become a dermatologist

Is it hard to become a dermatologist in the UK?

Is it hard to become a dermatologist? As with most things, there isn’t a straight answer. If we’re talking solely statistics, then yes. But remember, statistics apply to the population not to the individual. This is something that we often overlook. For example, the term percent is a composite of two words: ‘per’ and ‘cent’ (i.e. per 100). 

If you want to skip the rest of the article, I’m completely convinced that anyone of normal intelligence can become a dermatologist with a good work ethic. So, yes, it might be hard work but is completely achievable. If you asked me another question such as “is it hard to be a professional footballer?” I’d say yes without any reservations. Case-in-point, around 180 children of the 1.5 million who play organised football at any one time will make it as a professional. This equals a pretty slim chance of 0.012%. 

The steps you’ll need to take to become a dermatologist:

School

Nailing your GCSEs and A-Levels is no mean feat but will put you in the best position to get into medical school. Fun fact: I never went to a full week of school. Looking back on my shambolic attendance record, I’m surprised I wasn’t taken into care. I did, however, keep up with schoolwork even if I wasn’t the best at actually attending.

Medical school is becoming increasingly competitive. Being a straight-A student will no longer guarantee you a medical school place. Selection committees want to pick students who are well-rounded humans: this might mean extra-curricular sport or music. Being a good citizen who has committed to community service will always serve in your favour. It’s also useful to gain suitable work experience – spending a week in a GP surgery will give you an insight into what it’s like to work on the front line.

Speak to doctors – try and find a mentor who’ll help nurture your interest. This is often easier if you have family friends who are doctors. If you don’t, don’t stress – shoot us an email and we can usually advise.

Be tactical in your choice of medical schools to apply for. Even if you are the second coming of Bertrand Russell, it’s sensible to pick medical schools according to a set hierarchy of priorities.

I’d advise selecting based on:

a) personal preference of medical school;

b) best fit – this can mean the style of teaching, ethos of the institution, cost of living; and

c) competition – if you know that the school doesn’t consider BMAT scores under a certain threshold, don’t burn your application. 

Once you’ve secured an interview, prepare, prepare, prepare. This is the highest stakes interview of your life and can be the most difficult hurdle to getting into medical school. It’s pretty easy for a panel to identify the candidate who’s put in the work. We recommend rehearsing (but not memorising) answers to all the common questions. Don’t be scared of the questions that you’ve not prepared for – we recommend using answer frameworks to help you formulate answers on the fly. 

Medical school

Medical school is the part of life which sets up your future career. While you still want to enjoy the process (and retain a functional liver post-Fresher’s week), doing well at medical school will help maximise your chance of getting a dermatology job. Lots of keen medical students take an extra year out (also known as intercalating) to study a particular field in more detail. They therefore graduate with two degrees in six years rather than only a medical degree in five years.

It’s not all about scoring top marks though – see our guide on getting the most out of your medical school years.

Junior doctor years

Phew! After all that work, it’s plain sailing now, right? Sadly not, after qualifying, you have to navigate the two-year Foundation Programme (FY1 + FY2) where you perform the role of a junior doctor. You’ll rotate through a range of specialties (such as internal medicine, surgery and a few others depending on your rotation). This is where you’ll actually learn the job by doing it. No-one really knows what they’re doing until they’re actually doing it. Thankfully, you’ll have senior support to lean on to help you take care of your patients.

After the Foundation Programme, most aspiring dermatologists will enter Internal Medicine Training. This is a further two years in which you spend time in various medical specialties such as cardiology, gastroenterology and respiratory medicine.

The bonus of being a junior doctor is that you’re getting paid. The problem is that you don’t have much spare time. Alongside this, you need to build up your CV to be in with a shout of getting a dermatology job. Perhaps due to lifestyle factors (e.g. you don’t have to spend weekends in a hospital, clinics are usually 9 – 5pm and there’s lots of private work available), dermatology is competitive. While the numbers vary, there’s usually 4 junior doctors applying for one post. In order to be competitive, you’ll need to present cases, publish work and demonstrate your commitment to becoming a dermatologist. You’ll also need to pass the Membership of the Royal College of Physicians exam in order to be eligible to progress.

See our guide on what a junior doctor needs to do to get to the next stage.

Dermatology training (Specialist Registrar)

You’ve made it to the promised land! From here on out, assuming you don’t attack your consultant or maim anyone, you should be safe to become a consultant after four years of training (ST3/ST4/ST5/ST6). During these years, you’ll cover a comprehensive syllabus to make you an expert in all-things-skin. You’ll rotate through all the subspecialties – this will include skin surgery, paediatric dermatology and biologics clinics. By the time you’ve finished, you’ll likely have found what you like. For me, I’m quite geeky and decided to specialise in dermatopathology (looking at skin biopsies under the microscope). If you have a good pair of hands, you might like to specialise in skin surgery. I enjoy diagnosing skin diseases from a distance and so came up with the idea of skindoc while still in training. This has developed into one of the most enjoyable parts of my working day. 

Consultant

After a grand total of five years as an undergraduate (six if you intercalate), two years of Foundation programme, two years of Internal Medical Training and four years as a dermatology registrar you’ll be a Consultant Dermatologist. This means that AFTER leaving school, it will take a minimum of 5+2+2+4 = 13 years to make it. Lots of people do additional degrees or don’t get into dermatology at the first attempt and so it takes even longer. 

Is it worth it? I’d say so – but it’s not a complete cake walk. Here’s what my average day looks like

So, is becoming a dermatologist hard? Maybe, but it simply takes mental commitment to jumping through the hoops rather than being super difficult in itself. 

This isn’t an exhaustive guide: there are non-traditional routes to make it as a dermatologist. Some people do medicine as a second degree after having first been to medical school. Others do an Access to Medicine course to help people from different backgrounds. There are even ways to study medicine which can be done via distance-learning. 

referral

How to make a dermatology referral – a guide for junior doctors

I remember being a junior doctor and always putting off making specialty referrals to the end of the day. For some reason, I didn’t like getting grilled or even flat out told off for making a rubbish referral. Now, having made it to the other end of the phone, I try to be humane in how I deal with every dermatology referral.

Before we get into the specifics of the best way to make a dermatology referral, remember that the person on the other end is a human. They might be stressed, a general grump or you might have caught them in the middle of an overrunning clinic. Please don’t misconstrue this: this isn’t an excuse for bad behaviour by the dermatologist. Rather, it’s an explanation for why, despite making an excellent referral, they might still give you a hard time.

Step 1 – Get to know the referral guidelines in your hospital

Some hospitals only operate a phone on-call service for urgent referrals (read: A&E) and request an electronic dermatology referral for everything else. Before picking up the phone, ensure you’re referring via the correct pathway. If you can’t find any information (or you have serious clinical concerns), always pick up the phone. If it’s a dodgy widespread rash, it will likely need a ward visit by the dermatologist. If you’re worried about a dodgy lesion that you think might be cancer, it’s likely better managed by making a Two Week Rule referral

Step 2 – look at the clock

Dermatologists spend most of the day within clinic and so reviewing ward patients can be tricky. That being said, we recognise that it’s part of the job. If you know you need to make a referral to dermatology, try and do it as soon as you can – this makes it more likely that your patient gets reviewed on the same day. Leaving it until 4.50pm is going to irritate even the most placid of dermatologists. If it’s after 5pm and the referral isn’t urgent, leave it until the next day. Dermatology registrars provide a regional on-call service (i.e. the person you’re referring to may not be based at the hospital you’re at). If the review can’t wait until the next day, it’s perfectly fine to refer out-of-hours.

Step 3 – have all the information to hand

This sounds obvious but I can remember the chaos that goes on within a busy ward. Someone might have nicked the drug chart, someone else has the paper notes, someone else is logged in and has locked the electronic record. Before picking up the phone, ensure you have everything you need to hand. If you’re dealing with a widespread rash that could be drug-related, have a timeline of medications ready – we will ask for it and it will probably nail the diagnosis!

Step 4 – lead with your headline

  1. Introduce yourself – I’m Sarah, an FY1 on Derby Ward. (You can mention the named consultant who’s asked for a review for added oomph.)
  2. I’d like to refer a patient for remote discussion/an in-person review
  3. How urgently you need it with justification – in the next 24 hours/within the next few days as we can discharge her once the patient is reviewed
  4. Clinical photographs if you have them – dermatologists are very visual – we can often make the diagnosis from a picture. If you’re going to share them, make sure you do it securely. WhatsApp might be fine for gossip but it may land you in hot water if used to share clinical photographs. NHSMail is a safe bet.

Step 5 – clinical information

  1. Demographics: age/sex of patient
  2. A BRIEF progress history and duration (e.g Mrs. Thompson was admitted on Tuesday with this rash that has been worsening over the last few days.)
  3. Previous treatments trialled
  4. Physical examination findings (e.g. this lady has a widespread urticarial eruption)
  5. Investigations (e.g. this lady has a mild eosinophilia – a raised eosinophil count can be seen in eczema, allergy as well as bullous pemphigoid)
  6. If appropriate, mention the presence or absence of red flags (e.g. skin tenderness, mucosal involvement, blistering)

Step 6 – Document the treatment plan

Prior to physical review, most dermatologists will recommend some initial management – this might include emollients/topical steroids and sometimes antihistamines. Ask for the name of the doctor who’s given the advice before putting down the phone.

Step 7 – Liaise with pharmacy and nursing colleagues

Get me the Diprobase, STAT! – screamed the Emergency Medicine Registrar, never

Dermatology plans are rarely considered a high priority within the hospital. One of our biggest irritations is where we make treatment recommendations, come back for a routine review on the ward and find that nothing has been actioned. If it’s an urgent issue (e.g. suspected severe drug eruption), page the on-call pharmacist. Ensure that you’ve obtained adequate quantities of the creams. Case-in-point, if someone needs their whole body covered in Betnovate, you will need to request 2 x 100g tubes to ensure adequate coverage for a few days. If you don’t specify this, the pharmacy may give the nurses a measly 30g tube that won’t do for one visit.

Step 8 – sit back in restful bliss

Eat a Kit Kat, gloat, put your feet up. Or, more realistically scoot onto the next job on your interminable jobs list! 

 

day in the life of a dermatologist

A day in the life of a dermatologist

Before you call the GMC (or the Samaritans), I’ll point out that this is meant to be a day in the life of a dermatologist. To contrast, this is not to convey that this is typical of the day-to-day life of a dermatologist. I’ve always tried to avoid the tried and trodden path – apart from my enduring love of Coco Pops for breakfast. Thus, if you do pursue a career in dermatology it’s quite likely that your working day will look very different to mine.

4am – Wake up

I wake up at a ridiculous hour for a number of reasons. First and foremost is that I don’t like commuting at busy times – why would I want a journey to take double the length of time than it needs to? Secondly, I’m full of beans in the morning and so like to make use of this high-energy state when I can. Thirdly, dermatology is a fairly sedentary career – I gained weight after having switched from ward-based work as a junior doctor to sitting in a clinic room all day. Waking up early gives me some time to do some exercise.

5.30am – Get on the train

Door-to-door my commute is around 90 minutes. I try to take public transport as much as possible. I’m usually armed with a textbook and some Bose noise-cancelling headphones. This time that would otherwise be spent navigating London’s road can otherwise be put to some use. This is usually when I tend to do my best reading and writing.

7am – Walk through the hospital front door

I’m mindful of my energy levels and try not to waste it on issues that don’t require it. I’ll typically glance at my email to establish if there’s anything that needs urgent attention, leaving the less urgent issues for later in the day. The secretaries will have plonked a heap of patient results letters (e.g. biopsy results/blood test reports) and clinic letters in my admin tray. Again, I’ll try and triage what’s urgent and what can be left until later. 

I’ll then try and get some learning done – this can include reading through a journal or a textbook. I also sometimes use YouTube tutorials to learn. I’m currently doing a dermatopathology fellowship and have found Jerad Gardner’s channel very helpful to review pathology.

8am – Multidisciplinary team meeting

Dermatologists don’t work in silos – we need the help of pathologists as well as surgical colleagues to get stuff done. We have a weekly multidisciplinary team meeting (MDT) in which we discuss skin cancer cases. This is important since skin cancer can kill people. Therefore, we tend to agree treatment plans with our peers so that we have consensus. This helps protect the clinician from medicolegal liability (e.g. being a nutter) as well as the patient from rogue treatment plans (e.g. being a nutter).

While some dermatologists enjoy doing big surgeries, most of us will refer any tricky stuff along to surgical colleagues (e.g. Plastic or Maxillofacial surgeons). Given that the case has been discussed at the MDT, this ensures that the receiving surgeon knows what they’ve signed up for. The focus of the MDT switches from skin cancer to inflammatory dermatology on a weekly basis. Inflammatory dermatology essentially refers to skin issues that don’t involve skin cancer – this includes common entities such as eczema and psoriasis. Straightforward rashes typically don’t need the help of the MDT. However, I’m sometimes bamboozled by the weird and wonderful. This is where the combined knowledge of senior dermatology colleagues can be helpful – the cumulative experience of seniors who’ve been doing this for decades can help nail a diagnosis in seconds (where I’ve been struggling for months!)  

This is part of the beauty of dermatology – the visual nature of the field means that if you’ve seen the rash before, you can easily diagnose it when you come across it again. Think of it as a medical version of Snap

9am – Clinic

The clinic room is where we spend most of our working day. Most dermatologists do some themed clinics (e.g. paediatric clinic/biologics clinic/vulval clinic) but the bulk of the job is general (inflammatory) dermatology clinics and Cancer Clinics. Hospital trusts typically have a need for dermatologists because of the financial penalties of a cancer breach. NHS Trusts get fined severely if a suspected skin cancer patient has to wait longer than two weeks to be seen within the clinic. Therefore, an increasing proportion of a day in the life of a dermatologist is occupied by skin cancer. Because of this, many other patients with important but non-cancerous skin issues have significant delays to being seen. Clinic templates vary between hospitals and consultants but I tend to see 12 patients during a morning session. I try to dictate my clinic letters as I go along rather than at the end. I tend to run at least 30 minutes late by the end of the clinic.

1230pm – Lunchtime

If there’s nothing demanding my attention (such as a ward round), I tend to go for a walk during lunchtime. This helps clear my mind of the morning’s stresses and helps get my step count up to something respectable. I try and get back for 1.30pm so I can prepare for the afternoon’s sessions. This includes reading the notes, getting hold of relevant kit (e.g. skin scraping tools if a referral letter queries a potential fungal skin infection) and preparing blood forms. 

2pm – Minor Surgery

As a general dermatologist, I don’t have a special focus on skin surgery. I do, however, excise plenty of dodgy moles, take punch biopsies of odd rashes and curette crusty lesions for treatment and diagnosis. I try to avoid anything too risky or large. Having previously taken a biopsy directly through paper-thin skin and going into a varicose vein (with blood squirting everywhere), I now try to avoid being a hero. Surgeons are only too happy to be referred the trickier end of skin surgery. 

I do 6 surgeries during the afternoon session. In contrast to clinic, I usually run to time doing surgery.

5pm – Admin

By now, my energy is flagging a little. I’ll have a spot of dinner (shout out to Huel), browse the internet for a bit and try to relax for a few minutes. Once suitably numb, I’ll tackle the admin that I’d deferred throughout the day. This works for me – I haven’t a school run to do and I’d rather use my higher energy periods for higher-order thinking. Seeing patients is the most interesting part of my working day. Dealing with large volumes of admin is part and parcel of being a dermatologist – it doesn’t make it any better though.

6.30pm – Skindoc

While many consultants spend their evenings consulting in private clinics, I prefer doing my private work remotely. Using the platform that I designed with my ultra-smart business partner Dr. James Denny, I provide video consultations and review clinical photographs. People are busy and don’t want to have to take time out of the working day to go and visit the doctor. Skindoc helps people see a consultant, get diagnosed and get the medication delivered to their door. 

While still in its infancy, I love the work and challenges of running a teledermatology platform.

8.30pm – Get on the train home

I’m usually flagging by now so the books stay in the bag. I tend to listen to some music, deal with DermCoach emails, respond to all those angry folk on WhatsApp and start to wind down.

10pm – Home – wind down

I’ll start to unwind a little, read some fiction, nod at family members and slink off into la-la-land. I’m often accused of using home as little more than a lodge and reading this back, I can understand why.

And there you go…that’s a day in the life of a dermatologist. Again, I should point out that this is not typical but is just how I spend my working life.

medical student prizes

Medical student and junior doctor prizes

How to succeed in your ST3 Dermatology Application – Part 2

Before reading further, make sure you’ve read Part 1!

Scoring top marks at medical school to be awarded Merit or Distinction is no mean feat. Unless you’re blessed with an otherworldly memory (or are a top blagger), getting these honours is no mean feat. This means working hard, consistently all through the course. The key difference between those who achieve these awards and those who don’t is those that do, REALLY work hard. We’ve all heard the tales of that random guy or girl, who claims to not have worked AT ALL and yet gets a top score. Ignore them – and work hard!

This isn’t the place to discuss how to develop a monster work ethic and sail through medical school. There are some well-known resources that you might have seen, not least Dr. Abdaal’s YouTube channel . If this is still under your control, it’s worth putting in the work. Scoring an Honours classification for your undergraduate degree will get you 6 valuable points on the form.

Don’t despair if you’ve slacked (join the club), or have already graduated. There are still plenty of opportunities to score points in this section. One option is to submit for any of a number of annual medical student and junior doctor essay prizes. There is a wide range available, each with differing degrees of competition. All you need is to win one and you’ll get four points. I’ve listed a variety of options below:

Association for Palliative Medicine – undergraduates can submit clinical audit reports or a palliative medicine-themed essay for a £250 prize

British Geriatric Society – don’t knock the oldies. They are very generous with a selection of prizes available to junior doctors and medical students.

British Society for Clinical Neurophysiology – bit of a longshot, but the organisation hosts an essay competition. Worth a go if you don’t mind writing a 3000 word essay.

Royal Society of Medicine – Student Prizes – the RSM has a range of Sections – these may be areas to focus your efforts.

Royal Society of Medicine – Trainee Prizes – there are a whole range available to junior doctors to bolster your CV.

British Association of Dermatologists Prizes – the Essay Prize is probably the most prestigious undergraduate prize a dermatology aspirant can win

British Society for Dermatological Surgery – twice a year, the BSDS hosts an essay prize. The £300 prize doesn’t hurt too. Perhaps start your essay with “If in doubt, cut it out.” (and prepare to not win)

British Holistic Medical Association – a left-field choice which is usually slightly less competitive than some of the other better known prizes. This being said, the forms treat all national prizes as equivalent. Points are points!

ENT UK – another essay prize worth £500

HealthWatch – a nice test of those critical appraisal skills that you’ve developed – a win equals a national prize and £500

Medical Council on Alcohol – an annual essay competition focusing on topics relating to alcohol and society. Perhaps you could use the £500 prize to buy a nice bottle of wine (but not White Lightning).

Pathological Society – an essay prize run by the Pathological Society. Why it couldn’t be known as the Pathology Society, I do not know. Would YOU want to be known as a member of the PATHOLOGICAL SOCIETY?

Royal College of Obstetricians and Gynaecologists – this may be a good one to consider on the basis that they offer first, second and third prizes. The first prize of £750 isn’t too shabby either.

Royal College of Ophthalmologists – these folk run an annual undergraduate exam on eye stuff. I figured that my own shambolic knowledge of ophthalmology would not give me a shot at this as an undergraduate but hey, you might have actually turned up for your rotation.

Royal College of Paediatrics – this is a bit of an unusual one: if you can manage to convince the named person at your medical school to nominate you for the prize, you have a good shot at winning this prize (one is awarded per medical school). This is a pretty solid way to score a prize without even needing to write an essay.

Royal College of Physicians – this is a treasure trove or prizes for medical students and junior doctors alike. One highlight is the RCP Regional Poster Competition which can provide an opportunity for prizes without massive competition.

Royal College of Radiologists – those folk in dark rooms have ventured out with some sweet temptations for you. They run an impressive selection of prizes which can be seen on this page.

succeed dermatology ST3

How to succeed in the Dermatology ST3 Application – Part 1

When I look back at my own preparation, I was shooting in the dark. If you’d asked me for my tips on how to succeed in the Dermatology ST3 application, I’d have shrugged and mumbled ‘work hard’.  There weren’t, however, the same degree of resources as are available now. It’s never to early to start preparing – yes, medical students, we’re looking at you!

The general principles remain the same – if you prepare well, you’re likely to get a post. The problem is preparing for an interview is time-consuming, stressful and can be even more difficult if you don’t know where to start. 

Do the basics first

Before doing anything else, we would recommend familiarising yourself with the ST3 Recruitment website. This is the first step in your preparation. Broken down into its component parts, getting into dermatology depends on two things – your shortlisting application form score and the interview score.

While candidate scores in the two components are correlated (e.g. you are likely to score more highly on Suitability and Commitment if you have plenty of publications), the two are distinct entities. We know plenty of candidates with sparse CVs who have absolutely nailed the interview and get a post. Conversely, there are candidates every year with loaded CVs who still don’t get a post – much to everyone’s shock.

Interview performance is King

The final score is heavily weighted in favour of the interview: In 2021, there were 80 points allocated to the interview with 20.16 points available from the application form. Thus, interview performance is around four times more important than your application form. You do need sufficient points on your application form to even get an interview though.

 

In the remainder of this series, we’ll work through optimising your chances of success.

Undergraduate qualifications

For those of you who haven’t graduated yet, consider an intercalated degree. A first class degree will get you 6 extra points while a 2.1 will still score you 3 points. It’s not mandatory but every little helps. You should note, however, that an extra year spent in training has a knock-on effect on your career earnings. While we don’t often flag it as such, an intercalated degree will cost you one year of consultant salary (as your career progression is delayed by a year). Despite this, we still strongly recommend intercalating – not least for the points, but because it will enable you insights that you otherwise would not have. Some people opt for management degrees, others humanities subjects. Whatever you do – you will likely learn something invaluable from the year.

We recognise that this isn’t an option for everyone though – with mounting student debt, you may not be in a position to afford another year of not earning. Don’t worry, this won’t destroy your dermatology aspirations. There’s still plenty to play for in the remaining sections.

Postgraduate qualifications

This is always a controversial topic. A PhD scores you 6 points but takes 3 years (and you may lose your hair with the stress of it)! 

A middle road might be to do an online Masters degree – some of these take a couple of years to do and could be completed alongside the Foundation Programme or IMT. This will still get you 4 points. Newcastle University offers a Masters in Clinical Research which could be completed in two years. This degree often translates into a publication which can then score you points in other categories. Some people plump for a Masters in Epidemiology. This helps get you acquainted with medical statistics, the factors that lead to disease, critical appraisal skills and can result in those all-important high impact presentations and publications! 

If you don’t fancy taking on a full Masters, you could do a Postgraduate Certificate – these are usually pretty straightforward and, even better, can be completed in a few months. Many candidates opt for a Medical Education flavoured qualification here – this can be used to demonstrate your passion for teaching and score you brownie points at interview. University of Dundee and the University of South Wales both offer reputable formal educational qualifications.  

Remember, the interviewers are trying to pick candidates who would be good colleagues – we don’t really fancy people who aren’t interested in helping the next generation of clinicians.

Coming up in part 2: Prizes, Publications, Presentations

dermatologist

From student to consultant dermatologist

Inauspicious beginnings

There’s a long-standing joke in Indian households: you can be anything you want to be when you grow up, so long as it’s a doctor, engineer or lawyer. While I’m half-joking, I’m sort of half-not. Coming from a family of medics, it was almost assumed that I would follow in these footsteps. In fact, I can’t really remember having very many discussions with regards to my future career until a few days before it was time to submit my university application forms. 

My mother has long been supportive of my hopes and dreams. When I told her I wanted to study physics at university, she stopped what she was doing and looked at me quizzically. When she realised this wasn’t some sort of ill-thought out joke, she told me in a very matter-of-fact manner: “Sreedhar, you think you are clever. But you are not that clever. Just be a good boy and do medicine.” As a man who avoids conflict at almost any cost, I was a ‘good boy’ and dutifully applied to medicine.

If it’s dry, make it wet. If it’s wet, make it dry

Medical school is an odd rite of passage. You are essentially an adult walking around hospital wards but you are often made to feel a nuisance, a burden to the doctors doing the Important Clinical Work and a ‘go-fer’ whose only job is to facilitate the mundane. Some of this is the sorry state of the status quo: there is the notion of paying one’s dues before we get to do the interesting stuff. This notion is outdated and squeezes out any joy from enthusiastic medical students and junior doctors. 

We rotate within different specialities as students. While many of my consultants didn’t have much time for students, my dermatology consultant on placement couldn’t be more different. She treated me like a human being, took time to address me by name (!) and was actually interested in my thoughts. This then imbued me with the interest to actually learn more about the field. Some non-dermatologist doctors joke that dermatology is very simple: if it’s dry make it wet, and if it’s wet, make it dry. This is, however, actually pretty accurate! 

The eyes cannot see what the mind does not know

In contrast to cardiologists or lung physicians, we usually don’t need to rely on fancy tests to make diagnoses. The disease sits plainly in front of our eyes. We use our training and visual memory bank to make the correct diagnosis. Just because you can see it, doesn’t automatically equate to knowing what the problem is. As the medical adage goes, the eyes cannot see what the mind does not know. 

Before we get to call ourself a Consultant Dermatologist, we have spent years studying the skin. This means that we can often diagnose a lump on the skin or a rash within seconds. With an image, we can diagnose and treat the problem with minimal fuss. This has meant that the pandemic has had less of an impact on our ability to provide good clinical care.

Diagnosing people from the comfort of their sofa

Due to restrictions on people visiting the hospital, NHS waiting lists for dermatology have spiralled out of control.

In view of this, we developed an online dermatology platform where we’re able to diagnose and treat people from the comfort (and safety) of their own homes. As the phrase goes, a picture is worth a thousand words! Not that I’m plugging it, but if you have any friends or family complaining about their skin – send them our way!

skindoc.

teaching hospital

Teaching hospitals versus District General Hospitals: perception versus reality

“What do you plan to specialise in?” asked the pinstripe-suited consultant general surgeon to his gaggle of medical students.

“Surgery.”

“Something surgical.”

“I’m really interested in surgery.”

These, of course, are the correct answers. His gaze turned to my student self, eyes expectant:

“Dermatology.” He simply let out a snort, shook his head and proceeded to ignore me for the remainder of the placement. I looked at one of my turncoat student colleagues and asked Zara, “Since when did you want to be surgeon?!” She brushed off the question…

 

Rocket scientist, brain surgeon…dermatologist?

For better or worse, there are certain stereotypes of a dermatologist. While I don’t wish to tar surgeons with too broad a brush, I certainly didn’t encounter many surgical folk who were impressed by my choice of specialty. There is a fairly established pecking order within the hospital: transplant surgeon, cardiothoracic surgeon, plastic surgeon, surgeon of X, Y, Z. On the second tier, sit the internal medicine specialties. Somewhere around the bottom, sit the dermatologists. Derided by many, we are often called when a patient has an odd rash or a red, hot leg that just won’t respond to antibiotics. While we can provide assistance in complex inpatient cases, your medical colleagues are not going to bow in your presence just because you’re a dermatologist. If you want to induce deferential awe everywhere your cape trails, consider becoming a superhero or an organised crime boss. Dermatology may not be the one for you.

In my previous post, I alluded to the competitive nature of medics (which I have no particular problem with) however there is also a tendency to do down those from a different tribe (e.g. the archetypal matchups – surgeon vs medic; hospital consultant vs general practitioner). In the reflexive defence of our own gang, we can lose sight of the ultimate goal: to provide the quality of clinical care that we would expect for our own parents or children. The folly of the arbitrary divisions we create for ourselves knows no bounds. Where will it stop? London versus the rest of the country? New hospitals versus old hospitals? I want to discuss with you which is better – teaching hospital or district general hospital (DGH)?

Definition:

While there may previously have been clear definitions of both of these terms, there is considerable overlap in their current usage. My understanding of the teaching hospital is that it is central to the teaching of a university and has established research interests. They are usually larger than DGHs and have a greater research output. There is often a special focus on rare diseases and there may be specialist tertiary clinics.

Which is better?

This is not to say that teaching hospitals are superior to DGHs however. Case-in-point, the broad exposure that trainees can gain in a generalist hospital can be invaluable experience. You’re far more likely to be able to perform practical skills such as a lumbar puncture or chest drain in a DGH as compared to a teaching hospital. This is because there aren’t the same huge number of juniors clamouring for the next procedure. Anecdotally, there are many (including myself) who argue that DGHs are friendlier than teaching hospitals. This can make life easier when you’re a junior. If you’ve been on-call with the respiratory registrar on a weekend, and you subsequently need their help with a deteriorating patient, it’s a lot easier to pick up the phone to speak with someone you already know. 

In a smaller setting, most of your colleagues (nurses, fellow juniors and consultants) will likely know you by name. Additionally, the notion that DGHs are backward or not as involved in research is quickly becoming outmoded. Illustrating this, the dermatology department at Kingston Hospital is one of the most active departments in the UK and are involved in far more clinical trials than many larger teaching hospitals combined.

There’s no right or wrong – and you’ll likely get exposed to both sorts of hospitals both as undergraduates and also as postgraduates. Your experiences will help mould the future life (and consultant post) you choose. 

My view

I had the opportunity to work in large centres earlier on in training but quickly realised that I much prefer DGH settings. I can remember being a medical FY1 in the Scottish Borders looking after patients with head injuries and having ABSOLUTELY-NO-BLEEPING-CLUE what I was doing. When put in the heat of the moment (without readily available senior support), you quickly learn to make management decisions.

Having escaped the Borders with my GMC licence intact, I still work in a DGH setting. Regardless of this, I can get my academic kicks from looking down a microscope and yet avoid the trappings of the teaching hospital. Not to generalise, but I’d rather not play pseudo-intellectual games to show people how clever I am. (Disclaimer: some of the nicest consultants I worked for were within teaching hospitals…)

Teaching hospital – pros

  • Wide range of cases coming through the front door which broadens trainee experience
  • Ability to rotate in niche areas – in dermatology, this could mean advanced dermatological surgery
  • Generally, ample opportunities to get involved in research

Teaching hospital – cons

  • Teaching hospitals are usually in larger cities which can drive up living costs
  • It may be difficult to get practical experience due to the number of trainees.
  • You may be a somewhat anonymous fish in a large pond.

District general hospital – pros

  • Friendlier (and possibly smaller egos!)
  • Ability to get hands on experience due to smaller numbers of trainees
  • Smaller hospitals and their systems can be easier to understand and navigate.

District general hospital – cons

  • It may be difficult to get into tertiary clinics
  • There may be little opportunity for socialising 
  • If you don’t have a car, you may feel a bit stuck due to the locations of many DGHs.

So you’re a medical student and want to do dermatology?

Inauspicious beginnings

During medical school, I was sufficiently disinterested so as to receive a letter of warning from my tutor…and now I’m a consultant dermatologist. The moral of the story is that if I could manage this from such an inauspicious starting point, you definitely can. If you need to drive from London to Leeds (a journey I can recommend to you if you like average 50mph speed limits on motorways), you need to do some planning. Don’t fancy that?

Sure, you can get there with a few wrong turnings but you’ll probably get there in the end. Alternatively, if you do want to get there in a timely and efficient manner, check out our tips below:

  • Get to know your local department

Most hospitals have a dermatology department and there will likely be someone who has a special interest in education. When I was a student, there were two consultants who showed me the way: Dr. Nuala O’Donoghue (who has since escaped to Manchester) and Professor Chris Bunker (who is now at UCLH). On reflection, I hope I’m not the reason they left their previous posts… Get in contact – if you don’t hear anything back by email, leave a message with their secretaries. If you still have no luck, leave a note for them at their clinic. If they still won’t get back to you, cut your losses and move on.

One thing that I would implore trainees to know is that most departments will frequently receive expressions of interest from students. Mark yourself out as somebody who will be helpful for the department. This can mean helping out with audits, grand round presentations, case reports and even research projects. It’s important to be realistic – not every contribution will yield a presentation and publication. The commitment that you show in the seemingly menial may translate into a win down the line. A good policy when dealing with pieces of work is to under-promise and over-deliver. Case-in-point, I remember doing an all-nighter with my good friend, Dr. Ajoy Bardhan (who is now incidentally a Consultant Dermatologist and Clinical Lecturer at the University of Birmingham) in order to get some work to Prof. Bunker as quickly as possible. We were subsequently rewarded with some international presentations that are still helpful on my CV.

  1. Make full use of your time as an undergraduate

I know, I know…I didn’t. But you didn’t come here to gloat about how I don’t practice what I preach, did you?

To paraphrase the late boxing champion Muhammad Ali, doing the hard work now will reap dividends down the line. If medical school were easy, we’d all be scoring first class undergraduate degrees, publishing papers as easily as Instagram stories and winning prizes left, right and centre. Unfortunately, it doesn’t work like that.

If you’re still a student, you control the outcome of your undergraduate studies. We would recommend liaising with your local department and enquiring if you can do a specialty choice module/student selected module/student-selected component/shambolic seductive caterpillar (just checking you’re still paying attention!)

Ask if you can sit in on clinics/shadow a registrar when they do inpatient rounds/do a taster week. It’s never to early to start preparing: case-in-point, a large proportion of your points at ST3 application can be secured while an undergraduate. These include:

– doing an intercalated degree (and ideally scoring a good classification of degree)

– winning a national prize

– scoring merits or distinctions

– presentations (oral or poster)

– publications (PubMed-indexed journals are key!)

– teaching (this can be as simple as teaching colleagues how to perform certain clinical skills but you MUST collate feedback for the points)

This is not an exhaustive list but simply goes to show that the ball is in your court when it comes to preparation.

  1. Come and have a cup of tea – get to know us!

Well, you can have a cup of tea. I’ve never actually liked hot drinks but I’ll get you one if you’re ever in London and fancy a natter.

On the subject of tea, my first consultant in dermatology was a fine gentleman called Dr. Jana (who is the current president of the St. John’s Dermatological Society). One of his rites of passage was his formal assessment of the quality of tea produced by his registrar (I’m not joking). I wonder if the scene below was triggered by an overly sweet tea sugar-rush…

I can’t promise such moves (the GMC insist that I don’t dance in the workplace) but I can offer some words of wisdom. Get in touch.

 

Good luck!

dermatologist

Dermatology – why it’s great and how I became a dermatologist

Why become a dermatologist?

While we might be a bit biased, dermatology is a great specialty to get into. As a relatively newly-appointed consultant and registrar, the variety that dermatology can offer is hard to match. Dermatology is something of an ecosystem in itself: if you like seeing children, become a paediatric dermatologist. Prefer something more practical? Surgical dermatology? Want to drive a big car? Do cosmetic dermatology! (actually, maybe don’t mention the last one at interview…)

Aside from the interesting patient mix that you’ll enjoy, dermatology can offer some of the advantages that people allude to but never really mention. 

  1. It’s family-friendly with a large proportion of dermatologists working less than full-time.
  2. There’s major scope for private practice if you want to pare back your NHS workload.
  3. You have your choice of locations for consultant jobs given the sheer number of unfilled consultant posts.
  4. Escape the medical registrar rota. We’ve been there – while it’s undoubtedly important work, it’s not really compatible with a sensible work-life balance.

Competition – why we set up our course

The only problem for you is that your colleagues have noticed the above and want a piece of the action. This manifests with increasingly serious competition ratios and well-prepared candidates. In this climate, it would be sensible to come equipped with every advantage. It’s important to recognise the limitations of this course however. We can’t tell you what exact questions you’ll be asked on the day. We can’t do anything if you freeze under the spotlight. We can’t do anything if you haven’t put in the groundwork. 

The course will give you an understanding of the application process, frameworks to deal with unfamiliar scenarios and a roadmap of how to get to your goal – a National Training Number in dermatology. We haven’t yet invented a USB port for your brain to download this information – until then, you’ll have to work through the course to give yourself the best chance at success.

How I became a dermatologist – and my mother’s wooden spoon

While at medical school, I felt quite deflated by the fact that I had signed up for a degree at the behest of my mother. I tried to leave on a number of occasions but was shepherded back to university with the gentle persuasion of my mother’s furious screaming and threats with a wooden spoon. 

After one too many Acute Medical Units ward rounds where the consultant told me to refer to do a D-dimer, CRP and troponin, I realised that I didn’t like unknown unknowns. For example, if a neurologist is dealing with non-specific sensory symptoms and syncope, they will often come up with a short differential diagnosis. I didn’t like that. In my life inside and outside the hospital, I prefer certainty. I like the visual element of dermatology. I can usually look at a rash and give a confident definitive diagnosis. If I’m not sure, I can simply take a skin biopsy and confirm what I’m dealing with. 

While a pretty forgiving specialty, the life of a dermatologist is not a complete cakewalk (“derm-a-holiday”). Seeing 24 patients a day in a clinic can be quite mind-numbing and I decided that I needed some time away from patients. In search of some respite from humans, I decided to do dermatopathology. This means that I can look at my own skin biopsies and get to the answer more quickly. Additionally, when I’m in the clinic and looking at skin, the background of knowing what a rash can look like under the microscope can help me secure the diagnosis in difficult cases. 

Through gritted teeth, I have to admit to my mother that I’m glad that she didn’t let me leave medicine! (But don’t tell her or she’ll be even more unbearable.)