Student Misdiagnosis of Dermatologic Disorders More Common for Skin of Color

Medical students more frequently misdiagnosed dermatologic disorders in patients with skin of color compared with lighter skin phototypes, according to survey data published in the Journal of the American Academy of Dermatology,

Students at Tulane University School of Medicine and the University of Oklahoma’s College of Medicine were recruited for participation in a 10-item multiple choice quiz. The quiz comprised a series of photos with brief descriptions, for which students were asked to select the most likely skin disorder. The percentage of correctly diagnosed disorders was calculated for 2 categories: patients with Fitzpatrick I-III skin phototypes and patients with Fitzpatrick IV-VI skin phototypes (“skin of color”). Trends in quiz performance were also calculated for specific dermatologic disorders.

A total of 177 students completed the quiz. Among preclinical medical students (years 1-2), mean score was 47.3%; among clinical medical students, mean score was 62.0% (P <.00001). Across all skin phototypes, the disorders most often correctly diagnosed were herpes zoster (83.1%), psoriasis (81.9%), and atopic dermatitis (80.2%). The most commonly missed disorders were verruca vulgaris, contact dermatitis, and squamous cell carcinoma, which were correctly identified just 26.6%, 30.5%, and 30.5% of the time, respectively.  The greatest disparities in diagnosis for Fitzpatrick IV-VI and Fitzpatrick I-III phototypes were observed for squamous cell carcinoma (14.9% vs 45.6%; P <.0001), urticaria (57.5% vs 82.2%; P =.0003), and atopic dermatitis (74.4% vs 86.2%; P =.0495). Approximately 34% of students misdiagnosed squamous cell carcinoma as melanoma in skin of color; this trend likely reflects a “reliance on dark pigment alone as the [primary] feature of melanoma.” Students were more likely to correctly identify tinea versicolor in patients with skin of color than in patients with lighter skin phototypes (62.1% vs 42.4%; P =.0082).

Significant rates of nonresponse among students may affect the validity of these data, investigators wrote; results should be extrapolated with care. However, participant quiz performance suggests significant disparities in diagnostic accuracy across patients of different skin phenotypes. Investigators thus endorsed training programs that present dermatologic data for all skin types.

Reference

Fenton A1, Elliott E, Shahbandi A, et al. Medical students’ ability to diagnose common dermatologic conditions in skin of color [published online February 1, 2020]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2019.12.078