Dermoscopy use by Canadian dermatologists and dermatology residents: a cross‐sectional nationwide study

Dear Editor, Dermoscopy has demonstrated clinical benefits in improving early melanoma diagnosis and reducing unnecessary biopsies.1 Despite this, the prevalence of dermoscopy use by dermatologists varies from 81% to 98% worldwide,2 3 with a lack of training being a commonly cited reason for not using dermoscopy.4 To date there are no studies examining the prevalence of dermoscopy use in Canada. Our study aimed to examine the use and learning of dermoscopy by Canadian dermatologists and dermatology residents, as well as the current state of dermoscopy teaching within Canadian dermatology residency programmes. Practising Canadian dermatologists and senior (year 3–5) dermatology residents were asked to participate in an online dermoscopy survey between March and May 2015. The questionnaire design was based on prior dermoscopy surveys conducted by several groups,2,3,4,5 and it was pilot tested by eight Canadian dermatologists. Survey questions focused on four areas: practitioner/trainee demographics; usage of and training in dermoscopy; user confidence; and future training preferences. Following ethics approval, a link to the online survey in both English and French was e‐mailed to all 97 senior Canadian dermatology residents and 388 of 621 Canadian dermatologists, based on their membership in the Canadian Dermatology Association. A response rate of 35% for dermatologists and 47% for residents was achieved. In total, 87% of dermatologists and 100% of residents use dermoscopy in a clinical setting. Among practising dermatologists, dermoscopy use was significantly associated with female sex (P <0·001), but not with younger age of practitioner, years in clinical practice, number of patients seen per week or type of clinical practice. Lack of training (53%) was the major reported reason for not using dermoscopy. Clinicians obtained dermoscopy training from formal dermoscopy courses (67%) and informal clinical experience (60%). Residents received the majority of their dermoscopy training informally in clinic (78%) or through instruction in their residency programme (61%). While 72% of residents reported receiving formal didactic dermoscopy teaching in their home residency programme, most (63%) receive < 5 h of teaching per year. At their current level of training, 54% of clinicians and 28% of residents report being confident or very confident in their ability to diagnose melanoma correctly with dermoscopy. Both trainees (87%) and clinicians (93%) feel they would benefit from additional dermoscopy teaching. Trainees desired further teaching predominantly through formal courses outside their residency programme (74%) or as didactic teaching within their residency programme (63%). Clinicians found multiple methods of instruction desirable, including continuing medical education seminars (61%), formal courses (58%) and online tutorials (56%). In summary, there is good uptake of dermoscopy by both Canadian dermatologists and residents. While our study is limited by a low response rate and possible response bias, the results are similar to those of other international dermoscopy studies.3 6 Our study found a statistically significantly higher rate of dermoscopy use among female dermatologists. A female predominance in dermoscopy use among practising dermatologists has also been reported in studies from the U.S.A.5 and France.7 Further study into the reasons for this bias is warranted to help identify and address any sex‐specific barriers to dermoscopy use that may exist. Despite the high reported prevalence of use, Canadian dermatologists and residents reported a lack of confidence in their dermoscopy skills, and a desire for additional training. As found in other studies worldwide,3,7,6 a lack of training was the major reported reason for nonuse of dermoscopy by Canadian clinicians. This lack of training in dermoscopy likely continues to represent a barrier to its broader implementation. One response would be to expand dermoscopy instruction during residency, and currently Canadian dermatology residency programmes vary in the amount of teaching they provide. Only 72% of Canadian residents reported formal training within their home programme, and of these, most received < 5 h of instruction. Personal correspondence with residents in each programme revealed that three of nine Canadian residency programmes provided no formal dermoscopy instruction at all. Improving and increasing dermoscopy training in residency programmes could potentially increase its clinical use, as well as clinician confidence. As there is currently no consensus on the best way to teach dermoscopy,8 understanding the differing educational preferences of clinicians and residents can aid in the design and delivery of future educational programmes. Residents preferred formal didactic sessions, while clinicians are interested in more self‐directed learning, possibly reflecting the differences in age, practice type and lifestyle of the two groups. This study identifies an unmet need for dermoscopy training within Canadian dermatology residency programmes and for Canadian dermatologists. It also provides insight for medical educators into learners’ preferences, which will aid in the design of future dermoscopy training curricula. By providing further training, we hope to improve our colleagues’ confidence and diagnostic accuracy in dermoscopy, so that it may ultimately assist in improving patient care. E‐mail: t.burbidge@ucalgary.ca Funding sources: Funding for this study was provided in part by a grant from the Canadian Dermatology Foundation. Conflicts of interest: none declared.

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