PS30 From episodic training to structured pathways: a proposal for cross-college recognition of psychodermatology

Abstract

Despite well-established psychiatric comorbidity in dermatology patients, the referral gap persists. Commissioning, funding and patient stigma present systemic challenges. However, clinician training deficits represent a modifiable obstacle within our control. We aimed to evaluate UK psychodermatology service provision and training pathways, and propose how royal colleges can create structured routes for interested trainees. We carried out a targeted review of UK service audits (2013–2021), royal college curricula and literature (2020–2025). The 2019 BAD audit found that only 24% of dermatologists have access to psychodermatology services (4.8% paediatric). Thirteen clinics exist: 10 in England, 2 in Scotland, 1 in Northern Ireland and none in Wales. The 2020 All-Party Parliamentary Group survey (n = 544) found that 98% of patients reported emotional impact, yet only 18% sought help and over half were unaware services existed. Multiple training opportunities exist: Psychodermatology UK courses, BAD meetings, European diplomas, NHS e-Learning and Barts fellowships. Yet a 2022 survey of 79 dermatologists found 90% lacked confidence prescribing antipsychotics for delusional infestation. Knowledge is not translating into competence. The critical gap is that all training is episodic. Each college recognizes psychodermatology independently (BAD curricula outline specific competencies, liaison psychiatry addresses psychiatric presentations in medical settings) but no cross-college framework exists for joint training. Dermatology trainees learn isolated from psychiatry; liaison trainees have no structured dermatology exposure. Between introductory courses and competitive post-CCT fellowships, no supported pathway exists. Weekend courses build knowledge, but not always clinical competence. We propose: (i) the Royal College of Psychiatrists and BAD jointly recognize psychodermatology as a supported special interest with cross-­disciplinary competencies; (ii) college-endorsed clinical attachments using existing special interest sessions, or dedicated rotations, with portfolio recognition; (iii) mentorship networks and (iv) embedded liaison psychiatry in dermatology departments. Royal college collaboration is required to transform psychodermatology from parallel pursuits into an integrated pathway.