Recommendations for Competency in Allergy Training for Undergraduates Qualifying as Medical Practitioners: A Position Paper of the World Allergy Organization

The global increased prevalence of allergy is such that between 20-30% of the world's population now suffers from some form of allergic disease, with considerable and continuing increases in prevalence over the last three decades [1]. Although the specialty of allergy is practiced and recognized in most developed countries, even some developed countries lack adequate resources to manage the local burden of allergic disease. In many developing countries there are few or no allergy specialists due to either the prevailing healthcare infrastructure, to socio-economic reasons, and/or to the lack of recognition of allergy as a clinical specialty. There is often minimal or no inclusion of allergy education/training in the undergraduate medical curriculum, and this shortfall must be addressed if the increasing burden of allergic diseases is to be managed. The majority of patients with common allergic diseases around the world are treated by primary care physicians, and not by trained specialists. However, a lack of appropriate education and training in allergy at the undergraduate level leaves many medical graduates with low baseline knowledge and skills in the science and practice of allergy. In addition, because it is a relatively new discipline, education and training in allergy in medical schools has lagged behind scientific and clinical developments in this field, and there are few allergy specialists available to teach this multidisciplinary subject. This phenomenon is described by the World Health Organization as the knowledge/practice gap. Unless allergy training is included as an essential part of undergraduate medical education at the clinical level, many physicians will qualify with inadequate competency to manage the diagnosis and treatment of allergic diseases at the primary care level. Thus, a cycle of lack of basic knowledge about the most common allergic diseases, lack of recognition of allergic disease at the clinical level, and inadequate knowledge and skills in the diagnosis and treatment of allergic diseases will be perpetuated. To help break this cycle the World Allergy Organization (WAO) presents broad guidelines for the curriculum of education and training of medical students in the immune mechanisms of allergic responses, and the commonest manifestations of clinical allergy. Inclusion of these educational guidelines into curriculum development will provide medical graduates with the basic knowledge required to recognize and treat common allergic diseases during postgraduate training or as a general practitioner (care level 1), and the knowledge of when to refer the more complex problems to appropriate organ-based or allergy specialists (care levels 2 and 3) [2]. These guidelines outline optimal curriculum content, and are offered for consideration and modification to meet local needs and healthcare provision structures. Although certain immunodeficiency states may accompany allergies or may need to be considered in the differential diagnosis of allergic diseases, this document is not intended to provide a comprehensive guideline on the teaching of immune deficiencies to medical students.