Leaders in Medical Education

Dr. Amanda Oakley, DermNet NZ

Osmosis Team
Jun 25, 2014

Dr. Amanda Oakley is the editor in chief of the New Zealand Dermatological Society's website, DermNet NZ. She has served as president of the New Zealand Dermatological Society Incorporated (2011-2013) and of the Australian and New Zealand Vulvovaginal Society (2011-2013). We were delighted to speak with her about her expertise in open source learning and her experience with online medical education.

How did you decide on a career in medicine?

I was brought up in England, where medicine is an undergraduate degree. Like many teenagers, I wasn’t at all sure what I should study. As several members of the family were doctors, medicine was on the list of possible choices, but entry requirements were very tough. Once offered a place at highly competitive Bristol University, I thought it was best to take it, thinking it would be easier to drop out than to ‘drop in’. Within a few weeks of starting at Bristol, I was hooked.

What made you pick dermatology as your specialty?

I first thought of dermatology while on my final-year medical school elective, which allowed me to spend 3 months in Trinidad and Tobago. I was impressed and fascinated by the variety and interest of cases in the outpatient clinic, and the dedication of the dermatologist.  Many inflammatory dermatoses I saw were quite beautiful! Dermatology was not going to be boring. I would be exposed to young and old, healthy and sick, surgery and medicine.  I liked books – you have to enjoy the academic side of medicine to survive the rigours of learning the particular characteristics of the thousands of disorders that dermatology encompasses.

And a few years later, as a medical registrar at Waikato Hospital in New Zealand, I concluded that the sharp-edge of acute internal medicine was not for me – too scary! In dermatology, I could take my time to research and plan management for my patient. If I chose the wrong treatment at first, I would have the opportunity to make that right later – a luxury in acute medical specialties.

I am very interested in your roles as managing editor for Medscape Reference Dermatology and chief editor for DermNet New Zealand. How did you become interested in open source learning? 

When I bought my first word processing computer, an Amstrad 256 (1985), I used it to write information pages for my patients and added these to others a senior colleague had prepared for our hospital clinic. When introduced to the Internet and the World Wide Web a decade later, it seemed right to offer these resources to my colleagues’ patients as well as my own. We thought of DermNet NZ as a public library – one that could be accessed anywhere, at any time, by anybody, with any skin condition.

Rapid increase in visitor numbers from all over the world was quite a surprise. I began to realise that dermatologists, primary care physicians and other health professionals were also hungry for authoritative unbiased information they could find quickly, easily and without barriers to access. These groups have been loyal to DermNet NZ.  We have worked hard to expand and update the resource. The work is on-going.

When Dr William James approached me to contribute to eMedicine dermatology (now known as Medscape Reference), I jumped at the chance. It’s a wonderful in-depth resource for dermatologists, and has gone from strength to strength justifying its ambitious aims.


How do you incorporate online medical resources into your own practice?

It’s incredible to think how medical practice has changed since I graduated from Bristol in 1979! I never imagined that I would be holding digital workshops in 2014, interacting with students based thousands of miles away. I can do this using a whiteboard that allows me to display, draw on and erase slides, and at the same time open up web pages hosted anywhere in the world to play movies.

I have been “paper-light” in my private office at Tristram Clinic since 1991. Last year, the dermatology clinic at Waikato Hospital took the same step. No paper records – just electronic progress notes, lab records, formal documents and images.  We can access these on desktop or laptop computers, wherever we are based in the world. We still have to sign prescriptions and lab forms, but both of those are moving to an electronic format soon.

External online resources are essential – I usually have 10 or so browser windows open during a hospital clinic: hospital intranet, directory, webmail, patient tracking board, teledermatology portal, clinical image database, drug resources (Medsafe, Mims Online, PHARMAC, National Formulary, Special Authority page), PubMed and of course, DermNetNZ.org.

Then, there are the apps on my Smartphone: BMI, SCORAD, PASI, PEST and melanoma outcome calculators, drug interactions, PicSafe Medi, messaging and more.

What changes do you think need to be made to bridge the gap between technology and medical education?

Medical education is rapidly embracing technology, at least it is in New Zealand. Staff and students at Auckland University access their teaching and learning materials online. Tutorials are delivered synchronously at all campuses using video conferencing and webinars. Smart simulation devices enable rapid development of skills.  Online resources reduce the need to buy expensive textbooks.

Today’s students are highly privileged compared to generations past – but expectations for performance rise in parallel. Barriers to access for students based in remote locations or with disabilities are disappearing, as ultrafast fibre is installed in remote locations. Costs of hardware and data are reducing. Bring it on!

Every few weeks there appears to be a new report discussing burnout rates of physicians and the fact that many would decide not to pursue medicine if given the chance. Do you have any advice for current medical students about avoiding burnout?

Love what you do. Choose dermatology!