Protocol: Trust Your Gut: An Analysis of Dermatologic Diagnostic Accuracy

Background: The current clinical misdiagnosis rate among all medical specialties is approximately 10-15%, but diagnostic error within the field of dermatology has not been studied thoroughly1,2. As a field that relies heavily on visual perception, many physicians consider clinical intuition to be advantageous in diagnosing skin diseases and consider it to be a rapid and unconscious phenomenon7. Therefore, too much contemplation may lead to more incorrect diagnoses4. However, while clinical intuition is a valuable clinical tool, it is widely considered to be developed throughout medical training and only successfully employed by experienced attending physicians, perhaps due to experiential knowledge and associated confidence1,2,5. One may expect that self-reported confidence in diagnosis would correlate with diagnostic accuracy, but this is not supported in the literature9. The focus of our study is to examine the development and reliability of clinical intuition as well as associated self-reported confidence levels in diagnoses at different levels of medical training among dermatologists. Methods: Approximately 20 dermatologists who are PGY-2 or higher will be recruited for study participation via email. Participants will be sent a Qualtrics survey at two separate time points with a month waiting period in between. The survey will contain demographics questions, photos of 10 different dermatologic conditions for dermatologists to diagnose, and a self-reported confidence level for each diagnosis. The first survey will allow 5 seconds to evaluate a clinical photo prior to diagnosis, and this timeframe will be extended to 15 seconds in the second survey. The second survey will contain the same diagnoses, but with different pictures to avoid recall of specific photos. Following completion of all surveys, descriptive statistics will be completed with goal of publication. Discussion: This study has the potential to provide invaluable information regarding the development of clinical intuition among dermatologic physicians while also examining their confidence levels and likelihood of changing correct diagnoses when given more time to ruminate. It is possible that physicians are more likely to second guess original diagnoses based off of certain demographic factors, as one systematic review found that women in medicine perceive their clinical performance as deficient more often than men10. Therefore, this study may give insight to the ways that complicated societal factors contribute to clinical decision making. Data from this study may be used to aid dermatologists in understanding their thought processes when diagnosing patients, and may be useful in developing education curriculum. The protocol will hopefully serve as a blueprint for creation of studies in a multitude of fields, ultimately leading to better understanding of clinical decision making and, thus, improved patient care.