BT07 A novel ‘super clinic’ model for registrar training in Advice and Guidance

Abstract Since June 2022, all referrals from primary care to our department have been streamlined through an ‘Advice and Refer’ pathway. In 2024, 49% (n = 5288) of Advice and Guidance (A&G) referrals were returned with advice for management in primary care, thus ensuring patients receive care in the right setting. Similar reforms are occurring nationwide, leading to a rise in A&G referrals and necessitating resource reorganization for timely responses. The dermatology training curriculum was updated to ensure trainees have sufficient teledermatology exposure for independent practice. However, a nationwide survey of dermatology trainees in the UK has revealed ongoing deficiencies in teledermatology education. We aimed to tackle this challenge by introducing a novel ‘teledermatology super clinic’ scheduled once weekly for 3 h. Each session was set up in an outpatient clinic room, supervised by one consultant and attended by three trainees. Trainees were provided with Trust laptops, all connected to one large monitor through a multiway adapter. Trainees reviewed A&G referrals, and displayed and discussed the cases and their responses on the larger monitor screen with the supervising consultant before submission. Crucially, interesting cases or learning points were discussed as a group, fostering peer learning and engagement. Over a 6-month period (February to July 2024), three registrars and one supervising consultant responded to 810 A&G referrals, which accounted for 15% of the department’s total A&G activity in that time period. Most requests were for lesions (47%, n = 380) and inflammatory conditions (44%, n = 360). Other referrals included hair and nail presentations (n = 54), genital and mucosal presentations (n = 6), cutaneous allergy (n = 9) and photobiology (n = 1). This highlights exposure to all specialist aspects of a comprehensive dermatology service, as required for Specialty Capabilities in Practice as part of the 2021 dermatology training curriculum. Each trainee handled an average of 19 referrals every session. Overall, 48% (n = 388) of referrals were returned with advice for management in primary care, aligning with the department’s average. A survey of attendees revealed that since the introduction of these clinics, all trainees felt confident or highly confident in formulating A&G responses. This novel teledermatology super clinic has now been integrated into registrar training within the department. These clinics are also conducted virtually (via Microsoft Teams) to enable further utilization of extended clinic times, for example on weekends, acting as a key strategy to reduce departmental backlog. This innovative clinic enhances trainee confidence in managing A&G referrals and has significantly reduced waiting times for responses in our department.