This might be the case but derm residents are pretty smart and good at taking these tests otherwise they would not be in derm to begin with!
I disagree. Yes, Derm residents are very smart, and so are a lot of Path residents. NRMP did a study and tabulated the USMLE Step 1 Scores and publications, among other parameters, of matched applicants in the past few years and Path was always in the upper middle group, usually trailing behind Derm, Rads, and Ortho, but always above IM, FM, Peds, and OB-GYN.
Dermpath is so competitive and there are way more applicants than there are spots and so one would think that the fellowships would tend to get the best of the best (just because there are so many excellent candidates to choose from). I am sure the Path residents who get into Dermpath fellowships are just as smart as their Derm colleagues.
Do not forget the fact that the Dermies study Dermpath for 3 years, throughout their residency. And skin is all they deal with and nothing else. And then, those who do a Dermpath fellowship get an extra year of focused training. By contrast, Path residents usually do only a month or 2 of Dermpath during residency. Add to this the fact that the Derm residents, prior to taking the Dermpath boards, had just taken the Derm boards and thus had reviewed Dermpath quite extensively already.
As for the clinical stuff in the Dermpath boards, I would think that they are never asked outside the context of a biopsy (so if a test taker knows the cutaneous histologic inflammatory reactions by heart, the clinical information should only help him nail the diagnosis). In a recent article in the Journal of Cutaneous Pathology, sample Dermpath board questions for the international board certification (which is headed mostly by US Path-trained dermatopathologists like Sangueza and Smoller) were published. One was on a pityriasiform dermatosis. The clinical information saying that the biopsy was taken from a young female with new-onset erythematous plaques and papules on her extremities gave away the diagnosis (it could only be PLEVA given the histology and clinical picture and PLC and PR could easily be ruled out). A good Dermpath fellowship tecahes a Path-trained person important clinicopathologic correlations such as this one (at sign outs, at the clinics, and at Grand Rounds).
I don't think that Path residency programs need to change their curriculum to teach more Dermpath to their residents. The low pass rate among Pathologists is a result, not NECESSARILY of their incompetency, but of other factors mentioned above.
