We Need to Nail It: Dermatology Resident Survey Highlighting Lack of Education for Nail Matrix Biopsies

Introduction: Dermatologists are experts in the skin, hair, and nails. However, it is the authors’ perception that many dermatologists lack comfort in performing nail matrix biopsies. Methods: Concerned for inadequate training, we surveyed US dermatology residents to assess their exposure to this procedure. Results: Of the 130 respondents, 43 were PGY4 residents. Of these, 37.21% had never observed and 62.79% had never performed a nail matrix tangential shave biopsy. Similarly, 32.56% had never observed and 58.14% had never performed a nail matrix punch biopsy. Overall, 83.8% of all residents did not feel comfortable with and 71.5% did not anticipate feeling comfortable with performing nail matrix biopsies by residency completion. Interestingly, size of the training program and presence of a nail expert at the institution did not increase comfort levels in performing nail matrix biopsies (p = 0.348 and p = 1.0, respectively). Additionally, the presence of a nail expert did not affect the number of biopsies observed or performed by residents. The only statistically significant associations were between year of training (p < 0.001) and having a formalized curriculum and comfort with nail matrix biopsies (p = 0.002). Conclusions: Our survey highlights a potential lack of instruction in performing nail matrix biopsies in US dermatology residencies and calls for improved resident education.