PS17 From hesitation to holistic practice: how psychodermatology clinics build confidence in dermatology registrars

Abstract

Overall, 98% of patients with skin disease report experiencing psychological distress. Competence in psychodermatology is therefore essential to provide holistic care, yet structured exposure within UK dermatology specialty training remains limited. While international literature highlights training gaps and limited physician confidence as barriers to providing effective care, UK trainee-focused evaluations are scarce. We sought to evaluate the educational impact of dermatology registrars co-consulting with a psychologist in multidisciplinary psychodermatology clinics on their confidence and enthusiasm in managing psychocutaneous disease. A mixed-methods service evaluation was conducted. All dermatology registrars co-consulting in the multidisciplinary team clinic completed pre- and postclinic questionnaires rating confidence and enthusiasm on a 0–10 Likert scale, and provided reflective comments. Diagnosis, management outcomes, psychological involvement, follow-up and additional consultant input were recorded. Quantitative data were analysed descriptively, and qualitative responses reviewed thematically. All five registrars completed paired questionnaires. Mean confidence increased from 3.2/10 to 7.4/10, and enthusiasm from 5.4/10 to 8.4/10. Qualitative feedback indicated a greater understanding of psychodermatological presentations and an appreciation of joint consultations with psychology colleagues. Seventy-four patients with a range of presentations were reviewed, including delusional infestation, eczema, contact dermatitis, lichen planus and medically unexplained symptoms. Over 40% were referred for further psychological input; others received structured management advice or onward mental health referral. Only 6% of patients required a consultant’s second opinion. Registrars valued the breadth of cases in developing diagnostic confidence, communication skills and holistic management, and reported learning much more about psychological approaches. Co-consulting psychodermatology clinics enhance registrars’ confidence and enthusiasm. This model fosters holistic care, effective multidisciplinary collaboration and improved management of psychological comorbidity. Given limited psychodermatology exposure in many UK specialty training programmes, structured registrar involvement in such clinics offers a practical route to strengthen trainee competence and enhance patient-­centred care.