PA05 Paediatric dermatology training experience and career intentions: a survey of UK dermatology trainees
Authors: Stokes Natalie King , Ravenscroft Jane , Cartledge Natalia , McPherson Tess , Solman Lea 
Published: June 2024

Abstract
Improving access to paediatric dermatology services was a key recommendation in the ‘Getting It Right First Time’ Dermatology Report (2021). All UK dermatologists train in paediatric dermatology; however, there is a shortage of dermatologists providing specialist care, despite a high level of demand. This study aimed to explore the extent and level of paediatric dermatology training received by dermatology trainees and to explore their career intentions. Current UK dermatology trainees and Certificate of Eligibility for Specialist Registration (CESR) candidates were eligible to participate. A survey was distributed using Microsoft Forms via dermatology trainee representatives and the British Association of Dermatologists newsletter. The survey remained open for 4 weeks. There were 72 responses, from 55 trainees (response rate 19%) and 17 CESR candidates. In total, 53% of respondents had completed, or expected to complete, a dedicated paediatric dermatology rotation during their training. Around three-quarters (74%) had, or expected to gain, tertiary care experience. Most (97%) had, or expected to gain, on-call experience managing paediatric patients. Overall, 78% had received local paediatric dermatology teaching. When asked about confidence in diagnosing and managing paediatric presentations, most were ‘very confident’ managing eczema (65%), acne (61%) and psoriasis (50%). Most respondents were ‘not at all confident’ managing malignant or infiltrative disease (28%), serious neonatal presentations (24%) and genodermatoses (19%). Low confidence was reported in aspects of paediatric care: recognition of developmental delay (63%), recognition of abuse or neglect (36%) and systemic physical examination (36%). Most (90)% felt that curriculum ‘Capabilities in Practice’ were achievable within their training programme. Only 13% of final-year trainees felt ‘very confident’ managing paediatric patients once they completed training, while 75% felt ‘quite confident’ and 13% ‘not very confident’. When asked about career intentions, 35% of respondents planned to incorporate paediatric dermatology clinics into their consultant job plan, while 43% were unsure. Reasons for not wanting to continue paediatric dermatology included other subspecialty interests and lack of experience. In total, 14% planned to do a post-CCT fellowship in paediatric dermatology, with 25% unsure. Location and salary were highlighted as key barriers to accessing fellowships. Study limitations include potential sampling bias, with trainees interested in paediatric dermatology more likely to participate. This may explain the relatively high percentage of respondents planning a post-CCT fellowship, compared with low uptake previously. Despite this, there is still a low proportion of trainees planning to practise paediatric dermatology. Improvements to training could include widening access to specialist centres and more regular exposure to paediatric patients throughout programmes. However, many trainees simply have other interests, highlighting the need to encourage further dermatology training among paediatricians to collectively address the concerning gaps in paediatric dermatology care.