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Healthcare Professionals

GP Trainees

There has been a substantial rise in the prevalence of common skin problems such as atopic eczema, venous leg ulcers and skin cancer. The prevalence data suggest that nearly 12.9 million people or 24 % of the UK population visited their general practitioner with a skin complaint in 2006 [1]. Skin diseases are a common reason for injury and disablement benefit or periods of certified incapacity to work [2,3].

Although skin diseases are common, dermatology tends to have a low priority in the medical curriculum for undergraduates. Prospective general practitioners must be able to care properly for people of all ages with skin problems so dermatology should be an essential component of any training scheme for general practitioners. Dermatologists, in common with general practitioners have highly developed clinical skills and are less reliant on laboratory and invasive diagnostic tests than other specialties.
 
The All Party Parliamentary Group on Skin (APPGS) report published in 2006 comments on the difficulty that many general practitioners have in making a correct diagnosis leading to sub-optimal prescribing and high levels of inappropriate or non-referral [4]. Feedback from the October 2013 MRCGP exam showed an area that needs addressing is dermatology. 
 
Most trainees learn some dermatology when working within the general practice component of vocational training, but specialist input is minimal except on day release courses. Some doctors are more fortunate, obtaining experience in dermatology as a senior house officer (SHO), and some hospital SHO rotations for general practice trainees do offer an attachment to dermatology. Ideally the SHO post should include no less than the equivalent of 3 months' full-time dermatology. More rotations should include a post in dermatology to meet the need for training.
 
Patients with skin disease need dermatologists to work closely with skilled general practitioners to help them cope with the demand for skin care. A survey performed by the British Association of Dermatologists revealed that many consultants, principally working in district general hospitals, would be willing to teach a general practice trainee in out-patient clinics. To ensure maximum benefit, these clinical attachments should be maintained for a minimum of 4 months, ideally 6 months, and trainees should attend the clinics at least once a week. General practice course organisers, trainers and consultant dermatologists should develop local programmes.
 
The educational value of any hospital post must be maximised by ensuring that trainees have formal teaching and clear educational objectives. Dermatology is a varied speciality, with a strong surgical bias as well as medical input. Many general practitioners want to be able to treat small skin tumours surgically. The content of the training programme must be flexible enough to meet the needs of each trainee. Dermatology is a visual speciality and there is no substitute for clinical experience in the out-patient clinic, but this clinical experience should be supplemented by tutorials or other formal teaching (e.g. distance learning courses). It is not appropriate for SHOs in dermatology to spend all their time caring for in-patients. The demands of the service must not be allowed to subsume the educational needs of the trainee.
 
References
1. Schofield J, Grindlay D, Williams HC (2009) Skin Conditions in the UK: a Health Care Needs Assessment. Nottingham. Centre of Evidence Based Dermatology. 
2. Department of Social Security (1994) Social security Statistics 1994. London, HMSO.
3. Health and Safety Commission (1992) Annual Report 1991/1992. London. HMSO.
 4. All Party Parliamentary Group on Skin (2006) Enquiry into the adequacy and equity of dermatology services in the United Kingdom. London: All Parliamentary Group on Skin.   
5. Survey by the British Association of Dermatologists, 1997.
 
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