Understanding the Factors Associated with US Dermatology Resident Trainees' Diagnostic Confidence and Skill for Skin of Color Pathology
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Keywords
skin of color, dermatology education, resident education, disparities in skin cancer
Abstract
Background: Inequities in dermatologic health outcomes translate to worsened clinical outcomes for minority groups. For example, despite a lower incidence of skin cancer overall, African Americans are diagnosed at later stages with greater degrees of lymph node involvement. This has been shown to lead to disproportionate mortality when compared to lighter skinned individuals. Medical education materials contain a significantly lower percentage of skin of color (SOC) images than of lighter skin and research has indicated lower diagnostic accuracy of dermatologic conditions in darker skin by U.S. medical students. The objective of this study was to explore U.S. resident dermatologists’ ability to accurately identify skin pathology among SOC patients verus lighter skin to potentially identify gaps in training that may contribute to this disproportionate morbidity and mortality.
Methods: A cross-sectional electronic REDCap survey open to all U.S. dermatology residents asked participants their basic demographics (e.g., level of training, racial and ethnic identity) and program characteristics (e.g., geographical location, proportion of patients by Fitzpatrick type, presence of a dedicated SOC clinic). This data was correlated with participant visual diagnostic accuracy on a 22-item multiple choice quiz (images selected by a senior academic dermatologist) of characteristic nonmalignant and malignant conditions in lighter skin and SOC.
Results: Residents preferentially misdiagnosed malignant lesions in SOC over lighter skin (p <.0001) and preferentially misdiagnosed malignant lesions in SOC over nonmalignant lesions in SOC (p <.001). None of the residents’ basic demographic or program characteristic variables had significant relationships with any assessment of performance.
Conclusion: Dermatologists should maintain a high clinical suspicion for malignant conditions in patients with darker skin types, given that these lesions are the most preferentially misdiagnosed and the fact that these lesions carry higher risks for morbidity and mortality. Dermatology residency programs should instill efforts to emphasize correct detection of malignant lesions amongst those with skin of color.
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Kaylin Beiter, LSUHSC School of Medicine
Kaylin is an M.D., Ph.D. student at Louisiana State Univeristy Health Sciences Cetner School of Medicine who has successfully recieved her Ph.D. in Public Health. She will be graduating in May 2025 from the Medicine program and will then begin her residency.
Deborah Hilton , LSUHSC School of Medicine Department of Dermatology
Dr. Deborah HIlton is a faculty member of the Department of Dermatology at LSU School of Medicine. She serves as the residency site director at University Medical Center in New Orleans. She also treats patients at her private pratice.