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Dermatology
RCGP British Association of Dermatologists
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 | corticosteroids |
| azathioprine |
| methotrexate |
| dapsone |
| retinoids |
| cyclosporin |
Ultraviolet Light
The trainee should understand the indications for:
| UYB (phototherapy) |
| PUVA (photochemotherapy) |
Patch Testing
The trainee should understand the indications for patch testing. The trainee should have an opportunity to see patch tests applied and read.
Learning experience in the subject
| History and examination / description of skin problems. |
| Problems related to age, sex and ethnicity |
| Pemphigoid |
| Cellulitis / infections |
| Acute manifestations of systemic disease |
| Herpes zoster |
| Common viral rashes |
| Eczema:ˇAtopic,ˇInfantile, Contact dermatitis |
| Psoriasis |
| Leg ulcers, Venous / arterial, (role of diabetes & ischaemia). |
| Pigmented lesions, Benign, Malignant |
| Birth marks |
| Fungal skin infections |
| Acne, Vulgaris, Rosacea |
| Alopecia |
| Pruritis |
| Presentations of systemic disease |
Source: D Rapley Surviving GP Training (Download Word version)
* Special emphasis should be given to the introduction of dermatology into the hospital component of training. Several methods of providing experience can be considered:
| Incorporating SHO posts in dermatology into vocational training schemes. |
| Reconstituting SHO posts by bringing dermatology experience into existing medical SHO posts. |
| Creating innovative hospital posts based on need e.g. composite dermatology/ophthalmology posts. |
| Releasing GP SHOs from their normal hospital duties to attend dermatology clinics. |
A six month post in dermatology alone or in a combined post (such as dermatology/general medicine or a combined minor specialty rotation) will help General Practitioners to take a special interest in dermatology.
There are, of course competing demands from other specialties during the two years of hospital training. There is nevertheless a need to be more imaginative here as the NHS is changing and traditional training may no longer be relevant. For instance the traditional six months experience in obstetrics and gynaecology could probably be reduced as obstetrics is becoming a midwife-led service and most General Practitioners are no longer involved routinely in intrapartum care.
Currently, about 75 doctors per year submit experience of dermatology as part of their application for a certificate of prescribed or equivalent experience from the Joint Committee on Postgraduate Training for General Practice. This is about 5% of the yearly output of GP registrars. It is not clear how many dermatology SHO posts are available or the number of posts combined with other branches of medicine. It is probable that the number of SHO posts in dermatology is inadequate to train all entrants into general practice even if they were all incorporated into vocational training schemes, which is unlikely as many are taken up by doctors prior to specialist registrar posts in dermatology.
Protected time for doctors to attend dermatology clinics while they are working in other specialties remains the most likely way of providing dermatology experience for the majority of doctors training for general practice. Study leave could be used to supplement this. Release to clinics during the general practice component of training will inevitably be difficult as it still takes only 12 months for most registrars and there are the added pressures of Summative Assessment, the MRCGP examination, and seeking a career post. It will be helpful however if trainees have some experience of general practice before attending dermatology clinics so that they can appreciate the purpose of this training and place dermatological problems in the context of general practice. The introductory period in practice employed by most schemes should provide this.
Arrangements for an adequate provision of dermatology training should be organised at local level, between VTS scheme organisers, consultants and the hospital personnel departments. The wider and more imaginative the training the more they will attract recruits. In this context combined minor specialty posts will be particularly relevant.
It is difficult to determine how many dermatology clinics will provide adequate experience for doctors on a training scheme for general practice. The minimum requirement would seem to be twelve clinics and more if minor surgical training is to be included. However attendance at clinics by itself does not suffice. An overall package of dermatology training and assessment should ideally include experience in general practice. This will involve co-operation at a local level between dermatologists, scheme organisers and trainers. Planned teaching, on a one to one basis or in small group seminars, should supplement the practical experience. Teaching sessions can be programmed as a hospital teaching activity or form part of the half-day / day release programmes which all doctors training for general practice have. Competence in dermatology should be required for the issue of vocational training regulation form 2 (VTR2) certificates and a satisfactory trainer's report.
If adequate dermatology training has not been provided in hospital the onus will fall on the GP trainer using the core curriculum as a guide. This is assuming of course that the trainer is competent to provide this and raises questions about the training needs of GP trainers.
It is important that adequate training is provided in minor surgery of which skin surgery is a big part. In North West England the Royal College of General Practitioners organises a two day course with "hands on" experience using dummy tissues, supplemented by practical experience under supervision in the training practices. This course could serve as a model for other regions. Skills can be further enhanced by the RCGP minor surgery CD-ROM ( Minor Surgery and Skin Lesions, Diagnosis and Management on CD-ROM, by Roger Kneebone and Julia Schofield). It might also be useful to link GP minor surgery training with that received by dermatology specialist registrars.
Source: Training - British Association of Dermatologists
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