January 2024 

A unique speciality

Dermatology is a unique speciality with tremendous variety,  covering over 2000 skin diseases, skin cancer and surgery in children and adults. Alongside this, it also boasts opportunities for research, medical education, subspecialisation and private practice. As such, it is no surprise that it is an increasingly becoming competitive speciality. The competition ratio in 2023 was 7.53 with 241 applicants for 32 posts in the UK and often times applicants require several attempts to secure a coveted National Training Number. 

A rough guide for aspiring dermatologists

This rough guide will give you tips on how to maximise your portfolio points, which in turn increases the chances of you getting short-listed for an interview and chances for a training post. 

Key:

IMT: Internal Medical Training
MRCP: Membership of the Royal Colleges of Physicians
ST3: Specialty Training Year 3
SCE: Specialty Certificate Exams
PhD: Doctorate of Philosophy
PACES: Practical Assessment of Clinical Examination Skills

Career progression in Dermatology

The above flowchart shows the path of progression for a career in Dermatology. There are membership and specialty exams required along the way (MRCP, PACES and SCE). There are also natural breaks in medical career progression which may serve as opportunities to take time out in order to build dermatology clinical, education or research experience. There is also an alternative pathway called the CESR (Certificate of Eligibility for Specialist Registration) training pathway, please see link in ‘Useful Links’ section for more information.

After medical school and foundation training, the most common way to get a dermatology training number is through Internal Medical Training (IMT). Additionally, there are also routes through Paediatric and Core Surgical Training, but these have additional requirements. Membership in the respective college (RCS, RCP, RCPCH) is mandatory regardless of the route you choose.

Short-listing for both IMT and ST3 Dermatology posts depend on portfolio points, the total of which is scored on specific domains (detailed below). For IMT, there are 7 domains and an additional 2 for higher specialty (ST3 Dermatology) assessment. Be aware that many of the points do not need to be specific to dermatology, so any opportunity/experience available to get these points would be useful.

There is a section, “Commitment to Specialty”, which scores candidates on their dedication to a career in Dermatology, and this is out of 20 points (scored by 2 individuals). This is used when applying for an ST3 Dermatology post.

Application Scoring: 

Postgraduate degree (max 4 points)

• Scores range from: 
  - 1 point: Diploma (which can take a couple of months). 
  - 4 points: full PhD (which can take 3 years).
• A way to incorporate this into your training is to apply for a teaching/leadership Specialty Foundation Program (SFP) as a foundation post as some offer a PGCert (Postgraduate Certificate).
• You could take a year out later down the line or consider a teaching fellow job (also often offers PGCert qualification).
• Diploma courses are also available, with some offered in Dermatology also (i.e. St Johns Diploma). 
• On balance this section is a significant time and financial investment for relatively little points, there are other sections worth focusing on.

Additional achievement (max 3 points)

• Points are available for a prize related to medicine, or high achievement in medical school. 
• It is worth looking at what prizes are available on the following sites (BSDS, RSM prizes).
• The competition ratio is often lower than getting top scores in medical school (!) so why not apply and give it a go?
• Again this does not have to be Dermatology-related.

Presentations (max 7 points)

• Scores for local presentations i.e: presenting a project to your GP placement practice, or any other department you have done placement.
• Oral presentations at an international / national meeting score maximum points.
• Send off any projects you have done, and you may well get a chance for a presentation, if not there are usually slots for posters which will also give you points.
• NMRC is a good option for medical school posters Inspire Nottingham or Bristol Patient Safety for quality improvement projects (QIPs).
• Search on google for different conferences and send your abstract in - try your luck!
• This is a highly achievable section so worth your time and focus.

Publications (max 8 points)

• This is very opportunity based, if you meet someone who is willing to take you under their wing for projects then this is great way to learn and earn points.
• While on placement, approach senior members of staff to show your interest and initiative as they may often have a project or a case report they need help writing up.
• If you are at the University of Nottingham, this scheme is useful.
• At other universities, why not set-up a scheme like the above?
• An SFP or an intercalated degree may also be a good opportunity to undertake this.

Teaching (max 9 points)

Two sections within this

1. Organising and delivering teaching schemes, where points vary depending on the audience (local to national schemes) , and involvement
   - The scheme should offer regular teaching for 3 months, so get in contact with the medical education at your medical school/hospital and think of a gap in teaching/knowledge.
   - An achievable way to this may be collaborate with colleagues and undertaking teaching on a lower frequency, for example fortnightly.
   - Full points also require evidence of a timetable, feedback and letter from consultant supervisor.
   
   
2. Teaching qualifications i.e. a teach the teacher course up to a PGCert in teaching 
   - Free course available on OpenUniversity.
   - Use the study budget in foundation/IMT training to do a face to face or online course, if you are struggling to find one, email the postgraduate department at your training school as they may know local courses that others have done.

Quality Improvement (max 5 points)

• GP placements are a great place to do this, most practices will have an audit team that you can contact to do a project.
• However, QIPs can be performed in any department, the key is to find one that you can drive and push forward.
• Cycles can also be brief.
• More points are available if you do more than one PDSA cycle, so keeping in contact so you can repeat it again to do more PDSA cycles.
• This is a low hanging fruit and worth prioritisation, as it is a mandatory component of IMT Foundation training.
• Additionally, a good QIP can be also turned into a presentation.

Leadership (max 4 points)

Points available for local/regional leadership posts. Highest available for national role, and evidence that you have demonstrated change. Ideas to get involved with include:

• Committee on societies.
• Captain of sports teams.
• BMA student rep.
• Student/foundation doctor representatives.

Additional Sections for Higher Specialty Training:

Commitment to the specialty: this is the section that needs to be specific to Dermatology

• Join DermSoc at university, if there isn’t one, create one.
• Aim to get a rotation in Dermatology in IMT or Foundation training.
• Speak to Dermatology charities and see if you can help out with any events etc.
• Get to know your local Dermatology department, build a rapport and possibly find a mentor to guide you.
• Taster days.
• Electives.
• Attend clinics during study days.
• Write reflections/case reports on interesting Dermatology cases you see on placement.
• Try and become a member of the British Association of Dermatologists.
• Attend conferences relating to Dermatology.

MRCP

• Need part 1,2 and PACES before getting an ST3 post in Dermatology.
• 100% worth prioritisation as this is mandatory to start ST3 and is worth many marks.

Useful links

IMT self-scoring
Higher Specialty Scoring
BAD events
RSM prizes
CESR pathway

We hope you have found these tips useful. If you have any questions don’t hesitate to contact Jemima on LinkedIn or email [email protected].

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