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Hello. Hello. Um, so there are a few people who joined there. There's like five people who joined. They're expecting a bit more people. So we give it like a three, a few more minutes. Ok. We're expecting around 40 people, 40 people signed up anyway. So should be seeing more people joining. Yeah. And that'll be a few more people. I think we can, we can start because the session is recorded anyway. So as people, you know, uh, join, uh, even though they're a bit late, they can still watch the whole thing. So, hello, everybody. Uh, can you hear me? Can someone say, uh, type something in the chart? Yeah, there's a yes. Yes, yes. Great. Ok. Hello everybody. Um, I'm Kaim. I'm a final year medical student at Queens, uh, University of Belfast. Uh, we've, uh, sent the link to all the Derm socks around the UK. So I'm pretty sure there are non qu students with us here today. Uh, anyways, thank you very much for joining us. Uh, uh, tonight. Um, this is Doctor Shad. Uh, she's an ST five registrar in Dermatology and she's very kindly, uh, accepted, uh, to give us tonight. AAA little, a little talk about, you know, dermatology and, uh what is it like to be a dermatologist? And what are some tips and tricks for, you know, applications and stuff like that? So, I think we'll, we'll start and is that ok, Doctor Schott, and we're having a bit of a technical issue, so I'll be controlling the presentation while doctors, you know, walks you through it. Ok. Uh, so screen. Ok. Ok. So I'll make a start then. Um So yes, I'm Shahad Eine, I'm a Dermatology register in Belfast. Um And thanks Kare for asking me to come and speak to you today just about a career in dermatology. Um And basically, I've sort of designed this talk um to talk a bit about the dermatology specialty, but also what you can do to um basically increase your chances of becoming a dermatologist to the next slide. So the first slide really is kind of thought I put down really a couple of words, what why should you be choosing dermatology? You know, the dermatology has a specialty is not really taught very well at an undergraduate level. So a lot of um people like yourselves, which I assume you're all medical students, um you get very limited exposure to the specialty. Um And I feel like a lot of it comes from people who are just have an interest on it anyway. But just as a summary, this is a specialty that deals with any disease that affects the skin, the hair and the nails. It is so varied and, you know, you, you deal with many different diagnoses. I mean, in fact, there's probably over 2000 diagnoses that exist in dermatology and they range from inflammatory conditions to infectious diseases, to cancer, to pigmentary disorders. Um and, you know, just to name a few and dermatology itself, you know, we see patients from the minute they're born to, you know, very e elderly. Um, so it's, you get a really good mix of patients in your clinics and one of the um good factors about this specialty, although it's a medical specialty, we, we have a bit of procedures, we have surgery skills that we need to attain and we need to perform surgery as part of our job. So it's quite, it, um, it really breaks up the week a little bit, it breaks up the, the mundane routine. Um, and it's quite nice. Um, and also lots of consultant jobs um that are available and, uh, you know, that's important to think about as well when you're picking your career. Um, further down the line, you know, are there gonna be jobs available um for me to go into the next slide. So, you know, I'm, uh, I'm sure a lot of you are aware of, you know, where dermatology is based, it's predominantly outpatients. So just over on the left hand side of the screen, you know, we have your nice office. So patients come to you and they leave and you're, you're based there for most of the time. You know, historically, there would have been in dermatology wards, um, where there was inpatients and, you know, we would have done ward rounds and would have had specialist nurses, you know, looking after the patients in the wards. But because the treatments have improved dramatically over the last 10 years or so, there's very little inpatient work. Now, you might get the odd patient. Um, you know, that we admit as dermatologists to the ward. Um uh, you know, that's there. But um, the most of the inpatient work is referrals. So, um seeing um, requests and consults from other medical specialties or surgical or whatever, you know, whatever specialty um that want a dermatology review at ward level, but predominantly outpatient. So, um, quite nice if, if that's what you want next slide and in terms of what we do, I mean, it's so varied as I mentioned earlier and I've sort of tried to sum up as much of the specialties as there are as, as possible. The subspecialties within dermatology starting from the left hand side of the screen. I've talked about surgical skills, but it's more than that, you know, you, you come become really advanced where you're doing the same stuff as plastic surgeons do, um, you know, advanced, um, skin surgery. But also we, um, dermatologists have, have it, um, a specific type of surgery that you know, that we do. And that's most macrographic surgery. So we'll talk about that a bit later on. There's a whole subspecialty just related to photo dermatology. So, these are skin conditions that, you know, are, um, uh, caused by sunlight UV, light, um, or exacerbated by it. And we also use UV, light as well to treat um, skin conditions. So that's a whole um, area in itself. Pediatric dermatology is a huge part um where you know it uh of, of the specialty and also cutaneous allergy and immunology. So, uh you know, allergic skin reactions um is something that we deal with and we diagnose as well with, with doing diagnostic tests like patch testing, hair and nails could also be regarded as a subspecialty as well where you're, you're dealing with conditions that affect the hairs and conditions that affect the nails. Sometimes they are, you know, the same condition that affects both and can affect the skin as well or they can be completely independent and then just moving on to the next line, you know, advanced medical dermatology. Some of these medical, you know, um dermato dermatology patients are very complex. Um And so, you know, they're regarded um and, and so you have people that have interest in a more sort of complex advanced dermatology and then we have the skin problems that affect the um the, the oral and genital mucosa. Ok. Um And then you have branches of cosmetic dermatology, which, you know, as a UK dermatologist and it, and a chest based dermatology, it is not something that we deal with quite a lot. This tends to be dealt with a lot in the private sector. And then finally, dermatopathology, you think you all, if you, you think you've got, you've finished with your pathology, think again in a career dermatology, this will, this is a, is, this is a big part. And in terms of, you know, when we take biopsies for diagnosis, we this is how we get our results is through dermatopathology. OK. So next slide. So just um I'm gonna just talk about some of these specialties, just so some pictures of what we, what we see within them. So within medical dermatology, you know, again, starting from the left hand side of the, the screen, you know, we've got a picture here of hand eczema. We've got a picture of psoriasis in the middle and over at the right hand side of the screen, you've got a blistering skin disorder. So this is, you know, bullous pemphigoid. So these are just some of the uh you know, very common things you would see in a general medical dermatology clinic, your bre bread and butter. Um And then down at the bottom here, um we've got a picture on the left hand side of this ulcer with a purple edge. Can anybody shot out with the thing? The diagnosis here is I don't know how many people are on this call. Anybody want to hazard, I guess, very painful enlarging ulcer on the shin with a purple edge. So Pyoderma gangrenosum. Ok. So again, that would be something that we would typic typically see in a medical dermatology clinic. And then um just a picture there. The last picture is a picture of a hand um um sort of the extensor surfaces. You've got this papular eruption, very keratotic um and dry, very, very itchy. Um And if I was to go further and say this person has um you know, in Wickham Stria and no mucosa, any idea what this diagnosis might be extremely, extremely itchy. So this is, this is a form of lichen planus. OK. It's called um hypertrophic hypertrophic lichen planus. So it's very thick and scaly and, and rough um but very, very itchy. Um And so yeah, so just some examples of what we're seeing at medical Dermatology clinic. But you know, just a very few example. I mean, it's, it's such a vast area. So, next slide please, Kaim. And then, yeah, so now we're gonna talk briefly about skin surgery. So I'm sure uh you know, some of these have been to the dermatology um departments would have been uh hopefully would have had the chance to see some, some basic skin surgery being performed. So, on the left hand side, we have a picture here of a skin biopsy, which is our bread and butter. Um, you know, we do it to diagnose, um, uh, you know, rashes if we're not too sure what's going on or even just a sample from a lesion. Um, just to see, just to confirm a diagnosis or to reassure a diagnosis in the middle here, we have a procedure where we scrape off the lesion and that's called, um, a curette. And sometimes we use ca cautery or ha a Hypercare just to burn off um uh sort of the, you know, the, the bleeding. So, um, so, and that, uh, so when we use what we call AC and C A car and Cautery, and then finally, at the over in the right hand side here, we've got a, a picture of this very worrying looking pigmented black mole on somebody's preic area. Uh And so this has been excised with a simple elliptical excision and stitched up as you can see in the bottom half of the picture next slide and then you have the more advanced stuff. So, uh most surgery is a specific type of surgery that only dermatologists do, but you need sort of spec um specific training for that. Um So this is where we would remove skin cancer sort of bit by bit um, in small areas and in, in a cosmetically concerning areas in particular, something like the nose. Um And so what we do is we remove, um, where we think the cancer is, take it to the lab immediately have a look under the um the microscope. And if we can see tumor cells in the micros uh uh under the microscope, then we know that there's still some tumor cells left. So we go back, take a bit more and we'll repeat the process until we see no more tumor cells under the microscope. Um And so you're left with a defect at the end. So basically, it took the uh a couple of um sections to uh to remove all the tumor in this case. And then when we have a circular defect like this, then we have to think about how we're gonna um construct this. So, you know, this is where we then start to consider about flaps. Um Sometimes we use grafting as well. So in this case, I think, oh sorry. Um So in this case, a graft here has been used, I'm sorry, on the left hand picture, but on the, on the right hand picture, they've used a flap and this is called an island pedicle flap where you've got this sort of triangular shape. Um But it's just to give you an idea of some stuff that dermatologists do. So this, this is all purely dermatology. OK. But you need specific training to do most surgery. So next slide and then as I talked about earlier, peds, dermatology is a huge part. Um you know, uh over on the left hand side, the top picture is uh a child with eczema and that at the bottom is a child with hemangioma. If you've been to any Peds clinics, I would be surprised if you haven't seen any of these two conditions. They're so common. But there are some other things that we see other than eczema and hemangioma. So we see a lot of um ge ge genetic dermatosis. So, p patients that are born with genetic problems um particularly in their skin. So over at the top here, we have a child with ichthyosis, which is a very dry scaly skin condition um that uh that you're essentially born with and very um and, and, and lifelong, essentially and down at the bottom here, we've got sort of these um uh um sort of papules, nodules um that looks a look a bit sort of um vesicular, but they're not vesicular. Um and they leave. Um So they go away and they leave scar. So this is an infection uh as a clue. And does anybody wanna hazard a guess as to what this might be? So, the picture at the bottom right corner, it's very infectious. Yeah. Whoever said molluscum. Yeah, well done. So this is Muscus and it's a very common skin condition that we see in Children doesn't require treatment. Um It tends to go away. It's a, it's a viral pox. Um So it's in the pox family of infections. But yeah. So just to give you an idea that this is some of the infectious stuff that we see, but obviously childhood infections is huge. So the next one, next slide then, so yeah, contact allergy then. So this is a branch of dermatology where we deal with um allergic reactions on the skin. And we're talking about type four hypersensitive hypersensitivity reactions, not the type one reactions that you see with sort of being allergies in people that carry epipens. So the picture here of the ring shows somebody that has an allergy to uh what looks like a ring. And so we have to think about what's in that ring. Um It is likely to cause an allergic reaction on the skin. So a nickel is a very common allergen. So, um it's likely that, you know, there is nickel in this ring and it's causing an allergy, but we need to diagnose that. So we do a uh a procedure called patch testing, which is done in a sort of in, you know, in, in dermatology department in outpatient setting. So you come on a Monday, you get all these different allergens sort of strapped to your back and then you come on a Tuesday and you get all of these taken away and then you come back again on the Friday and then we have a look at your back and we should have something like what you see on the last picture there on the right. And anything that's red basically shows that you're allergic to that allergen, so that poor person has a lot of allergies it looks like, but it's usually not really that floored. Usually it's a couple of things that you're allergic to. Um And the reason why we do it over that length of time is because we're dealing with a delayed hypersensitivity reaction. So we need to give it time to see. This is not an acute hypersensitivity, this is a delayed one. OK. So next slide and then photo dermatology um just briefly, you know, this is a uh a branch dermatology that deals with UV light, either what we um you know, skin diseases that um are affected or made worse by sunlight. So here o on the left hand side, we have a picture of a um a UV machine where patients go there to get treated for um for their skin diseases. So, eczema and psoriasis are the most common ones that we would use them for. But over on the right hand side of the slides, we have pictures of skin conditions that are worsened by the sun. So in the middle here we have a condition called hydro villi forme, very rare, but usually a child gets infected with Estin Barr virus. And for some reason, um the the EV V virus makes them more sort of sensitive to the sun. So the V light causes them to have this blistering, that sort of eruption, particularly on the face and on the ears and then the last picture there of a lady's neck with the redness, it looks like a sunburn. It's not, this is somebody that's, that's got, you know, a photosensitive reaction and it's quite marked because this is the area that would have seen the sun. So she was wearing a low cut top. So you can see the tshirt has covered the areas on her shoulders and the redness is where she's just would have been exposed to the sun. So just a very, very brief deri deri description for the dermatology. And then lastly, um just briefly talk about dermatopathology. As I said, this is, this is a very important part of dermatology. Um uh where, you know, uh the dermatologist themselves don't, you know, do the reporting, but it's still very useful for us to know what we're looking at when we're looking at of histology slides. So the pathologists are um the, the um the, the individuals that will look at the report, look at the histology and give us a report. But you can do dual training in pathology and derma and dermatology. So you become a dermatopathologist essentially. Um And you know, this is all, I don't know if Queens um I went to Queens, so I'm not sure if Queens still do this where you would do a lot of histology in the 1st and 2nd year. Um So, you know, this will be coming back. You will need to know this is a dermatologist, especially for like exams and things, but also just, you know, for, uh, to make yourself even AAA better doctor. Um, you know, eventually you will look at this, um, image of a histology slide on the right hand side and you'll be able to figure out exactly what's going on. Ok. So Q is needed. So I just, um, so not quantities, it's a type up there. So it's qualities needed by a dermatologist. So I just tried to put a couple of things down that I felt are needed, you know, for, for you to excel in the specialty. So excellent pattern recognition, you know, dermatology is a visual specialty. Um So you need to um be able to recognize rashes, recognize uh lesions and be able to um spot exactly what is it you're dealing with and if it looks odd or if it looks different, does it look infected? You know, so you need to, is this something that you will just learn with time as, as the more you're exposed to the specialty, you need to be able to work well under pressure? You know, there's a lot of um sort of external pressures, you know, from services um waiting lists. Um You know, we're trying to jam as many patients in our clinic. So you need to be able to work fast and work quick. You're seeing lots of patients in the clinic and because you're seeing so many patients to, you need to be able to be confident, to make a quick and accurate diagnosis and that just comes with time and practice reading um and asking questions, seeing colleagues sitting in with as many people as possible and to become a bit more confident as to seeing these conditions yourselves, you need to be able to work well in a team. Um you know, uh in a clinic, you know, you'll have you uh you know, me as a trainee, I have a consultant, I'll have the nurses. Um I'll have the healthcare professionals and we don't need to work well together. So we need to see the patient, bring the patient to the room. If the patient needs surgery, we need to let the nurses know we about the forms, they need to go around the corner to the theaters, you know, it, it all needs to flow very well if they need bloods, if they need the swabs, if they need anything else, you know, we all need to work together and communicate well with each other to make sure that the patients get seen treated safely and also um efficiently as well. So excellent hand eye um co hand eye coordination really is um relevant to the s the surgical side of the specialty, um organizational and pri prioritization skills. So this is really um in regards to the admin work that you accumulate. So you'll get lots of um anytime you do a biopsy, anytime you do a blood test. Anytime you do a scan, these results take time to come to you. Um, and you need to be able, I need to have a, a system where you can safely retrieve all the, um, the, the results and, um, and be aware that you're waiting on results in case something takes a long time or something gets lost. You need to, you need to be really organized and have, you know, uh uh methods and ways in which you can stay on top of all the investigations that you've ordered. And in terms of prioritization, you know, some conditions, for example, skin cancers, they are uh you need to prioritize seeing them regardless. Um but also say, um if you're in clinic and a patient come, comes in and then you've got a referral comes in or you've got maybe three referrals you need to try and work out, right? Which, which one do I need to see first? I can't be all, you know, all of these places at the one time I need to work out what I need to do first and it is busy and that is something that we deal with in an almost daily basis, empathy. So these patients, um you know, ii feel sorry for them, you know, uh because they have a skin problem, a lot of uh they get dismissed quite a lot by, you know, other specialties by, you know, um uh other people. So they they're coming to you frustrated and, you know, you need to give them the time and the space to just f to, um, you know, let it all out, just listen. Um because some of the, and, and, and a lot of the time they've been written years to come and see you as a dermatologist. So you need to really be empathetic um and be empathetic that they have a skin problem as well. That's, you know, affecting their quality of life too. Um It not, it may not be life threatening as such, but it's affecting their quality of life. And then finally, you know, working in a team comes again but also leading a multidisciplinary team. So, you know, sometimes these complex um dermatology patients, you will be working, you know, with other, other specialties, other disciplines seems to be able to work well and be able to lead a multidisciplinary team if, if you're the dermatologist in, in, in in charge of the care of that patient. Ok. So just some qualities um things that well that you love about the specialty. Well, I hope that you'll love because these are things that I love about dermatology. I love the fact that it is so highly visual um because you're able to make a diagnosis quite quickly. Um sometimes by just seeing it, you know, without a, without a biopsy, without any investigations, you can look at something and diagnose it and that's very satisfying at times, but obviously that's not the case with every single patient and it is fast paced and, and so you're able to have a quite a quick turnaround. Um, if, if you, if, if that's something that you enjoy, um, you know, uh, for example, you know, a standard clinic for us, we'd be seeing 12 patients in, in, you know, each in one clinic. Um, so that's quite quick, you know, um, and you need to, and so you end up seeing a lot and, and, and dealing with a lot. So the procedure side of things again is an area that I love to. Um, so apart from the, you know, the medical side, you know, we've got surgery we've talked about, but also we've got laser as well that can be, um, that we can use sometimes, uh, and also contact allergy, the photo stuff, the dressings, the wounds, you know, these are all things that we can do. Um, you know, just at, from a practical perspective, I love working with the specialties. I love sort of that multidisciplinary input, you know, um, uh, a lot of you that I know are medical students now, but whenever you, um, go on to foundation and, and eventually if you want to do dermatology, I mt you'll find yourself that you, you know, through all the medical specialties you're working, um, in, in large teams with lots of different specialties and then when you start dermatology, it feels a bit lonely at times. So it's really nice to, to move to work with other specialties and kind of mingle and, and chat to people outside the specialty a bit as well. There's lots of teaching and research opportunities in dermatology as, um, and, and that's something I love to. And I also love the chance to go to lots of different conferences and meetings as well to be able to, you know, listen to other lectures, learn things, um be able a chance to present as well at them and get to meet other people in the field. And last, but not least the work-life balance. Um It's so important to think about, you know, what you want um later on in life. Do you want to be, you know, working weekends? Do you want, do you not mind doing night shifts and being called in, in the middle of the night? Well, that's not gonna happen a lot in dermatology. And so if you want, you know, to, you know, if you have a family and you want to have time for that, you know, just, just for uh an example of, for personal reasons. So, I mean, that, that is a massive disadvantage but it's still not a Derma holiday. I hate that term. Um You know, the day work is busy, it is busy but the, when the evening comes you're finished and that's it. And that's, uh that's a, a massive dis a massive advantage next slide then. So things you might not love so much about the specialties. So it is competitive and just even looking at last year's when I was preparing for this presentation, you know, 241 applicants for a third or two spots, training spots in the UK. I mean, the ratios are mad, absolutely mad. So it is, it's one of these things you just have to, you know, put the effort in, you know, nice and early and just keep working and chipping away if this is something that you really want. Dermatology can be misunderstood amongst our peers. Again, not a dermat holiday. And I hate that term, but you find that sometimes other specialties will sort of just think this is the skin and that's it, you know, whereas, you know, we're dealing with a lot more what we do and we're, you know, we're doing a lot more, you know, we're using exciting treatments, we doing lots of surgeries and we feel like we have to justify ourselves, which I think annoys me, uh, some at times. So the, the fast paced side of things, you know, is a sort of, um, uh can be an advantage and a disadvantage because sometimes it's, it doesn't give you an awful lot of time with your patients, which is not very satisfying at times. So it's particularly with the older patients that, you know, need that bit of extra time. They want to chat, you know, and you want to be, you more than anything, you want to be able to give them that time. But you just can't because there's about six other people waiting to be seen. So that can be, that can be quite stressful at times. Another aspect too, for me personally is there's not a lot of cures for, um, there's not cures for a lot of skin conditions. So we, we're managing the disease or rather than curing it because they just, we just don't know enough about it, you know, uh a lot of the, the, the the the skin diseases. Um There's not a lot of research being done on them. It's for us to be able to find the cure. So we're managing them and we're seeing them again in a couple of months' time and it's just, it just seems to be a cycle but just never really ends. And finally, as I've mentioned before, sort of that external pressure is a managerial side. You know, the waiting lists, the red flag clinics, the squeezing every um the most amount of patients you can in the clinic that can be stressful and yeah, something, something I just wish that wasn't, wasn't there at times. Ok. So just a couple of things just to think about. It's not all, it's not all um you know, rainbows and sunshines, you know, every specialty has its downsides. So, next slide. Ok. So just a brief summary. And I'm sure you all know about dermatology training within the UK. That's all I can talk about is being a trainee here. So it's four years long. You start ST three and you finished in ST six. So it's only four years, which is not really an awful lot of time, which is why they allow for sort of fellowships after you CCT. So when you finish training, then there's um opportunities to apply and do fellowships um in various institutions during the, the UK, it could be done in medical dermatology, peds, mos um whatever, whatever you um end up uh having developing an interest in, so that you can be consulted with a special interest in, in a particular area throughout training. You are supposed to have sort of mandatory rotations around um subspecialties. So that would be your peas, no photo derm path allergic diseases at a bare minimum, but depending on where you are and which center you are, you may have exposure to different um subspecialties that others um won't have. Um you need to have the exam. So the specialty certificate examination, the SCE, so they recommend that you do that. Um So it's part of the M RCP. They recommend that you do that in the second or third year. Um And it's a, it's a two, it's a two papers that's um two or three hours long. I can't remember exactly, but it took a whole day and it's online. But you do it in a test center. Um And then you do, yeah, you, you complete your sort of e portfolio is how you achieve all your sort of achievements. Um At the end of the year, you have your competencies and you need to have your evidence for teaching all of Q I research and you have an RP at the end of every year where they sign you off for the year and then you can move on to the next year. And then, you know, they, there, there is um um opportunity for time out of training if you're really interested in doing research through an MD or a phd or even something different, like a leadership or a manager, for example, um in, in northern, there's a, a um a program called DE which is like a leadership management. So I know there's some dermatologists that have taken a year or just to focus on sort of leadership skills and then there's life reasons for time out of training, you know, I'm on maternity leave at the moment. So I know that's a reason also to be um out of training for a while. OK. So next slide. So just a very um brief look at what a typical week looks like um of a, of a dermatologist. So this is what sort of a rough idea of what mine looked like before. Um I was on maternity leave. So I will start the week off with the red flag clinic. So these are also the referrals that come from GPS, sometimes A&E or the wards or they're occurring a skin cancer. So we need to see those um ASAP well, within, within two weeks, ideally, um So we would see that and sometimes, you know, surgeries and biopsies happen in the middle of the clinic. So it's a busy morning. Um We finish say at um half 12 1 o'clock. Um and then clinics then start again at half one. But I have sort of admin time. So I go through my admin, I go through any emails that have been sent. But also if there's any ward referrals or if there's any GP phone calls or, you know, phone calls from any other hospitals, then I would take that time to do it as well. The next morning I have a general dermatology clinic. Um You know, I would see lots of different medical dermatology things, eczema psoriasis, but you know, the things that we talked about earlier, um again, it's a busy clinic. Um So then uh we finish and then I move, I then go to the children's hospital for a pediatric clinic in the afternoon. And if I'm in the pediatric clinic, then if there's any referrals that need to be seen on the wards, then I will know about it that afternoon so that I would try and see them in between clinic in between patients in the clinic or at the end. So when five o'clock comes, I'm actually on call that evening, so I'm on call. Um, I'm contactable via phone and so I'll make sure to put my phone on loud. Always remember to do that. Um, and yeah, so, and the on call has recently changed, it used to be overnight on call. So it would be on call to nine o'clock in the morning, but they've recently changed that, um, just to 10 pm in the evening. So now we've got a nicer, we've got a nicer sleep now. So I get up now on Wednesday morning, I have a surgical list. I've got four patients um on, um, about 45 minutes each for each patient. Um I've got a mixture of a bit basal carcinoma, um, a squamous cell carcinoma. I've got somebody who's got a melanoma, you know, so I'm, uh that was added all sort of, um urgently from Monday's clinic. Um, so I'm, I'm doing all of that and then in the afternoon I've got another sort of admin session. Um, and, and also a chance to go check up on all the patients that I've seen on Monday from referrals. Um, just check up on them. Anything else that needs to be done on the wards and chase up any other things as well. If I've got an audit or I've got a case report, then I will try and use that time if I've got any extra time to do with them. And Thursday morning is a skin cancer MDM. So this is a regional skin cancer MDM in Northern Ireland. Um So where all the, um, all the departments link in it. It's, I think it's still happening remotely. It used to be face to face um before COVID. But, um, so this is where all the complex skin cancer patients are discussed. So, you've got the dermatologist there, you've got the plastic surgeons, you've got pathologists, you've got radiologists. So, um for anybody that's based in Northern Ireland, this is a really good meeting to attend. Um You can reflect on it um as well for your portfolios and it's, it's very interesting, you kind of get to see how the complex patients are managed. Um And then I've, I've come back to. Um so the, you know, the, the MDM is in the city hospital. I come back to the Royal. Um So it's about a hospital, it's about 10 minutes away from each other. Um And I do a medical dermatology clinic and then I have another clinic on Friday morning. Um And then we finish, we have a better lunch and then our Friday afternoons um is usually dedicated for teaching um and meetings. Um So, yeah, so this is a rough uh sort of idea of what a week looks like. And then after the weekend, if I'm on call, I will be on call sort of all weekend. And if not then happy days. But, um, I can enjoy the weekend. Ok. So next slide. So I've given you a, a brief sort of overview of what the specialty entails. I mean, uh, what I've talked about for 20 minutes I could have talked about for 20 hours. There's lots, there's a lot more that we could talk about, but just a brief overview. And I'm, and I'm ca, I'm cautious. I, I'm speaking to people who are in Derm socks. So I know you're all aware of what the specialty involves, but hopefully there was something useful there for you. So I'm dedicating in the second half of this talk to talk about how to actually become a dermatologist. And I've tried to um break it down into just five simple steps. So again, I'm sure some of you are aware. So just bear with me. But if there's anything um you want to discuss again in more detail at the end, I'd be more than happy to. So first step. So I'm um bearing in mind that you are all medical students on this call. So next slide k sorry. So step one, my advice would be to start to begin to start to show commitment to specialty. So think about your experience. I know as uh as medical students, you're gonna get very, very limited experience. I know at Queens University. Whenever I um whenever I was a student, we had a week, we had a whole week. And now, in comparison, I think you're, the medical students are only getting a few days if even so the, the experience is very limited. So try and arrange test weeks, um particularly when you start sort of foundation program. Um if you could try and arrange your elective placements or in dermatology specialty, um you know, that will, you know, maximize your exposure and also when you're picking your foundation jobs, um or even just your I MT um Derma uh rotations try and be mindful of which jobs have dermatology as part of as part of that rotation. And if there's no dermatology rotations, I know that in, in northern Ireland, I don't think, I think there's only one maybe um in Derry where there is a dermatology rotation, but it's not purely dermatology. I think you, you're working on specialties, think about other rotations where maybe it would, there would be an overlap in dermatology or something that would be useful. For example, rheumatology and immunology job or even like a plas you know, a surgical specialty or some sort. Um you know, just to, to kind of get some surgical skills. So just think things to bear in mind and think about the things that you can do to boost your CV. So, you know, working on audits um and quality improvement projects and it doesn't necessarily have to, to be, you know, has to be in the dermatology department, you know, it could be anything related to skin. It could be, you know, some a project like cellulite is managing cellulitis in a, in a medical take or, you know, looking at the management of pressure sores. I mean, they're not very glamorous things, but at least it shows an interest towards in trying to improve skin health. But obviously, you know, do get in contact with your local dermatology departments and see if there's any projects that are, that you can help with, you know, you may not be able necessarily to lead a project. But at least if you can assist with some data collection or something like that, you know, that's, that's something at least think about, you know, teaching, I know in DERM. So, you know, there's lots of teaching and things like that involved. So that's brilliant and again, sort of case reports and reviews, you know, even if you did like a systematic review, um you know, look in a Pubmed or MEDLINE or things like that, you know, something that you can do maybe um you know, as, as a potential publication or a presentation. And then again to the presentation, you know, think about oral, think about posters, think about, you know, submitting abstracts to meetings. I'll talk about in the next, in the next box as well and sometimes you can even get publications out of those as well. So just being mindful about, I mean, you've probably already done things but just being mindful about how you can actually show evidence that you've done these things and then there's lots of different courses and meetings that you can do. I know that the Derm School is quite good. I did that whenever I was um, in foundation or a co training, I can't remember. And the Derm Dock is another brilliant course as well. Um, that's, um, that, that the B AD offer and there's lots of things as well within the societies in Dermatology. So the surgical, the, you know, the, the dermato peds Dermatology, the surgical dermatology, the skin of color in the UK, there's lots of opportunities um to become members, um you know, to see what um educational stuff and material they have Saint John's Academy is another brilliance resource as well. And the EA DVI believe have medical student sections as well or people that are interested in dermatology. And then the I ad, the Irish Association of Dermatologists have meetings as well um that will be considered national. Um And they have a actual, they have um uh opportunities for medical students to present and you don't even need to, you know, submit uh you can just, you know, submit an abstract and it will be accepted because they have that platform. So, you know, definitely check that out um as a um as a potential place where you can present things, you can, you know, consider being memberships and as medical students and junior doctors, some of these membership fees are very low, so or nonexistent. So have a look and see. It just shows commitment, you know, um and potentially, you know, asking dermatology charities for any assistance. You know, the Melanoma Forum, the British Skin Foundation, you know, they might be able to have opportunities to become involved with and then having a look at journals. Um and, uh uh you know, sometimes these journals to me are a bit over my head. There's a lot of scientific rear original research, you know, lab based research that are just uh difficult to understand. But the clinical experimental dermatology is the one that I like and I have been reading for a long time. So it's a CE D and it's quite user-friendly and I think it's a good one to, you know, read and sort of and get to grasp um a as trying to learn a specialty as well. OK. So just some pointers for commitment next step then. So you need to complete your foundation and core training and you all know that and the, so the main route to um becoming a specialist trainee is dermatology is the internal medical training I MT or the CS um IM route. So you need to complete two years of IMT as dermatology is a group two specialty. So you can apply straight from um I MT two, but you can still do do IM T three as an option. And I know in Northern Ireland. Um I, you can do a dermatology rotation for six months as an I MT three. So, um some, I know that some people have done that and then applied for dermatology after. But the main thing is you need to take, uh you need to have done your M RCP. So that is a priority that needs to be done. Um you know, um in the foundation and core training. So all the routes. So you don't actually need to be a medic to get into dermatology. You need, you can go through the pediatric route. Um So you need three years of peds ex uh experience and also the full set of exams or you can actually go through the surgical route. So you need your full exam and the MRC S two years of co training and, but you also need to display the, the I MT two capabilities. So you need to have medical um experience and back um and um competencies before applying for dermatology. OK. So step three then. So you've finished um your court I MT or your foundation and your I MT or whatever co training you have done. And now it's the um process to apply for the ST three number that's been released. So the JR CTB, um So I have this website called ST Three Recruitment and this is where all the information that I've taken from and it's available for anybody that wants to have a look at it and it's also available for any other specialties, not just dermatology, but this is um uh so you will find the jobs released on this website called oral. Um And that's where you will do the application form. So the application form is quite lengthy. It has nine domains and, and you're scored in it and depending on your score it, they will um uh they will then decide if you're going to be shortlisted for interview or not. OK. So how, well you do just bear in mind Northern Ireland has a separate application to the rest of the UK. So if you don't mind where you work, you can apply to both and hopefully increase your chances that way. So, or if you only want to work in Northern Ireland, then you just apply for the Northern Ireland one. It will also the application will also be through oral, but it's um organized by NTA. OK. So the first um set of um scoring points. So um once you've filled your application and you've submitted it, then there's, there are gonna be two independent assessors that will look through it to assess how committed you are to the specialty. And depending on how they feel um how you're committed and you understand the specialty of dermatology, then you will get a maximum of 10 points. So I've tried to screenshot here. You can't see it, but you'll see it in the D RD R CTB website, the exact details of how they score this area, then the one of the, the second domain then is postgraduate degrees. So if you are somebody that's already done a, a phd or an MD, then you can get a maximum of four points. If you've done a master's or some sort of intricated degree, um that's equivalent to a master's, then you will get three points and so forth and so forth. You can't claim M RCP for this section. And if you're sitting here as an it one or a 92 and you haven't done any of these postgraduate degrees, don't worry, not, a lot of people will have this done. And I, and there's other uh domains where you can get points from. OK. So next slide, then you have the additional achievements and this is in relation to prizes. Um So if you've won um uh prizes from a medical, a medical related prizes to awards, um or if you've got distinctions or honors in university, they all um sort of count towards um towards this area. So there's a maximum of three points and it doesn't have to be Dermatology or Radiated Prizes. It can be, you know, anything you could have won sort of, you know, a best poster at a local competition or something like that. Um would, would suffice and then your M RCP is sort of regarded as the fourth domain. If you have all your M RCP done. So there's two written papers and a clinical paper and a clinical exam called PS, then you get the maximum of eight points. And if you only have part of it, then you get lower points. Um However, you still need the full M RCP. By the time you get the ST you know, if you're successful in getting SC three and you haven't finished your M RCP, you need to have, have it done by the time you start the ST three number. So this is a um uh opportunity for me to emphasize to invest getting your Mr CPS up early because that to me is one of the most important things in your application, even just to apply to be able to be eligible to apply for an ST three. OK. So next slide. So presentations then, so again, a maximum of seven points here, oral presentations are gonna be worth more in, in terms of points than poster presentations and national and presentations at national and international meetings are gonna be worth more than regional and local. So just bear that in mind. Um Whenever you are looking to get sort of presentations done, um there's lots of different meetings, I've sort of mentioned some of them earlier in the B AD, the I AD which would be national, the EA DV, which is international, think about that. And, you know, don't be afraid to just submit abstracts to any other meeting, you know, this doesn't have to be dermatology, you know, you could have a, a respiratory rotation in your foundation and you've got a good audit and you've submitted as a poster in a, in a respiratory conference that still counts, you know, um in terms of points, but a dermatology related project is going to show more commitment specialty. OK. So this is worth again investing a bit of time in this section cause you can easily get, get, get, get points cause even like the Royal College of Physicians um have a um a conference every year where they give you a chance to present and you can present a dermatology poster or a presentation and there's chances to win prizes as well. And the, and the BMA or um or the BM, they have, they have conferences as well. So just bear that in mind and have a look so publications. So this is an area that maybe not, a lot of people will get a lot of points on. Um because I feel like, you know, original research is gonna get you the most points. And so this is really only gonna be relevant for somebody who's maybe done a phd or an MD or a master's, you know, on so on and um and have a lot of scientific um and clinical research to publish. So don't get bogged down, sometimes the abstracts that you submit to um meetings get published. And so they will count for a point or two, I think as well on this. Um And if you're a first author that will count more towards if you're a co-author, so just bear that in mind. Um, think about journals that, you know, are going to be more achievable than others. You know, the British Journal of Dermatology is so high impact that, you know, uh it's, it's very difficult to publish in, whereas in more locally in northern Ireland, we have the, a medical journal which may be, you know, not, you know, the e easier, I'm not saying it's easy, but just something more achievable than the B the B MJ or the CE D. So just think about what's, what's relevant and what's achievable. So, next slide um so teaching um and teaching is divided into two sections. So uh um organizing and delivering, teaching could get you a maximum of six points and this is sort of organizing a teaching scheme and having evidence of formal feedback. So if this, uh I'm sure Derm, so counts as um if you're all within Derm. So, you know, consist um at teaching um arranging a teaching scheme. But if you're not involved in anything, you know, get in touch with the medical education departments at the university or the hospital, you'll be working at and see if you can set something up. I know that I had, you know, whenever I was f one we had set up sort of a teaching and ay sessions for finally new medical students. And we have done that over the course of a year. So I was able to count that towards, you know, towards this area and then having a teacher qualif teaching qualification as well, um can, can also uh get you some additional points here as well. So if you've done a master's level, I know that um the magical education masters at Queens um or other universities seem to be popular ways to um to try and get teaching qualifications. So that could be something that you can do as well. And then quality improvement project is um a must in these applications and to be fair whenever you start working, they're gonna be a must as part of your E portfolio. Um a mandatory part, but you must demonstrate um a good understanding of quality improvement methodology. So you've done AAA Ati, you've done two P DSA cycles at a minimum, you've led it um as in you to provide the rest of the team that will get to the maximum points in this section and you can be clever as well with these key I projects, you know, they can be presented or they could be published as well. Um And then you can get sort of uh almost hitting two birds with one stone. OK. Next slide. Um So this is the last bit of this section. So um this is just bear with me. So leadership and management is the last bit. Um and it can be done um you know, at a healthcare or nonhealth care capacity. So, uh as long if you're able to demonstrate and show impact from your leadership and managerial skills with evidence, um uh and it has to be for uh in a rule that more than six months then not get you the maximum points. And again, national and regional um rule um get you more points than local rules. For example, you know, a BNA rep isn't a national um national position. Whereas if you're say, you know, President of the Derm, so that's probably more of a local role. Um So just be that in mind whenever you are taking on sort of leadership and managing your rules and just to summarize this sort of application section, um you know, prioritize what's important. So I, I'll emphasize here again, you know, things like the M RCP, you need, you need to get that done, you know, don't look at trying to get publications and posters when you haven't even passed, you know, your exams. So just it's all about balance and think about what's achievable and what's done, you know, is, you know, try and get points. Um If you don't have a postgraduate degree, try and think about, you know, presentations. Q I get, get all those important things and all these projects, they don't have to necessarily be done related. I it'll be nice to have some of them dermatology related cause then if you get the interview, then at least give you something to talk about. Um But you know, if you, a lot of you are not gonna have an opportunity to work in dermatology and foundation or I mt so think about um you know, so all the projects that you will do, they will not be going to waste. And then he said be op opportunistic, be clever with the projects that you do. So a key IP or an A can also be a, be a presentation, you know, and, and you know, just, just think uh along those lines. Um and a lot of the societies that are out there, the dermatologist societies, you know, they have positions for reps for medical students and even like prizes for medical students that they're not very competitive. So have a look and see what are available. Um And you know, you can start to score yourself some points already, you know, before you've even, you know, graduated and started working. So just, you know, try and be clever and savvy with these things. OK. So next slide. So step four, you've done the application, you've heard the wonderful news that you have been shortlisted for interview. So now you have got to prepare, OK, so just a brief overview of what the format is like um for ST 30 interview. So there's three stations and there will be two interviewers per station um whenever I did it, it was uh virtual. Um I think some of them are still virtual. Uh Well, in terms of northern, at least anyway, um and you have seven minutes per station. Um And approximately the whole interview process will be about half an hour long because you know, there will be time to go in between the stations. So each station gets a score out of 10. And then in terms of then offering you the the number will be not only just the interview score but also your application score. So it just goes to show how important the application score here is because not only is it there to shortlist you, but it's also there to actually help you get the job. Um In addition to the interview and preparation is key when it comes to interview, you will find out roughly about a month before the actual interview date, but you will, you will know the interview dates will be sort of confirmed before they even application. Um uh forms have application process has even um been completed. So have a look at that and start to prepare early, you know, ask someone who's been through it before, what sort of questions have been asked before? There's lots of different resources out there. You know, Derm coach Derm Ole me, you know, they all have sort of examples and scenarios, some of them are pay, some of them are free, but there's also lots of different general interview courses. So if you're somebody who's not really um had a lot of practice with interview or not very confident, you know, I would advise try, you know, chatting to someone um having a sort of a formal course or something like that 1 to 1 session just to get an idea. Cause uh II mean, the way I treated this, my interview was like an exam. I, you know, I was worked for it. I studied for it, II prepared for it, you know, and it pays off at the end of the day. OK. So next slide then, so, so this just a quick summary of the stations and what sort of to expect in terms of questions? So station one is sort of dedicated towards research and academic medicine. So you will be provided an abstract just before the station starts, you'll be given some time to read it and appraise it. And then when you go into the station, then there'll be a discussion around the abstract, you know, you know how your critical appraisal, you know, using the po algorithm, the results, how strong the study is, you know, things like that will be asked and then you might be asked a bit about research experience, you might be asked about teaching. Um I know that I got asked about a recent paper that I read that I find interesting. So, you know, uh prepare, prepare, you know, your sample answers for questions that might get asked essentially. OK. The second session is a clinical scenario. So again, just before the station or no, it, I think it is during the station, you will be given a clinical situation and then um and then you will be asked um sort of an initial response um uh your initial response and then there'll be a series follow up questions and they're really just trying to see, you know, your steps on how to manage this scenario in this patient. Any treatments you will suggest any further information that you want to get and how you communicate, you know, with the patient in this case or the, you know, the the other uh the other people that are in this scenario, there's a second set of marks that come from communication skills. So it's how you organize yourself through, you know, and your thought processes throughout this clinical scenario. As I said, a lot of you won't have any dermatology, you know, uh we uh or, you know, long enough dermatology experience to confidently, you know, deal with um a clinical scenario. They just wanna make sure that you're safe and that you're not just, you know, being overly confident, claiming to be able to manage this patient to the best of your ability, you know, calling a senior calling for help. These are things that they want to hear at the station. OK. And then finally, station three is your suitability and commitment. So this is where they will ask, you know, the why dermatology, why this Deanery, you know, tell us what your leadership, tell us about your management. It was an opportunity to, to discuss your commitments um to the specialty, um what you've put in an application form, sort of highlight that further and, you know, and really just um just your generic sort of interview questions will be that one. OK? So the next and final step then is to prepare for the outcome and there's only gonna be one or you're one of two outcomes, you're either gonna be successful or you're gonna be unsuccessful. And I have been on both these books, OK? So successful, you um the way that I see it is um you get the number or you get a lot position, which is um a local point for training where you just get a year's post, um where you basically are doing, you're a Dermatology registrar for a year. So these are available everywhere except in England as far as I'm aware. And the last bit um of this successful section is you can be added to a waiting list. Um where basically depending on whether people accept the numbers or not, then you might be able to um you know, and how high your pr in terms of your scoring, you might be able to be offered a number at the next round. And if you're unsuccessful, don't panic I have been there before. It took me three applications to finally get the number. Ok. So don't panic. You know, most people will have more than one try to eventually get the number, use the feedback that you get to know where you need to improve. Um You know, so if you see from your application form that, you know, you needed maybe some extra points, then you could work on that in the next year. But it's also useful to have backup options. Um I know, so if you have somebody who's applied straight from I MT two, then you have I MT three as an option, you know, to do and then apply again next year and you know, improve the CVA bit more. But there's also sort of clinical fellow um um um options. So these are available in England where you can work in a dermatology unit for a year, but there are also research fellows, teaching fellows and there's also the option of, you know, um uh the route of specialty doctor as well where you can do temporary, you know, temp uh if you want the number or you can, you know, continue on that long term and you do use a seizure pathway, a different pathway to training to actually to become a consultant and dermatologist at the end of it. So, don't panic. Um If you're unsuccessful, as I said, most people will, it will take them more than one. application to, to, to succeed and get a number? OK. So next slide. So is it for me the dermatology? So if you like something visual, if you like something challenging and if you like a huge variability and also practical and specialty, I highly recommend dermatology as a specialty than and to apply for. OK. And then last slide, the next slide. Thank you for listening. This is just um the Belfast team, I think when we present, we hosted the um IE D conference last year. So I just thought I'd put it there just to show you that the people, you know, uh the team that you'll be working with. And OK, it's very nice and nice to be part of a team like that. But um I hope that I didn't bore you to death and I hope that this was a useful talk. Um And you've learned something, as I say, I know a lot of you are um part of the Derm Sock society. So you will probably know a lot of this information. But if there's anything that I can help with, please don't hesitate to ask. I put my email address there and please contact me if there's any questions at all. Thank you. Are you trying to say something? I think you're on mute. Oh, hi. Sorry. Ok. Mhm. Did I have my camera on? Ok. Uh Yeah. OK. I I'm just asking if um well, thank you very much doctor si was just asking the uh attendees if there's any questions that they had. Um I can see some questions here on the chart. So Joanna, um mcw is asking, is there any differences between applications for dermatology training in Northern Ireland versus the rest of the UK? There isn't much difference to be honest with you. Um I think even the interview format is pretty much the same. It used to be slightly different. But I think if now I change it to that, it was, it's reflective of um sort of the national training programs um in terms of pediatric training, right? Can you treat dermatology patients in the future? Yes, you need to be able to um ii it's, it's a tricky one because obviously, um you start pediatric training at ST one, you do ST two and you need to, you need to do three years. You need ST three, but a lot of um the pedia pediatric trainees would have dealt with other patients in foundation program, but they need to be able to see all patients um in dermatology training. Um And then Ohma Asari apologies if I'm not pronouncing that right? This year, the call for ST three interviews was seemingly 39 out of 50 which is high. Is there any way we can stand out to get ahead? What would you recommend we prior you med school? Um as I said, you know, um start to show commitment to specialty, you I've, I've went through the application form, you know, where these points um are, are you, where you can get these points, you know, and how to get the maximum points. So, you know, get your um presentations, get all presentations in the national conference. That's your maximum point. If you can get a publication or your first author and it, and if it's an original research, you know, you can do that as part of a master's um or integrated degree, then that's, you know, that you get the maximum points, you, if you show good Q I methodology, then it's maximum points. Get your M RCP, have it done before your application and you get the maximum points there. So, you know, you uh going through that application form, then you know where you can get your points. Um And hopefully you can get the maximum points that you need to, to get an interview. OK. Um The see RHA um what did you do in years between I MT training and before you started Derma training? So, um I, so I was uh I feel like I'm making myself sound so much older than I am, but I used, I was in the core training um skiing before I MT training. Um And I, so I was core training, I was in my CT two year when I first applied. Um And I, so I happened to be on maternity leave at the time then. So um I didn't get the number then. So then I applied when I was back in court training after maternity leave. And I got the LA. That was my second time and because it was a lot, I still had to apply again because that was only a year long post. So it was during that LA position that I applied and then I got the ST three number. So I was lucky enough in that I didn't actually have um time art in between, sort of finishing coating and starting a lot. Um But I know people that have had that time and I know in Northern Ireland because we don't have uh the clinical fellow jobs options as there are sort of in England, you know, some people look um sort of for the year, some people they went on to do I MT three and sort of um uh and sort of applied again during I MT three. and some people just took on sort of like, um especially doctor jobs as well. So there are all options too that can be done in between. Ok. So I don't know if there's any other questions. Ok. All right. Ok. Uh Thank you very much, Doctor Schott and thank you, thank you guys for joining us tonight. Uh Doctor said that was very, very informative and uh very insightful and I got a few extra points there that I didn't really realize. So. Yeah, thank you very much. For that. Oh, there's just one last question. What particular degree would you recommend? Gosh, I don't know. Um, I don't know, actually, I mean, it, it depends what, what's being offered at uni university you could ask and see if there's anything around skin. I don't know where you're based. If you, you're in Queens, um, or if you're in an English University or, you know, another UK university, there's not a lot of skin research that happens in Queens, unfortunately, but I know that there's um you know, good research units in England, like Sheffield and um and Nottingham in particular um where they do a lot of research and things like that. So perhaps one of those um could offer integrated degrees that would be useful to dermatology. But yeah, I don't think a lot of them would necessarily be, you know, you know, a dermatology based one. So it may just be a case of, you know, take a year to learn about sort of research, to learn about sort of um blood based research. Um get a publication, you know, get a master's degree and hopefully there'll be points and towards the application. OK. It's very late now. I'm sure you all probably would just want to end the meeting now. Mm. OK. All right. So, yeah, thank you very much, everyone. And uh next week we'll continue with the uh the Comprehensive Dermatology Guide. So I'll take the next session and we will be discussing a few, um, important, uh, topics for the MCQ S. And then we, a few weeks later we'll have another, uh, the final theory session, uh, and then we'll have, uh, one session for OY, that will be very relevant for 3rd and 4th year terminology. Ok. Right. Ok. Thanks everybody. And good night. All right. Thank you. Good night. Bye bye bye.