Accuracy and Confidence Among New First-year Dermatology Residents in the 
Diagnosis of Common Dermatologic Conditions in Different Fitzpatrick Skin Types
Anuj Pranav Sanghvi, BS1, David Wang, MD2, Matthew Lipner, MD, PhD2, Kelly Tackett, MD, MPH2, Heather Holahan, MD2, and Julie Mervak, MD2
1School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 2Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC

• Minority groups associated with darker Fitzpatrick skin types are 
disproportionately affected by disparities in dermatologic care1-2

• Dermatologic conditions in darker skin types are underrepresented 
in many training resources3-4

• Previous studies have queried medical students’ recognition of skin 
conditions in different skin types5, but no similar studies have been 
published evaluating the abilities or comfort level of dermatology 
residents

• The purpose of this study was to identify differences in the accuracy 
and confidence of new dermatology residents in diagnosing common 
dermatologic conditions in different Fitzpatrick skin types

Synopsis and Objective Methods

• Distributed an online survey to new first-year dermatology residents 
at US ACGME-accredited dermatology programs

• Participants were shown 20 photographs of common dermatologic 
conditions in patients of varying Fitzpatrick skin types

• For each image, participants selected a diagnosis from a drop-down 
menu and rated their confidence in each diagnosis from 1 (“Not 
Confident at All”) to 5 (“Very Confident”)

• Participants also reported their confidence in diagnosing common 
dermatologic conditions in different Fitzpatrick skin types in a pre-
and post-survey questionnaire. 

• Survey data were analyzed using descriptive statistics, unpaired t-
tests, one-way analysis of variance tests, pairwise correlation tests, 
and Wilcoxon matched-pairs signed-rank tests 

• Fifty first-year dermatology residents (10% response rate) completed 
the survey.

Methods

• The small sample size may have skewed the results
• Response rate was limited by voluntary participation
• Survey was closed at the end of the first month of training 

to reduce confounding from inter-program differences
• The number of common skin conditions in the survey was limited out 

of consideration for the time 
• Survey did not fully represent the spectrum or prevalence 

of skin conditions seen in the practice of dermatology

Limitations

• New dermatology residents diagnose common dermatologic 
conditions in darker skin with less accuracy and confidence than in 
lighter skin

• There is a lack of statistical significance with participants’ 
demographics and background characteristics

• Differences identified in diagnostic accuracy and 
confidence may stem from a systemic deficiency in skin of 
color education rather than individual backgroundsnd confidence in 
lighter versus darker Fitzpatrick skin types may stem from a systemic deficiency in skin of color education rather than 
individual backgrounds.

Conclusions

1.Buster KJ, Stevens EI, Elmets CA. Dermatologic health disparities. Dermatol Clin. 
2012;30(1):53-viii. doi:10.1016/j.det.2011.08.002

2.Tripathi R, Knusel KD, Ezaldein HH, Scott JF, Bordeaux JS. Association of 
demographic and socioeconomic characteristics with differences in use of 
outpatient dermatology services in the United States. JAMA Dermatol. 
2018;154(11):1286-1291. doi:10.1001/jamadermatol.2018.3114

3.Ebede T, Papier A. Disparities in dermatology educational resources. J Am Acad
Dermatol. 2006;55(4):687-690. doi:10.1016/j.jaad.2005.10.068

4.Alvarado SM, Feng H. Representation of dark skin images of common 
dermatologic conditions in educational resources: A cross-sectional analysis. J 
Am Acad Dermatol. 2021;84(5):1427-1431. doi:10.1016/j.jaad.2020.06.041

5.Fenton A, Elliott E, Shahbandi A, et al. Medical students' ability to diagnose 
common dermatologic conditions in skin of color. J Am Acad Dermatol. 
2020;83(3):957-958. doi:10.1016/j.jaad.2019.12.078

References

Results

Figure 1 (left). Accuracy 
of incoming 
dermatology residents 
in diagnosing common 
dermatologic conditions

Figure 2 (right). 
Confidence of incoming 
dermatology residents 
in diagnosing common 
dermatologic 
conditionsa

* Signifies significant difference (P<0.05)
a Confidence was scored on a scale of 1 (“Not Confident at All”) to 5 (“Very Confident”)