. immunohistochemistry itself can systematically diagnose the most important inflammatory and neoplastic disorders.
3. Therapy
- independently draw up a policy plan based on the clinical and histopathological findings.
V. Phlebology, lymphology
1. Basic knowledge
- the physiology and pathophysiology of the venous, arterial and lymphatic system in relation to skin disorders;
2. Diagnostics
- the methods that are available to be able to examine the functioning of the vascular systems;
- interpretation of the results.
3. Therapy
- the treatment modalities of venous insufficiency, including compression therapy, sclerotherapy, ambulatory phlebectomy according to Muller and ultrasound-guided sclerotherapy, can introduce intraluminal techniques;
- the various compression therapy modalities including therapeutic elastic stockings;
- being proficient in the functional research of the vascular system. Can handle and interpret conventional instrumental non-invasive vascular research;
- being able to treat an ulcer cruris, including invasive and non-invasive methods;
- implementing a lymphological therapy plan.
VI. Children's Dermatology
1. Basic knowledge
- To have knowledge of the specific characteristics of normal skin and of the most important dermatoses in childhood.
2. Diagnostics
- See I, taking into account the specific characteristics of the child's skin.
3. Therapy
- use the age-related toxicological properties of local and systemic therapies;
- insight into the ideal timing of therapeutic options.
VII. Dermato-oncology
1. Basic knowledge
- knowledge of the origin, risk factors, growth behavior and natural course of benign and malignant tumors of the skin;
- knowledge of the treatment options.
2. Diagnostics
- know the actions to arrive at an accurate diagnosis;
- indication assessment for additional diagnostic examination and staging examination.
3. Therapy
- drawing up a policy plan that incorporates all of the above data.
VIII. Light dermatology
1. Basic knowledge
- knowledge of therapeutic and toxic effects of monochromatic and polychromatic light on the skin, whether in combination with photodynamic substances.
2. Diagnostics
- the basic principles, indication assessment and performing photo-diagnostic possibilities, given the potential value of and the limitations and contraindications for the above-mentioned examinations in that clinical situation where their use is being considered.
3. Therapy
- Indication and performance of therapy with monochromatic and polychromatic light incl. phototherapy, photodynamic therapy, and laser therapy.
IX. Dermatosurgery
1. Basic knowledge
- the normal phases of wound healing, as well as the necessary conditions that are necessary for normal wound healing to take place;
- the use of surgical instruments, anaesthetics, suture materials, haemostatic applications and agents, antiseptic techniques, instrument sterilization and maintenance of sterility in the operating room;
- performing a preoperative assessment to determine which therapeutic modality is most suitable;
- understanding and applying the principles of local anaesthesia.
2. Diagnostiek
Does not apply
3. Therapy
- indications and possible complications of a biopsy of skin and oral mucosa, curettage, cryosurgery, electrosurgery, primary and secondary wound closure, shear-, rotation and transposition plastics and split skin and full thickness skin grafts and Mohs micrographic surgery;
- the indications, limitations, and expectations for targeted referral for cosmetic dermatological procedures;
- performing excision techniques with an adequate sterile surgical technique such as punch biopsy, curettage, electrode dissection, cryosurgery, fusiform excision and layered operative closure using basic bonding techniques;
- the provision of post-operative care and wound treatment.
X. System-related skin conditions.
Below this point, all immunological and inflammatory skin conditions are categorized, whether or not associated with an internal pathology.
1. Basic knowledge
- Immunological dysfunctions and semiology of internal medicine.
2. Diagnostics
- Recognize and be able to place the skin manifestations and related symptoms related to the general clinical picture;
- To know the relevance of histopathological, immunofluorescent and immunohistochemical findings;
- The relevance of medical imaging and biochemical, serological and cytological additional studies.
3.Therapy
- drawing up a policy plan that incorporates all the above data;
- know the efficiency and safety of the specific therapeutic armamentarium.
XI. Hereditary and congenital skin conditions
1. Basic knowledge
- the embryonic development of the skin, and how congenital disorders and abnormalities arise during this process;
- the application of the principles of clinical genetics to genodermatoses.
2. Diagnostics
- To be able to place specific skin manifestations in a broader syndromic framework;
- Knowledge of the diagnostic possibilities;
- The relevance of the studies.
3. Therapy
- To be able to provide genetic counseling, whether or not in a multidisciplinary context;
- Prepare an optimal therapeutic policy taking into account the limitations specific to the disorder;
- Provide psychosocial environment.
XII Aesthetic Dermatology
Basic knowledge of skin physiology and skin aging
basic knowledge, indications, and contraindications of different aesthetic procedures (peeling, BOTOX and filler injections, laser)
The ASO further enhances its own problem-solving capacity during the various seminars and daily work.
- After each internship period, the ASO must complete the ABC questionnaire.