Training residents in dermatopathology: Why, when, where, and how

The observations and conclusions that follow are mine alone.They derive from more than 20 years of teaching dermatopathology full-time to residents in dermatology and surgical pathology, fellows in dermatopathology, and practicing dermatologists and pathologists.Colleagues may disagree with the accuracy of my observations and the validity of my conclusions.This essay makes no pretense to being scientific; it aspires to making sense.No two training programs in dermatology and surgical pathology have the same philosophy about teaching dermatopathology to residents or the same method for accomplishing that aim.In. all too many departments of dermatology and pathology throughout the world there is neither philosophy nor method with regard to teaching dermatopathology.Most residents learn dermatopathology by (I) memorizing "Lever" (which, they are told, is excellent preparation for Board examinations), (2) studying "unknown" slides to be discussed at conferences, usually weekly, (3) attending episodic lectures about various aspects of dermatopathology, and (4) "catch as catch can" time at a microscope in tutorial instruction or on their own.In my view these are not effectiveways to learn dermatopathology.What follows are reasons why and a proposal for how that desideratum can be achieved with repeatability.Why is it essential for residents in dermatology and surgical pathology to be competent in dermatopathology?The reasons are compelling for both groups but different for each of them.Surgical pathologists have responsibility for accurate diagnosis of sectionsfrom specimens of skin, just as they do for those from every organ.The riveting fact is that specimens of skin constitute about 25% of all specimens received in a laboratory of general surgical pathology, whereas specimens of kidney, spleen, and liver comprise less than I% of the total.Theoreti-