Navigating dermatology training in the United Kingdom

Sreedhar K Krishna¹ , Ankeet S Jethwa²

¹ Institute of Public Health, University of Cambridge, United Kingdom
² Faculty of Education, University Hospital of Leicester, United Kingdom

Correspondence Address:
Sreedhar K Krishna
Institute of Public Health, University of Cambridge, Robinson Way, Cambridge, CB2 0SR
United Kingdom

Sir,

While the breadth of skin pathology available in India is undoubtedly impressive, many Indian graduates are keen to pursue dermatology training opportunities abroad and often in the United Kingdom (UK). This short letter details the opportunities available and the seemingly confusing route that prospective applicants must navigate. It is currently an excellent time to consider dermatology training in the UK, as 102 of 525 consultant posts remain unfilled. The aging population of the UK is driving demand for dermatologists; between 2004 and 2009, the number of recorded consultant episodes in dermatology increased by 117%. An increase of this magnitude will undoubtedly lead to an increase in training posts within the field. While an excellent article was posted in this journal in 2004, the situation has since changed significantly, thus warranting an update. ^[1] In terms of key changes, there is now a new route to consultancy, which enables dermatologists trained abroad to practice as consultants with the UK. Furthermore, one may now access specialist training from Paediatric and Emergency Medicine backgrounds as well as General Medicine. The visa requirements for working in the UK, while constantly in flux, are detailed below. Finally, there a number of new dermatology courses available, which are briefly summarised as follows:

Dermatology Specialty Training

In order to operate independently as a Consultant Dermatologist within the UK, one requires a Certificate of Completion of Training (CCT). The path to securing the CCT is arduous and often lengthy. In order to obtain this certificate, doctors must complete 4 years of higher medical training (or whole-time equivalent) in an approved Specialist Trainee (ST3-6) post. Once this certificate is secured, the doctor is placed on the Specialist Register of the General Medical Council (GMC) and may apply for the Consultant posts [Figure - 1].

Figure 1: Conventional route to consultancy for the UK graduates

There is also a little known path to UK consultancy known as "entry onto the Specialist Register with a Certificate of Eligibility for Specialist Registration (CESR)." This pathway enables overseas graduates who have completed Dermatology training in their home countries to work as UK consultants. Broadly speaking, applicants are required to provide evidence (e.g., logbooks, portfolios, and assessment records) that their training has been equivalent to the standard of specialist training in the UK. This a complex route, and applicants interested in this path are advised to contact the corresponding author for a full breakdown of how this can be achieved.

Entry Requirements for Higher Medical Training

In order to be considered for Specialty Training, UK graduates are required to complete

• Two years of the Foundation Programme (a period of general training incorporating posts in medicine and surgery)

  And

• Two years of Core Medical Training, which includes at least 6 months of unselected medical admissions and b) Completed Membership of the Royal College of Physicians (MRCP) examination.

  Or

• a) Three years of Acute Care Common Stem (ACCS), which consists of 12 month posts in both acute medicine and emergency medicine as well as 12 months in anesthesia and intensive care medicine and b) Completed MRCP.

  Or

• a) Three years of Pediatric Training and b) Completed Membership of the Royal College of Physicians and Child Health (MRCPCH) examination.

Graduates who have undertaken their postgraduate training outside the UK are required to have completed 24 months in training posts and to have a completed copy of Certificate C. Certificate C is a document that must be completed by a senior clinician in the applicant′s place of work attesting that the applicant has reached the level of competence necessary to enter specialist training.

Acceptable Qualifications

MRCP is the preferred qualification for entering specialty training. The only equivalent exams that will be considered are as follows:

• MRCPI - Ireland
• MHKCP - Hong Kong
• MMed - Singapore

Non-Consultant Posts

Applicants who wish to work in non-consultant posts may consider the post of the Specialty Doctor. These doctors work as part of a consultant-led team, but are nonetheless a respected part of the team. For this, you will need to have completed at least 4 years of postgraduate training, including 2 years in Dermatology-this can be undertaken in India. There was previously an option to convert from Specialty Doctor to Associate Specialist (a post similar to that of Consultant), but this path is now closed.

Eligibility to Work in the UK

This is a fast-changing field and applicants are advised to be up-to-date with any changes at the UK Border Agency′s website (www.ukba.homeoffice.gov.uk).

Indian doctors wishing to work in the UK must now do so via the Tier 2 (General) category. This visa enables foreign nationals who have been offered a skilled job to fill a gap in the workforce. Gaining this visa requires the attainment of 70 points, with points being allocated for English language ability, the ability to support oneself in the UK, and sponsorship from the local education office.

Making Yourself Competitive

Dermatology is one of the most competitive specialties within the UK, and this is reflected in the competition ratios: 6.1 applicants per post in 2012. While this is fierce, a systematic approach to preparing for application increases the chances of success.

In order to secure an interview, applicants should demonstrate academic experience (e.g., teaching, audit, publications, and presentations), additional degrees (e.g., MSc/MD/PhD or additional undergraduate degrees) as well as evidence of high achievement-this can include prizes or honors awarded during medical training. The more points one secures, the better are the chances of securing the post.

Award-Bearing Courses in Dermatology

There are a number of award-bearing courses run in the UK, which may increase the chances of securing Specialist Training.

MSc (by Research), MPhil, PhD in Dermatology-University of Edinburgh

These research courses that take 1, 2, and 3 years of full-time study, respectively, are a useful adjunct to clinical training. The University of Edinburgh is well-established and focuses entirely on clinical and patient-orientated research. Completing these courses will likely result in the preparation of material that may be submitted for publications.

Web: http://www.ed.ac.uk/studying/postgraduate/degrees?id= 212 and cw_xml = details.php

Contact: Professor Jonathan Rees - jonathan.rees@ed.ac.uk

MSc in Clinical Dermatology-St. John′s Institute of Dermatology

This is a highly practical course in which students gain clinical skills and knowledge of the scientific basis of clinical dermatology. They develop practical training in laboratory sciences relevant to skin disease. St. John′s Institute of Dermatology is one of the leading Dermatology centres in Europe with a world-renowned faculty.

Web: http://www.kcl.ac.uk/prospectus/graduate/clinical-dermatology

Contact: Postgraduate Education Coordinator - derm- courses@kcl.ac.uk

MSc in Clinical Dermatology-Cardiff University

This 12-month course is designed to give a firm grounding in the fundamentals of modern British dermatology. It gives priority to clinical instruction, but also emphasises the basic science content of dermatology. Those who successfully complete the course may apply to the study for MPhil, MD, and PhD degrees at the same institution.

Web: http://www.dermatology.org.uk/courses/msc/msc-overview.html

Contact: Helpdesk - dermpostgrad@cardiff.ac.uk

MSc in Dermatology Skills and Treatment-University of ertfordshire

This innovative programme, which was developed in 2006, utilises a variety of teaching methods including seminars, group work, e-learning, and work-based learning. This culminates in a Health Disciplines Project in which students complete a small project, leading to the award of MSc.

Web: http://www.herts.ac.uk/courses/Dermatology- Skills-and-Treatment_details.cfm

Contact: Helpdesk - ask@herts.ac.uk

There are a variety of other dermatology qualifications available in the UK, which lead to the award of a Postgraduate Certificate (PG Cert) or Postgraduate Diploma (PG Dip). These lend little weight to job applications and, thus, should be avoided. Other courses that are available tend to focus on teaching dermatology to General Practitioners. These courses do not lend much to applications for Specialist Training.

Opportunities Elsewhere

Dermatology is a highly prized and competitive specialty throughout the world.

Australia

Training posts are only available to those with existing Australian residency status.

US

Dermatology has developed into the most competitive specialty within medicine. ^[2] Unfortunately, overseas graduates are very seldom successful in securing training posts.

Key points

• Demand for dermatologists is increasing and looks set to do so in the short- to mid-term.
• Around 20% of the UK consultant posts are unfilled.
• There are two routes to working as a Consultant Dermatologist in the UK. a) Dermatology Specialty Training in the UK or b) entry onto the Specialist Register with a Certificate of Eligibility for Specialist Registration (CESR)
• There are four routes to entry to Specialty Training-CMT, ACCS, and Paediatrics and Overseas Training (Certificate C). All require completion of either MRCP or an approved equivalent examination.
• Non-consultant posts are also available.
• The visa situation is constantly changing but the Tier 2 (General) is currently an option for Indian graduates.
• Competition for training posts is fierce, so one would be wise to build an impressive academic track record.

1.	Walton S, Finlay A. Dermatology training and career options in the U. K. for Indian graduates. Indian J Dermatol Venereol Leprol 2004;70:256-9. [Google Scholar]
2.	Wu JJ, Tyring SK. The academic strength of current dermatology residency applicants. Dermatol Online J 2003;9:22. [Google Scholar]