Best-practice dermatology treatment and training

North Queenslanders enjoy blue skies and sunshine 300 days a year, with stunning coastlines and countryside, so it is no surprise that this tropical paradise is also the melanoma capital of the world. Despite the exceedingly high rates of melanoma, and a health service catchment of over 200,000 people, there remains very limited access to dermatology services.

The workforce maldistribution crisis in rural and regional Australia, with limited access to specialist services, reflects a global phenomenon of smaller cities and towns facing the burden of healthcare worker shortages and limited access to training and upskilling. The Australasian College of Dermatology (ACD) is committed to addressing these workforce shortages. Through the Flexible Approach to Training in Expanded Settings (FATES) national funding program, the ACD is supporting a collaboration between the Sydney-based Melanoma Institute Australia (MIA) and the dermatology department at Townsville University Hospital (TUH), to evaluate a model for regional dermatology training and the implementation of a high-risk melanoma clinic.

Limited access to dermatology services in North Queensland often means patients must travel large distances – sometimes over 1300 kilometres – to a major city. This results in significant disruption to family life and work commitments and losses in productivity, or they face extended waits to access essential dermatological care. The increased training opportunities, with two registrar positions at the Townsville Hospital and Health Service, have improved clinic capacities and timely access to care.

Supervision of the dermatology trainees is being supported through access to onsite consultants, visiting medical officers and virtual supervision from an offsite Far North Queensland based dermatologist. North Queensland dermatology staff will also have access to a weekly real-time virtual education program delivered by a multidisciplinary team at MIA.

This project also evaluates the implementation of the first dermatologist-led melanoma diagnostic service in regional North Queensland. Dermatologists have been shown to reduce the morbidity and mortality associated with melanoma through improved diagnostic accuracy and management. It is the aim of this clinic to improve health outcomes of people living in North Queensland by utilising best-practice policies and procedures, and advanced specialist equipment including sequential dermoscopic imaging, tailored surveillance periods, reflectance confocal microscopy and total body photography. Access to the latest technology, education platform, case discussion and model of supervision is an exclusive opportunity for training and upskilling in a regional area.

Adequate dermatology services are essential to enhance the health of rural and regional Queenslanders. However, junior doctors are often required to relocate from their homes and families in regional areas to pursue specialist training. This research evaluates the implementation of service provision to develop a cost-effective and sustainable model that can be replicated in other regional hubs and will support trainees – the future dermatologist workforce in these regions.

This best-practice clinic, with the most-modern equipment, will be at the forefront of melanoma management in the high-risk region where it is most needed. The collaboration between MIA and the TUH dermatology department is expected to translate into economic, social and cultural benefits that ensure the quality of care that all Australians deserve.