A clear decision in taking up Derma

The below post by Respected Anupam sir can help many to make a clear decision in taking up Derma…

LONG POST ALERT (for students who have taken up Dermatology)

Dear Students,

CONGRATULATIONS to all those who have landed up in the coolest clinical discipline, DERMATOLOGY. Trust me, 10 years down the lane, you will be amongst the happiest and most satisfied clinicians. This post is to prime you, to tell about the branch, to make you aware of some facts related to the branch and of course, to motivate you (as always).

Most of you have taken up Dermatology because it is being sold like HOT CAKE during counseling. Many of you have taken up this branch because you wanted a cool life, because you didn’t want phone calls (from patients) at 2am, because you didn’t want to appear for another entrance examination in future (fortunately DM hair and DM nail is non-existent, yet), and most importantly, because you wanted to earn optimum money. Well, let me tell you, all of your wishes and expectations are going to come true.

How to handle the first 12 months of your residency?

  1. Start from Day one : Unlike other clinical branches, Dermatology is a discipline where you do not have exposure during UG days. This is a branch which is allotted for clinical postings, hardly for 2 weeks in 6 months; and that period is considered as a “bunk posting”. As a result of this, you shall feel disoriented in a heavily busy dermatology OPD during the first few months of your residency (there is nothing to worry because this is an absolutely normal phenomenon). You will come across your senior PGs and faculties who are diagnosing a condition within 10 seconds and writing the prescription within a minute. This is bound to give you frustration and anxiety, but as a first yr PG, your job is to OBSERVE, OBSERVE and OBSERVE. You may or may not get a very friendly environment, but trust me, that does not matter when it comes to learning (if you have the passion to learn). Keep observing as to what your seniors are doing, when they are diagnosing a condition as X and when as Y. Do not feel hesitated or ashamed of yourself in asking questions (may be the silliest ones as well). They are bound to reply to your queries, if you keep showing interest.

  2. Learn your basics : Dermatology is a discipline which probably has the maximum number of fancy diagnoses, signs, triads, syndromes and rare entities. Do NOT run after them NOW. This is the time to master yourself in the basics of the subject. By basics, I mean morphology of lesions, and of course the common clinical conditions which is going to fetch you bread and butter in future. You must be thorough in how to describe a clinical lesion (just forget about the diagnosis NOW), because once you are able to describe the lesion perfectly, you can always go back to your book and correlate your description with clinical features of a condition. As of now, ignore “pathogenesis” of a disease, and focus on “clinical features” and “treatment” only.

  3. Acquire accessory skills : The most important thing to learn in Dermatology, is how to counsel your patients (I am still learning). Remember most of the diseases will be diagnosed by non-dermatologists, but then why would patients come to you? You have to deliver something extra, which others cannot. This is best learnt, from some of the seniors in the department. I am sure, there will be at least 1 or 2 nice souls in your new family.

  4. Do not sacrifice clinical learning : Let me make one thing very very clear. If you have joined Dermatology because you want to make people fairer and beautiful 10 years down the lane, this is not the suitable branch. Cosmetology and Aesthetic Dermatology is now blooming up, and that is absolutely fine. But if you have not mastered clinical dermatology perfectly, there is no difference between a technician in a beauty salon and you! Learn the basics (I repeat) and focus on Clinical Dermatology during the first year and later on, cosmetology will be easily learnt through workshops, CMEs, conferences etc. In this context, I must mention that the best patients are the ones in your IPD (In Patient Department), where you can observe the evolution of a disease, where you can examine the patients without any hurry and pressure, where you can closely observe as to how your seniors are managing the condition, how they are choosing a drug, how they are managing the adverse effects etc etc etc. Please give due importance to IPD posting, trust me you will learn the maximum from that posting only.

  5. Organize your study : Coming to business. You will come across plenty of new entities (including some tongue twisters like Angiokeratoma circumscriptum naeviforme and porokeratotic eccrine ostial and dermal duct nevus)…PHEW!! Chill…whenever, you come across something which you have never heard of, keep a note of the same in a pocket diary during OPD or IPD. Go back home and read that entity from a textbook (NO google or Wikipedia please, I have supreme DISGUST for such resources). The interesting thing is : during the first few days, everything is going to be Latin and French for you, but as days pass by, the list of things to be read will eventually become shorter J. Remember, I am not asking you to mug up the entire disease (pathogenesis, clinical features, differentials and management) on that day itself. I am just asking you to read the topic in the form of a pleasure reading!

  6. Learn from EVERYONE : Do not ignore or show disrespect to anyone in the department. Everyone may not be in a good mood or temper on a particular day. Try to learn whatever is possible from everyone.

  7. Do not let the thesis be a burden : Quoting my mentor “THESE IS LIKE IMPACTED FAECES”. DO not worry too much about this particular thing. You are not going to get a Nobel Prize for your thesis work But yes, you should be able to learn the basics of learning a research hypothesis, the nitty gritties of research methodology and how to conduct a research in future (if interested). When it comes to choosing a thesis topic, in most of the cases remember that your guide will provide you the same, and in case you are being asked to ponder on some of the topics, we shall discuss this later

Which books to read ?

  1. If you ask me, I shall recommend a BIG LIST of must read books. But for me, the terrific trio comprises of three books (Andrews’ Diseases of the Skin: Clinical Dermatology, Atlas and Synopsis of Lever’s Histopathology of the Skin and Manual of Dermatologic Therapeutics by Arndt)

  2. Besides, there are three other books (Rook’s textbook, Fitzpatrick Dermatology and Bolognia Textbook). You have to go through them (in library and/or e books) and know yourself, as to which book you are comfortable with. Personally, I am in favour of Bolognia Textbook

  3. There are some other books like Morschella for basics, IADVL textbook, Textbook for STD by Dr VK Sharma, Textbook for leprosy by Jopling and many more. You have to read all of them, but don’t rush now. Start with the basic “trio” and get deeper in subsequent months

  4. Our book “Case Based Reviews in Dermatology” will hit the market soon. This one is not a textbook, but it focuses on how to approach a patient

Publications : Why or why not?

Well, in my opinion, it is always good to have some publications in reputed journals at the end of your residency, because it serves plenty of purposes, important ones being :

  1. Mandatory for scientists or specialists holding academic affiliations : If you plan to join a teaching institute in future, publications are indispensable

  2. Application for scholarships and fellowships : Someone who has good publications will always have an extra edge over those who don’t have publications

  3. Serves the purpose of academic recognition : Who doesn’t want to be recognized among the peers and scientific fraternity, by virtue of good quality academic work?

What are the setbacks when it comes to writing and publishing? (We shall discuss this later, may be in near future)

  1. Lack of technical and writing skills : Start writing at least. Skills will follow you

  2. “Uncooperative” institution (non-modifiable problem) : I cannot help you on that, sorry

  3. Time constraints (are you that busy?) : Its good to be busy partying and enjoying, but I am sure you can take out time for some academically productive work as well

  4. Lack of ideas : Ask you seniors to provide you ideas

  5. Repeated failures : Not to worry, my first article was rejected by 4 journals, before it was accepted by one and published later

Miscellaneous resources (for learning)

  1. You can become a member (PLM) of our association (IADVL) for getting access to plenty of digital lecture series and many other interesting things

  2. Attend workshops, CMEs and conferences (once in a while) to learn from the experts

  3. Some facebook pages (shall tell you later)

  4. Follow the journals (IJDVL, IDOJ and IJD mostly; besides you can read review articles from JAAD)

I think this is enough to give you the “kick” to learn, to observe and to stay happy. We shall soon create a whatsapp group for ease of communication.

Welcome again to the most lovely discipline, Dermatology. I am always there with you (during your NEET PG preparation and after that). See you soon in one of the scientific meetings in near future.