DERMATOLOGY - UNDERREPRESENTED IN THE BRITISH MEDICAL SCHOOL CURRICULUM?

Dermatological issues comprise at least 10% of all attendances to a general practitioner in the United Kingdom. In view of this, one would assume that exposure to dermatology while an undergraduate would be uniformly compulsory and comprehensive. Instead, some medical schools have no compulsory dermatology component while others have only a nominal component.

At St. George's University London, while there are lectures focusing on skin disease, clinical exposure is limited to two clinics. This is deemed to be sufficient to meet the curriculum requirements set by the General Medical Council. Examination of knowledge is restricted to minimal questions set within a multiple choice question exam while there is partial assessment of clinical competence - as in the OSCE (Objective Structured Clinical Examination). This can mean that students can successfully graduate while potentially being incompetent at dermatological history-taking and clinical examination.

OSCEs have been shown to be a crucial and reliable form of assessment in order to display a candidate's ability to carry out safe clinical examinations in patients and therefore form a key element alongside the written components.

30 medical students from the penultimate and final year of the MBBS medicine course at St. George’s University of London were surveyed regarding their undergraduate exposure to dermatology throughout their medical school career. It was attempted to recruit students in an equal ratio between the penultimate and final year. The results showed that a significant number of medical students in both the penultimate and final year felt generally unconfident in managing common skin conditions. Furthermore, only one student reported receiving formal teaching in examining the skin. Overall the majority of final year students felt unconfident managing dematoses in their future clinical practice.

We suggest that practical training in dermatology should begin at an early stage in medical school, and that practical dermatological clinical examinations should be compulsory. It is paramount to implement the core skills required for a competent and confident diagnosis and management of dermatological problems leading to a better outcome for all patients and an effective use of limited resources.

In the long run, the early exposure to practical training could increase the efficiency and efficacy of the National Health Service, as it would lead to less referrals to a dermatologist. As Millers’ age-old pyramid of pedagogy shows, the apprentice will flourish as a clinician only if he ‘knows’ (factual knowledge) followed by ‘knows how’ (applying knowledge), ‘shows how’, and finally ‘does’.