Dermatology Registrars and a career in Dermatology
This is a staff page for the dermatology registrar doctors.
There are eleven training posts (NTNs) for Specialist Registrars in the Eastern Region. These are at Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust (5 posts), The Norfolk and Norwich University Hospital Dermatology department (4 posts) and Basildon and Chelmsford (1 post each).
Registrars at the Norwich post spend one day each week at a local DGH, either at the James Paget University Hospitals NHS Foundation Trust (Great Yarmouth) or the Queen Elizabeth Hospital King’s Lynn and Wisbech Hospitals NHS Trust . They rotate to a new peripheral hospital annually to increase experience.
Training Committee Chair:
Dr Tina Green (Queen Elizabeth Hospital) – 01553 613705
Program Directors:
Norwich: Dr Ingrid Salvary (James Paget University Hospital Great Yarmouth) and George Millington (Norfolk and Norwich University Hospital) 01603 288225
Cambridge: Dr Pamela Todd (Addenbrookes Hospital)
Chelmsford and Baslidon: Dr Hillary Dodds
Research Lead for the Eastern Region:
Dr Jane Stirling (Addenbrookes Hospital)
DOPS and Mini CEXs
Trainee dermatology doctors undergo assessment by four directly observed procedures (DOPS) and mini clinical examinations (mini CEXs) six times yearly. They also have a 360 degree appraisal (MSF) done twice during training. These should be discussed 3 monthly in the educational supervisor review and the next DOPS and mini CEX and sutable assessors agreed. The registrar is then responsible for contacting the agreed assessor to arrange a time.
Newer assessments include the Case based Discussion (done twice yearly), Assessments both of Teaching and Audit skills and Patient satisfaction surveys.
Together these make a formidable battery of assessments. It should be emphasised that it is the responsibility of the trainee to show good time management and get these done well in advance of annual reviews of competency by the Deanery.
The knowledge based assessment, the SCE, is an exam for registrars taken in the second year of training.
A Career in Dermatology?
What is a dermatology “trainee” or “junior” doctor
All hospital doctors who are not consultants or senior specialty doctors are referred to as “junior” doctors or “trainees”. In fact, some of these doctors may have up to 20 years of experience as doctors.
How much training has a junior doctor had?
Medical training in the UK starts with a 5 or 6 year period as medical students to get a medical degree. After this doctors do a 2 year period of general training as foundation year doctors to become “registered as doctors”. Foundation year doctors do not work in dermatology at the NNUH as the work is too specialised. After Foundation years most doctors enter a “training programme”.
A training programme develops more specialised skills for doctors. This will be a minimum of 6 years to become a dermatology consultant, but is often much longer. The training is split into two parts, with progression to the last 4 years being very competitive in dermatology. During the first 2 years of this specialist training, doctors are called core trainees and the training is more generalised moving around various specialties. The core trainees in dermatology look after people who are staying in hospital, help in clinics under close supervision, and do some of the more simple surgical procedures such as skin biopsies. During this time these doctors are also studying for higher qualifications – usually Membership of the Royal College of Physicians..
Once the core trainees have obtained their higher qualifications (the pass rate for the exams is around 35%) they can apply for specialist trainee (registrar) posts.
What does a specialist trainee do?
Over the 4 years as a specialist trainee, the level of experience increases, so that at the end they should be at the same level as a consultant. Many trainees work part-time or have breaks for family reasons so training is on average 6 years. Many trainees take time out to do a period of research for a doctorate, either an MD (2 years) or a PhD (3 years) during this training period. It is quite easy for this period as a junior doctor to last over 10 years. By this time doctors may have been qualified for over 15 years and be nearly 40 years old. All these doctors do on-call work at night and at the weekend supervised by on-call consultants.
The trainees have 4 or 5 clinics or operating lists/week, working under the supervision of a consultant, seeing people referred from GPs. They have other clinics developing specialist skills (see other pages of this website, for example in ultraviolet treatment, allergy or more advanced surgery). Generally about 1 day/week is spent being trained or doing research to improve knowledge and skills.
During this period the trainees must pass the SCE national knowledge exam. In addition all trainees have an annual review covering progression against many targets (including DOPS and mini CEX -see above), before a regional training panel, that must be passed to allow continuation at work. If the trainees have pass all these and also reached the end of training, they are awarded a Certificate of Completion of Training (CCT). This means that they can then apply for consultant posts.
What are clinical fellow doctors and specialty doctors?
The are only about 30 vacancies/year in the UK for dermatology specialist trainees so not all core trainees find they can get these very competitive posts straight away. Some doctors may not pass the difficult, higher exams first time (there is a 35% pass rate). Other doctors emigrate to the UK and are gaining experience and competing for training posts; many of these doctors will be at consultant level in their own countries. Some doctors choose not to do nightime or weekend on call. Other doctors wish further specialist experience, before taking up a consultant post. Other doctors wish to spend periods doing research or education. Others change their mind about their career direction having trained in another specialty and need a period of experience.
These doctors work at the NNUH in clinical fellow posts. They are closely supervised, depending on the experience of the doctor. After at least two years working in these posts, depending on experience and achievements, some of these doctors then decide to apply for Specialty Doctor posts. Specialty doctors work under supervision of a consultant but can do clinics independently and at the NNUH at present do no night-time or weekend on-call. Apart from consultants. this is the only other grade of doctor that is not a short-term contract and they are senior, rather than junior doctors. Some of these specialty doctors gain sufficient experience over the years that they eventually apply to a national committee to have a certificate of completion of training (CCT). This process requires evidence of equivalent experience and training to that gained by a consultant. If they are successful then they can then apply fo consultant posts.
I would like a career in dermatology: what should I do?
Whilst at medical school or a foundation year doctor or core trainee join the BAD and BSMD as junior members. This wil
l open doors so you can then attend meetings and get the journals (which you should read critically).
Demonstrate enthusiasm, interest, ability in dermatology and evidence you can self-motive, plan and complete tasks. Do this by publishing case reports, publishing research, deliver training and think of innovations in your workplace.
Try to get foundation jobs and core training posts that develop competencies needed in dermatology: surgery, allergy, pathology are all important.