Differences in Descriptive and Diagnostic Capability in Dermatology: Referrals between Physician Assistant Students and Medical Students at a Student-Run Free Clinic

摘要

Background: At the OU-TU School of Community Medicine, medical (MD) students receive 12 hours of preclinical dermatology training lecture. Physician Assistant (PA) students receive approximately 29 hours of lecture and laboratory dedicated to dermatology. During their clinical years, MD and PA students provide primary care to uninsured patients at OU-Tul-sa's Bedlam clinic, a student-run free clinic. Students frequently encounter dermatologic conditions in their patients and often make referrals to Bedlam dermatology night for evaluation and treatment. This study aims to determine whether the more extensive preclinical dermatologic curriculum for PA students results in better lesion description and more accurate diagnosis in a clinical setting. Methods: This retrospective study reviewed patient records seen by clinical students at the Bedlam clinics from July 2017-August 2019. The ability for students to describe dermatologic conditions was assessed by the inclusion of primary morphology, secondary morphology, shape, and distribution terms. The student and dermatologist diagnoses were compared using the ICD-10 code reported in the referral order and the ICD-10 code in the specialty note to assess for diagnostic accuracy. A Mest was performed to analyze the number of lesion descriptions documented, and a chi-square test was performed to analyze diagnostic concordance. Results: PA students used significantly more descriptors to characterize skin lesions (M=2.79, SD=1.07) than did MD students (M=1.87,SD=1.20), t(121)=4.06,p<0.001. There was no significant difference in diagnostic concordance rate between referral diagnosis and specialist-confirmed diagnosis, χ2 (1, N=94) =0.025, p=0.874, for PA students (47) and MD students (45). Conclusion: PA students received more preclinical dermatologic training than did MD students. While this training increased the amount of descriptions of lesions, it did not improve the diagnostic accuracy of PA students. The findings underscore the need to enhance dermatologic education in preclinical instruction for PA and MD students so they can effectively diagnose, refer, and/or treat dermatologic issues.