Dermatology - The Royal New Zealand College of General ...

DermatologyDermatologyIn New Zealand, most dermatologicalconsultations occur in general practice. 1Around 15% of all GP consultations involveskin conditions.Dermatology encompasses not only thecommon chronic skin conditions, such asdermatitis, psoriasis, rosacea and acne, but alsoacute and chronic skin infections and infestations,skin cancers, congenital skin lesions and skinmanifestations of systemic disease.02Dermatology

DermatologyCommunicationDomain 1: CommunicationThroughout vocational training a registrar will develop avariety of competencies and be expected to:• identify patients’ beliefs and values concerning skinhealth and attempt to modify them where appropriate• demonstrate a person-centred and sensitive approachwhen breaking bad news in the diagnosis of melanoma• acknowledge and manage uncertainty when dealingwith unusual skin conditions• counsel a patient with chronic hair loss for which thereis no effective treatment• develop communication skills to effectively describethe use of steroid creams and address patients’ fearsabout side effects• explain surgical skin procedures and obtain informedconsent.• clearly explain potential side effects of isotretinoin,including the need for contraception, and the monitoringrequired before starting and while on this medication• negotiate an acceptable emollient regime in patientswith dry skin conditions• explain the use of the fingertip unit to patients andunderstand how to apply this to prescribing the correctamount of topical creams• be able to communicate effectively with family/whānauabout effectively eradicating scabies• be able to demonstrate the use of motivationalinterviewing in improving sun-smart behaviours ofpatients, particularly young adults and children• be able to sensitively explore the impact of having askin condition on the patient, including the use of theavailable tools, such as the Dermatology Life QualityIndex (DLQI)04Dermatology

ScholarshipContext ofGeneral PracticeDomain 4: ScholarshipThroughout vocational training a registrar will develop avariety of competencies and be expected to:• continue professional development in dermatology,which may include minor surgery, dermoscopy anddermatology courses and conferences• use online resources to update knowledge, such asDermNet courses and quizzesDomain 5: Context of General PracticeThroughout vocational training a registrar will develop avariety of competencies and be expected to:• establish a relationship with the local dermatologyspecialist service, which may include specialist nurses• be aware of local services available, such as communitynurses offering wet-wrapping, ulcer clinics, UV lighttreatment programmes• audit dermatological practice , for example skinexcisions, steroid cream prescription, referral letters• consider postgraduate diplomas in dermatology, minorsurgery and dermoscopy• identify personal dermatological learning needs and uselocal resources, such as dermatology outpatient clinics,to continue learning and fill gaps.• treat skin problems in the community context,including residential care and schools, providing goodcommunication and written plans• work with colleagues, seeking second opinions of rashesand lesions when the diagnosis is unclear• be aware of online support tools, such as best practicefor isotretinoin, PASI scoring, DermNet patient handoutsand patient.co.uk• be aware of extended family/whānau and the patient’ssocial situation and how this may impact on thetreatment of some skin problems.www.rnzcgp.org.nzDermatology07

Learning experiencesand assessmentYear 1 Learning experiences AssessmentIn practiceSeminar dayClinical attachments• Minimum five patients per half dayOne-on-one teaching• Role play of difficult cases• Calling teacher or registrar in to see rashes and skinlesions encountered in practice• Use of photos• Discussion on dermatology-related patientpresentations• Practice team meetings (participation as able)Community visits• Ulcer clinics• Local wet-wrapping services, eczema nurses• Patch testing clinics• Dermatology outpatient departmentsIn practice visit from a medical educator• Direct observation• Record review• Personal reflectionSpecialist presentationSmall group learning• Case-based discussion• Role play• Video interview• Journal club and discussions• Articles on Māori health inequalitiesRegistrar presentation of:• Vignettes on dermatological conditions• MATCH quizzes – including photos• WEBS – research on dermatology-related topicsIn-practice visitsVideo/direct observationVignettesWEBSMATCH questionsPatient satisfaction surveySkills logOnline quizLearning recordSummative• GPEP written• GPEP clinical• Academic outputFurther details about academicoutput in Year 2www.rnzcgp.org.nzDermatology09

DermatologyYear 2 Learning experiences AssessmentIn practiceLearning groupOther learningAs for Year 1, plus:• Increase in patient numbers seen daily• Attention to PHO performance parametersfor dermatology• Practice team meetings and input into these• Use of photography to share cases with specialistsand colleaguesAudit, e.g. complete excision rates for skin lesionsremovedMedical educator visits• Video/observation• Case discussion• Record reviewInvolvement in CORNERSTONE ® accreditation if occursSignificant event reviewEstablishing relationships with other providers ofdermatology servicesCase-based discussionRole playLiterature review and critical appraisalHigh level cognitive processesSpecialist or guest speakerNZRC resuscitation course minimum level 5 andappropriate for practice environmentCMEProfessional development planCollegial support – case discussionAcademic output• Enhanced audit• Research• University paperMedical educator visitsNZRC resuscitation courseAudit projectProfessional development planMini CEXCollegial supporteLearning modulesPatient satisfaction surveySummative• GPEP written• GPEP clinical• Academic output10Dermatology

Year 3+ Learning experiences AssessmentClinicalEducationalAs for Year 2, plus:Training under vocational scopes – if applicableManagement of dermatology presentationslearning in:• Outpatient clinics• Community-based servicesWork with allied health professionals involvedin dermatology care:• Pharmacy• Public health nurses• Specialist dermatology nurses• Multidisciplinary team meetingsInvestigation of dermatological conditions• Dermatological skills• Outpatient services• One-on-one teaching• Departmental teaching• Journal clubs• Peer groupsMedical educator visitsAuditAcademic outputMini CEXLearning logSupervisor reportsMulti-source feedbackPrevious summative assessmentsif not completedFellowship assessmentwww.rnzcgp.org.nzDermatology11

DermatologyReferences/resources• Dermnet www.dermnetnz.org• Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology:Sixth Edition by Klaus Wolf and Richard Johnson, SkinCancer College of Australia and New Zealand www.sccanz.com.au• Melanoma guidelines www.melanoma.org.nz• Cancer Society and skin cancer www.cancernz.org.nz/reducing-your-cancer-risk/sunsmart/about-skin-cancer/skincancer-facts-and-figures12Dermatology

978-1-927240-09-0© The Royal New Zealand College of General Practitioners, New Zealand, 2012The Royal New Zealand College of General Practitioners owns the copyright of thiswork and has exclusive rights in accordance with the Copyright Act 1994.In particular, prior written permission must be obtained from the Royal NewZealand College of General Practitioners for others (including business entities) to:• copy the work• issue copies of the work, whether by sale or otherwise• show the work in public• make an adaptation of the work as defined in the Copyright Act 1994.December 2013