Current Status of Dermatologic Education in US Medical Schools

Abstract

This survey study assesses the status and content of dermatology curricula in US medical schools accredited by the Liaison Committee on Medical Education.

Medical schools must negotiate priorities when deciding specialty representation in curricula. Thus, some specialties including dermatology are often given limited consideration or representation. Even though skin conditions are a leading cause of disease burden worldwide in terms of prevalence and morbidity,¹ we perceived that dermatology was not widely included in medical school curricula. Additionally, previous investigations of medical schools’ dermatology education are limited in both quantity and design.² Patients often present to nondermatologists, who may not know how to diagnose and treat dermatologic conditions. Thus, a lack of basic dermatologic knowledge may cause delays for patients in receiving high-quality dermatology care. We aimed to survey the current status of dermatologic education in US medical schools.

Methods

The survey study was conducted from October 2018 through August 2019 and was deemed exempt from approval with a waiver of informed patient consent by the University of Pennsylvania institutional review board because the study did not meet the definition of research with human subjects. This study followed the American Association for Public Opinion Research (AAPOR) reporting guideline for survey studies. Allopathic US medical schools accredited by the Liaison Committee on Medical Education (LCME) (n = 137) were contacted via telephone survey. Medical school representatives in the Office of Student Affairs or the Office of Medical Education (or equivalent) were surveyed with a series of questions designed by 2 of us (B.A.C. and J.B.L.) to assess status and content of any dermatology curricula and rotations. The survey instrument was validated by peers, although no formal validity assessment was performed. The telephone survey was followed up by additional telephone or email communication as directed by the telephone representatives. For questions with answers not provided or known by representatives after at least some telephone contact, answers were supplemented with available published information on official websites. Schools with provisional or preliminary LCME accreditation, schools in Puerto Rico, and osteopathic medical schools were not included. Questions focused on the required curricula during the first 2 years (preclinical coursework) and third year of medical school (clinical rotations) rather than free elective time in fourth year.

Results

The survey response rate was 100% (137 of 137) (Table), with all schools completing at least 1 question by telephone. Most schools (96 of 137 [70%]) were structured as 2-year preclinical curriculum followed by 2-year clinical rotations. Sixteen of 135 schools (12%) had a course dedicated solely to dermatology in preclinical curricula, with a larger proportion (49 of 135 [36%]) instead including dermatology lectures throughout broader educational blocks that include other systems. Two of 136 (1%) that responded had a required third-year clinical rotation in dermatology ranging from 1 to 4 weeks. Most (83 of 134 [62%]) offered an elective dermatology rotation in the third year.

Table. Survey Questions, Responses, and Response Rates Regarding Current Dermatology Education in US Medical Schools^a.

Survey Question	No./Total No. (%)
	Answer	Schools That Answered
Is your medical school set up as a 2-y preclinical curriculum? If not, how is it set up?	Yes: 96/137 (70); no: 41/137 (30); if no, most were 18 mo preclinical (n = 24)	137/137 (100)
Is there a dedicated dermatology course in the preclinical curriculum? If not, is it part of a broader block?	Yes: 16/135 (12); no: 70/135 (52); part of a broader block: 49/135 (36)	135/137 (99)
Has the dedicated dermatology course been a part of the preclinical curriculum for 3 or more years (including the schools with dermatology as part of a broader block)?	Yes: 61/65 (91); no: 4/65 (9)	65/65 (100)
Is there a required dermatology rotation in the third-year clinical curriculum?	Yes: 2/136 (1); no: 134/136 (99)	136/137 (99)
Has the required clinical dermatology rotation been a part of the clinical curriculum for 3 or more years?	Yes: 2/2 (100); no: 0/2 (0)	2/2 (100)
How long is the required clinical dermatology rotation?	1-4 wk	2/2 (100)
Is there an elective dermatology rotation in the third-year clinical curriculum?	Yes: 83/134 (62); no: 51/134 (38)	134/137 (98)
Has the elective dermatology rotation been a part of the third-year clinical curriculum for 3 or more years?	Yes: 79/83 (96); no: 4/83 (5)	83/83 (100)
How long is the elective dermatology rotation in the third-year clinical curriculum?	Average: 3.5 wk; median: 3 wk; minimum: 1 wk; maximum: 6 wk	83/83 (100)

^aAll schools answered at least 1 question by telephone, and per protocol, incomplete or unknown answers were supplemented with any available information published on school websites. Survey questions were designed to evaluate status and content of any dermatology curricula and rotations. The survey instrument was validated by peers, although no formal validity assessment was performed.

Discussion

Approximately 27% of the population seeks medical care for a dermatologic problem each year, accounting for 3.8% of US health care expenditures.¹ Yet, these statistics are not reflected in current dermatologic education in medical schools. Most US medical schools lack a dedicated course or required rotation in dermatology. When dermatology is consulted by nondermatologists, their correct diagnosis rate is merely an estimated 20% to 50% of cases.³ This low accuracy may be associated with the lack of dermatology preclinical and clinical education in medical schools.

Many schools in our survey expressed difficulty in incorporating dermatology into curricula. Challenges included lack of dermatology departments to assist, difficulty incorporating substantial dermatologic education into existing courses, and limited time in the schedule. In addition, some schools felt that exposing more students to competitive specialties could be counterproductive, as they were concerned that additional exposure might encourage more students to apply to competitive specialties and increase their chances of not matching.

Curricular decisions necessarily include some specialties at the expense of others. Other studies^4,5,6 of medical school exposure to ophthalmology, otolaryngology, and orthopedics showed similar results, though ophthalmology and otolaryngology have higher rates of exposure than dermatology. For example 34% and 18% of medical schools have a required otolaryngology and ophthalmology rotation, respectively, in their third year clinical rotations compared with 1% of schools with a required third-year dermatology rotation.^4,5,6

Limitations of this study include lack of curricular details from respondent administrators who did not know specifics. Further, reported curricular information may not always reflect actual practice. Our findings suggest the lack of formal dermatology education in US medical schools, despite the high prevalence of skin conditions. Given the problem of access to high-quality dermatology care, it seems prudent that medical schools should ensure at least basic dermatology education for all medical students. Our data may inform potential changes in curricula to rectify this problem.