Are plastic surgery residents in Canada expected to be proficient in dermoscopy (dermatoscopy)?

From the Guidelines

Plastic surgery residents in Canada are not expected to be proficient in dermoscopy as it is not a standard competency requirement for their board certification. Dermoscopy, a non-invasive diagnostic technique, is primarily used in dermatology residency programs for examining skin lesions and detecting skin cancers 1. While plastic surgery residents receive training in skin cancer management and reconstruction, their focus is on surgical techniques rather than diagnostic dermatological tools. Some exposure to dermoscopy might occur during rotations in dermatology or when working with skin cancer patients, but this is not a guaranteed part of their core training. According to the guidelines of care for the management of primary cutaneous melanoma, dermoscopy can improve diagnostic accuracy and help direct optimal tissue sampling, but it is not a required skill for plastic surgery residents 1.

Key Points

• Dermoscopy is a diagnostic tool primarily used in dermatology residency programs
• Plastic surgery residents focus on surgical techniques rather than diagnostic dermatological tools
• Some exposure to dermoscopy might occur during rotations or when working with skin cancer patients, but it is not a standard competency requirement
• The guidelines of care for the management of primary cutaneous melanoma support the use of dermoscopy for diagnostic purposes, but do not require plastic surgery residents to be proficient in it 1

Recommendations

• Plastic surgery residents who develop a special interest in skin cancer management might choose to pursue additional training in dermoscopy through electives or continuing medical education
• Dermoscopy can be a useful tool for improving diagnostic accuracy and directing optimal tissue sampling, but it is not a required skill for plastic surgery residents in Canada 1

From the Research

Dermoscopy Proficiency in Plastic Surgery Residents

• There is no direct evidence stating that plastic surgery residents in Canada are expected to be proficient in dermoscopy.
• However, a study published in 2021 2 found that while the majority of plastic surgery residents and practicing plastic surgeons in Canada were familiar with dermoscopy, only one respondent reported using it in clinical practice.
• The same study found that a lack of training and access to dermatoscopes were the most frequently cited reasons for not using dermoscopy, and 89% of respondents expressed interest in dermoscopy training in plastic surgery postgraduate training.
• Another study published in 2024 3 demonstrated the effectiveness of a brief and intensive dermoscopy training program for plastic surgery residents, with all participants achieving an accuracy rate of at least 80% for dermatoscopic diagnosis after the training.
• The importance of dermoscopy in plastic surgery is highlighted by its role in improving the diagnostic accuracy of melanoma and other cutaneous malignancies, which are commonly managed by plastic surgeons 2.
• While there is no direct evidence on the expectations for dermoscopy proficiency in Canadian plastic surgery residents, the studies suggest that there is a need and interest in dermoscopy training among plastic surgery residents and practicing plastic surgeons in Canada 2, 3.

Related Factors

• A study on skin tone diversity in plastic surgery resident education curriculum found that there is an underrepresentation of medium and dark skin tones in educational images, which could impact the ability of plastic surgery residents to diagnose and treat skin lesions in diverse patient populations 4.
• Another study on factors influencing practice decisions among plastic surgery residents and early-career plastic surgeons in Canada found that mixed practices that include aesthetics are the most popular among residents and early-career surgeons, and that hometown factors and positive interactions with colleagues and mentors are important factors in practice decisions 5.
• A scoping review on training primary care physicians in dermoscopy for skin cancer detection found that dermoscopy has an evidence base supporting its use in primary care, but that there is a need for training and that current training may not lead to long-term change in practice 6.