Hospital Dr News

Dermatologists say ‘no’ to general medicine

Trainee dermatologists are warning that any plans to make them work on-call in general medicine will put patient safety at risk.

This is the key finding of a survey released this week at the British Association of Dermatologists’ Annual Conference in Glasgow.

The survey shows that 82% of dermatology trainees are strongly opposed to such reforms.

Specialists in general internal medicine (GIM) care for a wide variety of patients who may be suffering from any number of common disorders, may have multiple conditions or complex needs or may represent a diagnostic conundrum.

These doctors have a continuing responsibility for hospital inpatients who are not being cared for in the acute medical unit.

The NHS is faced with a range of problems, including the rising tide of acute admissions, patients with increasingly complex illnesses and a medical workforce crisis. The Future Hospital Commission was established by the Royal College of Physicians to find solutions to the current challenges.

In September 2013, the Commission recommended training in general internal medicine to be mandatory for all doctors training in medical specialties.

This survey of trainee dermatologists across the UK, conducted by doctors at Norfolk and Norwich University Hospital, reveals that 82% are strongly opposed to the inclusion of general medical on-call for dermatology trainees, and 80% strongly disagree that participation in a general medical on-call rota would be beneficial for the development of dermatology-specific skills.

Patient safety was a frequently raised concern. Particular worries included performing unsupervised procedures that are not regularly done by dermatology trainees, including placing central lines, inserting chest drains and temporary cardiac pacing.

Dr Nick Levell, one of the study’s authors, said: “The results of this survey indicate that the majority of dermatology trainees are opposed to the inclusion of general medical on-call.

“The GMC states that doctors must put patients’ safety first and make sure that the care they provide is safe and effective. Patient safety must be taken into account when considering the inclusion of general medical on-call for dermatology trainees.”

Professor Chris Bunker, president of the British Association of Dermatologists, said: “This study highlights a major flaw in the agenda to make participation in general medicine mandatory for those training in all medical specialties. The trainees who would be tasked with the work have stated that they do not feel it is safe for them to do so.

“We recognise the crisis facing hospital services generally. However a viable solution should not be one that undermines the work of individual departments. Also, it is imperative that training the right number of specialists with the right skills in the right place is a protected priority, and that the effectiveness of this training is not diluted to fight fires in other areas of hospital services.

“In many specialties like ours, trainees provide a large part of the service. Forcing dermatology and other specialty trainees to fill the gaps in general medicine denies specialist patients the care they require. Furthermore, these trainees may not have maintained the required level of skills to serve the needs of general medical patients. This practice is not just harmful to specialty training and patient care in dermatology, but it’s also likely to have minimal impact on the crisis in the acute setting.”

Sir Bruce Keogh is also currently exploring how to offer 24/7 services in acute hospitals, which will increase the demand for general medicine skills.

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