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Original Investigation
January 6, 2021

Dermoscopy Proficiency Expectations for US Dermatology Resident Physicians: Results of a Modified Delphi Survey of Pigmented Lesion Experts

Author Affiliations
  • 1The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
  • 2Department of Dermatology and Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
  • 3Department of Dermatology, University Hospital Zurich, Zürich, Switzerland
  • 4The Skin Cancer Institute-University of Arizona Cancer Center, Tucson
  • 5Division of Dermatology at the University of Arizona College of Medicine, Tucson
  • 6Department of Dermatology, University of Utah School of Medicine, Salt Lake City
  • 7Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
  • 8Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
  • 9Melanoma Program, Dana-Farber Cancer Institute, Boston, Massachusetts
  • 10VA Integrated Service Network (VISN-1), Jamaica Plain, Massachusetts
  • 11Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, and Sylvester Comprehensive Cancer Center, University of Miami, Florida
  • 12Department of Dermatology, Brown Medical School, Providence, Rhode Island
  • 13Melanoma and Pigmented Lesion Program, Department of Dermatology, Tufts Medical Center, Boston, Massachusetts
  • 14First Department of Dermatology, Aristotle University, Thessaloniki, Greece
  • 15Division of Dermatology, University of Arizona College of Medicine, Tucson
  • 16Inova Schar Cancer Institute Melanoma Center, Fairfax, Virginia
  • 17Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
  • 18Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston
  • 19Department of Dermatology, Eastern Virginia Medical School, Norfolk, Virginia
  • 20Tufts University School of Medicine, Department of Dermatology, Portland, Maine
  • 21Maine Medical Center Division of Dermatology, Portland, Maine
  • 22Department of Dermatology, Stanford University, Medical Center and Cancer Institute, Stanford, California
  • 23Department of Dermatology, University of Texas Southwestern Medical Center, Dallas
  • 24Department of Dermatology and Cutaneous Surgery, University of Texas Health, San Antonio
  • 25Department of Dermatology, University of California-San Francisco, San Francisco
  • 26Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, California
JAMA Dermatol. 2021;157(2):189-197. doi:10.1001/jamadermatol.2020.5213
Key Points

Question  What are the learning constructs in dermoscopic image interpretation that represent an appropriate foundational proficiency for US dermatology resident physicians?

Findings  In this 2-phase modified Delphi survey of 26 pigmented lesion and dermoscopy experts, consensus was achieved identifying 32 diagnoses, 116 associated dermoscopic features, and 378 representative teaching images.

Meaning  A consensus was achieved among dermoscopy experts identifying the dermoscopic diagnoses, features, and images reflective of an appropriate foundational proficiency in dermoscopic image interpretation for dermatology residents; this list of validated objectives provides a consensus-based foundation of key learning points in dermoscopy to help residents achieve clinical proficiency.

Abstract

Importance  Dermoscopy education in US dermatology residency programs varies widely, and there is currently no existing expert consensus identifying what is most important for resident physicians to know.

Objectives  To identify consensus-based learning constructs representing an appropriate foundational proficiency in dermoscopic image interpretation for dermatology resident physicians, including dermoscopic diagnoses, associated features, and representative teaching images. Defining these foundational proficiency learning constructs will facilitate further skill development in dermoscopic image interpretation to help residents achieve clinical proficiency.

Design, Setting, and Participants  A 2-phase modified Delphi surveying technique was used to identify resident learning constructs in 3 sequential sets of surveys—diagnoses, features, and images. Expert panelists were recruited through an email distributed to the 32 members of the Pigmented Lesion Subcommittee of the Melanoma Prevention Working Group. Twenty-six (81%) opted to participate. Surveys were distributed using RedCAP software.

Main Outcomes and Measures  Consensus on diagnoses, associated dermoscopic features, and representative teaching images reflective of a foundational proficiency in dermoscopic image interpretation for US dermatology resident physicians.

Results  Twenty-six pigmented lesion and dermoscopy specialists completed 8 rounds of surveys, with 100% (26/26) response rate in all rounds. A final list of 32 diagnoses and 116 associated dermoscopic features was generated. Three hundred seventy-eight representative teaching images reached consensus with panelists.

Conclusions and Relevance  Consensus achieved in this modified Delphi process identified common dermoscopic diagnoses, associated features, and representative teaching images reflective of a foundational proficiency in dermoscopic image interpretation for dermatology residency training. This list of validated objectives provides a consensus-based foundation of key learning points in dermoscopy to help resident physicians achieve clinical proficiency in dermoscopic image interpretation.

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