BT23: The impact of the COVID-19 pandemic and use of teledermatology in specialty training: experience at two UK dermatology training centres

Jasmine Mann, Elisabetta Muttoni and Maulina Sharma

University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK

The COVID-19 pandemic resulted in significant changes within dermatology departments across the UK. Specialty trainees were redeployed, face-to-face clinics cancelled and services reduced, with a shift towards remote consultations. Specialty dermatology training was affected, where UK trainees found a lack of face-to-face clinical experience, reduced opportunities for learning, and a lack of support and resources to facilitate virtual clinics (Kumari R, Griffiths T, Murphy R. The impact of COVID-19 on dermatology trainees in the UK: lessons from a national survey. Br J Dermatol 2020; 183(Suppl. 1): 201–2). During the pandemic, use of teledermatology gained considerable advancement for the triage and management of dermatology patients. This has been reflected in the updated UK dermatology postgraduate curriculum, to equip the trainee dermatologist with the skills to deliver digital patient care safely and effectively (https://www.jrcptb.org.uk/sites/default/files/Dermatology%20curriculum%2023.3.20.pdf). We performed a survey at the two UK dermatology training centres of trainees who were working during the pandemic, to evaluate their experience of teledermatology training. Prior to the COVID-19 pandemic, 80% of trainees were not confident in giving advice based on photos. Sixty per cent were using photo triaging less than once a month, and 20% had never used photo triaging before. No trainees had received formal teaching on photo triaging prior to or during the pandemic. At the two training centres, there had been minimal use of teledermatology, both for inpatients and outpatients. To support adult and paediatric dermatology patients during the pandemic, a new advice and guidance (A&G) and consultant connect service was introduced. A photo-triaging protocol was prepared for inpatient dermatological emergency care and for on-call referrals from primary and secondary care clinicians. In the absence of formal training courses, the dermatology consultant body held sessions locally to educate trainees on the use of A&G and consultant connect platforms. Trainees gained experience with photo triaging for diagnostic and management queries, with availability of ‘hot slots’ in clinics to see acutely ill patients face to face. Following the consultant-led training sessions, 100% of trainees found the A&G teaching helpful, with a ‘good clinical insight in how to approach advice and guidance’. Eighty per cent of trainees felt confident in providing advice based on photo triaging and recommended teaching on teledermatology services. Seventy per cent of trainees felt they would benefit from a combination of a formal course, scheduled local teaching and supervised A&G clinics to develop the required skills and gain experience. With reduced face-to-face contact and a shift towards remote consultations, it is imperative to prepare dermatology trainees to use teledermatology platforms for their future careers. We recommend departments implement supervised teledermatology clinics and provide local teaching on A&G to facilitate postgraduate specialty training.