DE03 Toxic competition and dreams of unicorns: Reddit analysis of medical student and junior doctor perceptions of dermatology careers
Authors: Rosa Kamkar, Rosie McMahon, Oluwagbemisoke Adegboye, Cleone Riad, Jonathan Guckian
Journal: British Journal of Dermatology (2024)

Abstract In 2019, The All Party Parliamentary Group on Skin reported a nationwide shortage of dermatologists, calling for sustainable increased recruitment across the medical career spectrum. While dermatology applications remain highly oversubscribed, the impacts of competition, variable learner experience and working pressures on dermatology career perceptions are underexamined. A recent review identified limited research on worldwide dermatology career perspectives among medical students, warning about frequent stereotypes and numerous perceived barriers to access dermatology. Social media offers a unique window into medical discourse, with UK medical student and doctor Reddit pages featuring over 40 000 members and facilitating anonymous debate within communities of practice. For this study, data collection was undertaken directly on Reddit. Three subreddits were included due to relevance and popularity: r/medicalschooluk, r/juniordoctorsuk and r/doctorsuk. The search terms ‘dermatology’ and ‘derm’ were used to identify posts. Posts since 1 January 2018 were included to ensure applicability. Search results were organized based on relevance, and an initial screen was undertaken by the authors. Posts were excluded if they did not directly refer to dermatology as a specialty. Posts and all associated comments were downloaded via NVivo (QSR International, Doncaster, Australia) as PDF files for analysis. Reflexive thematic analysis was undertaken through inductive coding. The authors discussed relationships between data to generate themes collaboratively. The results included 65 posts and 1086 comments. Five themes were derived. Reddit users who posted on these subreddits experienced hopelessness, relating to lack of training numbers, sometimes ‘begging’ for posts, and held concerns regarding the role of specialist nurse-led services. Toxic competition was prevalent as users debated early-career experience, ranking, and the ‘injustice’ of lack of medical school exposure. A theme of gamification of systems manifested as aspiring dermatologists mapped routes to training while investing significant resources. Practical collaboration occurred as users interacted as a community to support each other to provide role models and identify opportunities. Dermatology was identified as a unicorn specialty, being perceived to stand out, featuring attractions such as positive work–life balance and financial benefits in private practice. In conclusion, this novel Reddit analysis has painted a unique picture of how aspiring dermatologists view their future careers. The findings challenge existing evidence on dermatology career stereotypes, instead placing competition and prestige at the heart of the applicant experience. Consistently negative language and hopelessness point to a potential wellbeing crisis among applicants. Social media platforms such as Reddit foster collaboration among aspiring dermatologists and also offer opportunities to dermatology educators in research and engaging with students and doctors.