Accuracy of a Second-Year Dermatology Resident's Pre-Biopsy Diagnoses

Skin biopsies are heavily relied upon in dermatology to diagnose cutaneous malignancies. Mastering skin biopsies and recognizing skin cancer is a core component of dermatology residency training. However, limited data exists on evaluative standards for biopsy training and residents accuracy in diagnosing skin cancer. This study aimed to analyze pre- and post-biopsy diagnostic accuracy of a second-year resident in the Harvard Combined Dermatology Residency Program from July 2021 to June 2022. This resident recorded biopsies performed in specialty dermatology clinics across three large academic centers with attending oversight and the hypothesized pre-biopsy diagnosis and the subsequent histopathologically confirmed diagnosis. Stratifying lesions into categories of squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and benign and subsequently comparing the recorded pre- and post-biopsy diagnoses, it was determined that this resident correctly identified the diagnosis in 64% of the cases and correctly diagnosed all histologically confirmed skin cancers as SCC or BCC. The specificity of this resident in identifying an SCC or BCC was 56%. This study provides a preliminary foundational dataset for developing evidence-based residency training guidelines to better prepare residents for independent clinical practice. It serves as a model for providing trainees and programs with information on variations in practice patterns.