The advantage of heading to the west coast of america is that 7am starts can be met with bright eyes and a bushy tail

Travelling Fellowship Report

Andrew Birnie (who is very grateful for the generous funding provided by the BSDS)
The advantage of heading to the west coast of America is that 7am starts can be met with bright
eyes and a bushy tail. Which was fortunate, as that is the time that activities commenced on Dr
Hugh Greenway’s Superficial Anatomy and Cutaneous Surgery Course. This is an intensive blast
through all things dermatological surgery, with some cosmetic procedures thrown in for good
measure. My second week in California was spent in UC Irvine’s Department of Dermatology,
headed up by Chris Zachary (see Dr Hann’s report in the January 2009 newsletter), which was a
great taste of dermatology practice in the States.
First up was a highlight, the best anatomy lecture I have ever heard by Eric Breisch; who spent
an hour talking through the important structures of the head and neck and relating it perfectly to
the practice of dermatological surgery. This was later backed up by a fantastic prosection
demonstration in the labs – so good in fact I sneaked in for a repeat performance later in the
week. The course is incredibly comprehensive, covering the basics that one ought to be aware of
when just starting out in derm surgery and then moving on to complex flaps that one can aspire to
(or on occasion just sit back and marvel at, safe in the knowledge that you will under no
circumstances attempt them).
One of the privileges of attending international meetings is the wide range of people you meet. I
enjoyed spending time with a group of residents from Michigan who, amongst others, comprised
a Mormon, with a far greater interest and knowledge of the English Premier League than me, and
a staunch Republican who had spent many years in Iraq with the military prior to commencing his
dermatology training. Inevitably, with Obama currently trying to reform US healthcare, I was often
quizzed as to the state of the NHS and my opinions of the US situation. I very quickly learnt to be
diplomatic as it was often difficult to ascertain the, often polarised, political viewpoint of the
We Europeans like to stick together and I also socialised with the relatively large Dutch
contingent. I spent the Friday evening at the end of the course with them at Mission Beach, a laid
back place with a great beach and Mojitos, plus the tastiest and most expensive burger I have
ever encountered!
A number of the residents from UC Irvine were on the course, so I knew a few people when I
started at the Dermatology clinic. I was made very welcome and encouraged to immerse myself
in all that was going on. Irvine is a wealthy town in Orange County, so the population may be a
little skewed, but I was amazed at the willingness of the patients (both male and female) to
embrace cosmetic dermatology and the amount they were prepared to pay! Whilst I was there
there was a teaching session for the residents on cosmetic procedures. This occurs monthly and
willing volunteers from the university are practised on for free. This week it was chemical peels
and following this and observing them taking place during the week and on the course I would
say that I would feel confident undertaking them.
Lasers comprised a large part of Dr Zachary’s practice and I observed the Erb-YAG, KTP, both
Fraxel lasers and IPL, plus Botox and fillers. I also observed other attendings (consultants), a
highlight was seeing a series of infants treated successfully with propranolol for infantile
haemangioma, and their “Grand Rounds.”
To conclude, they say that change is as good as a rest and I can endorse this as, despite the
long hours, long commutes on the freeway and jet lag, I returned home feeling mentally refreshed
and invigorated! I would certainly recommend combining a visit to the San Diego course with a
visit to a dermatology department as this provides a great insight into the lives and practice of US
dermatologists and I am certain that you would bring some knowledge and enthusiasm back
home, too!


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