Dr Cheng discusses a day in the life of a dermatology registrar; training/teaching; how to find out more
For me, dermatology is about the joy of making a correct diagnosis by piecing together clues from a thorough history and examination. There are very few diagnostic tests meaning this process is quick, gratifying and addictive!
There are a massive and ever growing number of described skin diseases meaning that even the most experienced clinicians are constantly learning. To be able to see new and rare conditions each week, often with just a few case reports worldwide, is unique to dermatology and very academically stimulating. The day to day work is varied and includes surgery, dermatopathology (histology) and adult and paediatric medical dermatology. It’s a small and collegial specialty with plenty of opportunity for research and subspecialty practice.
Training in New Zealand is via the Royal Australasian College of Physicians. Completion of basic training including the part one written and clinical physician exams is required before applying for dermatology training. This is different to the Australian training scheme which does not require basic physician training. There are advantages and disadvantages to the New Zealand system but I have been grateful for my physician training when dealing with medically complex cases. Dermatology training is four years duration; two years at a site in New Zealand and two years overseas. The New Zealand sites are Waikato Hospital, Middlemore and Auckland City Hospital. You generally spend one year per site.
Overseas training can be daunting however most look back on the process favorably. There are currently posts for New Zealand Dermatology trainees at Chelsea (London) and Lincoln in the UK but you can apply to the College to have a run approved wherever you can find a job as long as they are satisfied training requirements will be met. There are an increasing number of trainees finding job opportunities in Australia, which is where I am planning to go next year. This time overseas can also be spent doing subspecialty dermatology such as Mohs surgery, dermatopathology, contact dermatitis and paediatric dermatology.
The typical daily work at ADHB is clinic-based at Greenlane clinical centre. We see a mixture of medical dermatology cases (rashes) and skin lesions (suspected skin cancers). There is one paediatric dermatology clinic per week. We also do two minor surgical sessions per fortnight under local anaesthetic. The surgical lists include excision and biopsy of skin lesions including simple, flap and graft closures.
Auckland Hospital is the only site in New Zealand to have a dedicated dermatology inpatient unit. This is great for training as you get to see severe dermatology patients who often have complex management issues. On call is shared amongst the two registrars and time is spent on the ward each morning while on call. We currently have an SHO who works part time to help with inpatients. The SHO also does one clinic per week and attends teaching sessions. This is a great opportunity for someone interested in dermatology to gain exposure to the specialty.
Each week there is a teaching session on Friday afternoon and Journal club happens on a monthly basis. There is a weekly dermatopathology meeting where interesting cases are reviewed. There are also three-monthly academic sessions at Waikato Hospital and an annual academic day at Middlemore Hospital which is attended by trainees. Trainees are expected to attend and present a paper at the annual New Zealand Dermatological Society meeting. Attendance at international meetings is encouraged by the training committee and there are scholarships available through the New Zealand Dermatological Society.
For anyone curious about a career in dermatology I would suggest applying for the SHO job or just coming and observing a few clinics so you can get an idea of what it’s all about. There is very little exposure to dermatology through our medical training and there’s so much more to it than just eczema and psoriasis!