Dermatology Clinical Posting: Life of a Year 3 Medical Student

We move on to Short Postings! These are two-week postings where we rotate in specialties that are distinct from Internal Medicine or Surgery.

👩🏻‍⚕️ What Dermatology Clinical Posting is Like

Dermatology, or more accurately, Dermatology and Venereology, is under the purview of the National Skin Centre (NSC) in Singapore.

Quick sidenote: One might not automatically associate sexually transmitted infections (STIs) (Venereology) with skin conditions (Dermatology). However they are often combined together, historically due to syphilis.

For our Dermatology posting, we had a combination of teachings, clinics, and one ward round (in which the doctors reviewed blue letters, or referrals from other specialties). Unlike in Internal Medicine and Surgery, there are generally no morning rounds for Dermatology.

The two weeks were quite fully packed with either a teaching or a clinic session in the morning and afternoon.

👍🏼 The Great Parts About Dermatology Posting

1. Seeing the clinical signs. Dermatology is an extremely visual specialty. I mean, you literally look at the skin and start formulating differential diagnoses. It’s quite intriguing to as you learn about all these conditions and start to develop a sense of pattern recognition. It’s almost like a completely different way of thinking. It’s quite intriguing.
2. Amazing prof who made Derm make sense. With the vast array of possible skin lesions and conditions, there initially seemed to be no systematic approach to uninitiated medical students like us. Until we attended a lecture midway through our Derm posting, and this prof was really engaging and also gave us systems to categorise and think through various Derm presentations. (Somehow, it’s always doctors and teachings like this that will pique your interest and inspire a passion for the subject.)
3. DSC Clinic. DSC stands for Department of STI Control. It was a privilege to have an attachment arranged for us at the DSC Clinic. What we learnt about STIs previously, we managed to see some of it with our own eyes. An example: I watched the nurse squirt liquid nitrogen to freeze a wart on the patient’s penis.

👎🏼 The Not-So-Great Parts About Dermatology Posting

1. Only common things appear in clinic. We sat in one clinic for a few hours and saw only atopic dermatitis (eczema) and a few insignificant spots on the skin. That’s all. The tons of other Derm conditions we need to know about may not walk into clinic on a daily basis. Luckily, in this day and age, we do have google images and clinical photographs from NSC. It’s just that clinics might not be that high-yield, and may start to feel mundane.
2. Mostly clinics. As with specialties like Ophthalmology and ENT, Derm is a clinic-based specialty. Hence our time not at teachings were mostly spent in clinics. If you love clinics, that’s great. Otherwise, it just means less variety during the posting.
3. Mind-boggling content. Derm is really an entire foreign language of its own. First off, you have conditions with names like pityriasis versicolor, erythema multiforme, and loads more. Then, you have to be able to accurately match these names to their appearance on the skin—many of which, by the way, can look similar. On top of that, you need to have some knowledge about each of these conditions (how the patient presents, how to manage them, etc).

📝 Impressions of Dermatology as a Specialty

#1 Mostly Fact: Dermatology is a ‘lifestyle’ specialty

As one of the ROAD specialties (namely, Radiology, Ophthalmology, Anaesthesiology, and Dermatology), Dermatology is often helmed as a ‘lifestyle’ specialty. This might not be far from the truth, as the work is closer to a nine-to-five job than other medical specialties, and there are relatively few emergencies in Derm.

#2 Mostly Fact: Dermatology is competitive

Perhaps due to its reputation as a ‘lifestyle’ specialty, Derm is highly competitive and sought-after. This is also the case with specialties like Ophthalmology and ENT.

#3 Mostly Myth: Dermatology has no procedural or surgical aspect

While some may view Derm as a medical specialty, Derm actually does involve procedures and even surgeries as part of their diagnostic and therapeutic repertoire. For instance, a skin biopsy can diagnose conditions like skin tumours. Viral warts can be removed by excision, electrocautery, or carbon dioxide laser. Mohs micrographic surgery is used to shave off skin tumours.

TWO Examples of Something You Might See in Dermatology

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