LAUSR

How well prepared are dermatologists redeployed to COVID-19 wards? Dear Editor, Since December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been posing a serious challenge for the national health systems of numerous countries, such as Italy or the United States (US). The massive patient influx has led to shortages not only in vital medical supplies but also in medical personnel, resulting in health authorities taking emergency initiatives so as to face the consequences of this public health crisis. Among these initiatives is the recruitment of doctors of specialties other than internal medicine or anesthesiology and, in some cases, even of medical students. Such actions, although necessary and evident in critical times, can be a cause of concern for numerous physicians who are suddenly redeployed to COVID-19 wards yet lack even the basic intensive care training. As far as the structure of the dermatologic medical specialist training is concerned, there are certainly differences among the different countries and even among residency programs in the same country: some residency programs include a general medicine common trunk of variable duration, while others are constituted solely of a full-time dermatology training. It is therefore a reasonable concern up to which extent a skin physician without contact with a minimum critical care training during the last years of his career could perform adequately in the special emergency conditions and the complex cases of respiratory failure, such as the ones encountered frequently in the overworked COVID-19 wards. In light of the recent developments, it is important to reflect not only on the content of the postgraduate dermatology curriculum of the various residency programs but also on the nature of the specialty of dermatology overall. The expansion of dermatology toward surgical and aesthetic fields over the last years as well as the overlap of areas of our specialty with other medical specialties, such as infectious diseases or rheumatology, have gradually resulted in the fragmentation of medical dermatology and its gradual absorption into other subspecialties of internal medicine. Oncologists managing melanoma cases or rheumatologists handling individual patients with systemic scleroderma are examples reflecting the general framework that contributes to the lack of familiarity of many dermatologists with basic aspects of internal medicine. When dermatologists are gradually deprived—either willingly or unwillingly—of their privilege to be involved in the complex medical care of patients suffering from primarily mucocutaneous diseases who manifest variable systemic complications, it is normal to expect that their knowledge in the field of critical care medicine is even less wellfounded. The idea of providing dermatologists, throughout their careers, continuous access to the updated necessary knowledge so as to independently manage intensive care patients is not realistic. It is, however, essential that the residency programs as well as the dermatological societies encourage skin physicians to be actively involved in the management of systemic complications of complex dermatologic diseases. A suggested approach would be, for instance, endorsing the participation in regular educational opportunities that involve an interdisciplinary interaction with other medical specialties, or including a short rotation in the emergency department during the residency training. This would allow dermatologists to be gradually able to repress the inner emotional barrier that impedes them from assuming responsibility for such patients and to manage to rise to the occasion when confronted with certain types of internal medicine problems. As dermatologists, we should protect and preserve our right to be the primary care providers for patients with complex mucocutaneous diseases, and it is essential to acquire the sufficient competence in the principles of internal medicine that allows our involvement in the management of their challenging systemic complications. This process could definitely enhance our preparedness when it comes to handling critical situations or even—up to some point —participating actively as front-line physicians in times of extreme need, such as the currently ongoing SARS-CoV-2 pandemic or future difficult periods.