# Comparing Foundation Doctors’ Confidence and Dermatologists’ Expectations in Inpatient Referrals: A Multi-site Survey

## TL;DR

Newly qualified doctors lack confidence in dermatology skills, leading to poor inpatient referrals and suggesting a need for better training and clearer guidelines.

## Contribution

This study compares foundation doctors' confidence with dermatologists' expectations, revealing gaps in dermatology training and referral practices.

## Key findings

- Most foundation doctors reported low confidence in describing skin lesions and identifying serious dermatoses.
- Over 65% of foundation doctors were not confident in using different emollients.
- Dermatologists noted frequent deficiencies in referral quality, including lack of detailed clinical information.

## Abstract

Background: Inpatient dermatology referrals rely on non-dermatologist doctors to recognise and communicate skin problems effectively. Limited dermatology training during medical school may leave newly qualified doctors underprepared for this responsibility.

Objectives: This study aimed to evaluate foundation doctors' confidence in core dermatological skills and knowledge and to compare these with dermatologists' expectations based on observed inpatient referral quality across two UK hospital sites.

Methods: A cross-sectional survey was conducted at Basildon University Hospital and Northampton General Hospital in England. Foundation year doctors (n = 87) completed questionnaires assessing confidence (on Likert scales 1-5) in describing skin lesions, identifying urgent dermatological conditions, knowing what information to include in referrals, and using common treatments. Dermatologists (n = 8) were surveyed on expected referral information, common deficiencies, and examples of inappropriate referrals. Descriptive statistics were used to compare responses.

Results: Across both sites, most foundation doctors reported low confidence in describing skin lesions and identifying serious dermatoses: only 8-29% rated themselves "confident" or "extremely confident." Over 65% were not confident in using different emollients (only 2-10% felt confident). Only ~30% of foundation doctors were aware of the British Association of Dermatologists (BAD) handbook. Dermatologists consistently expected detailed clinical information in referrals but noted that many lacked these elements. Common conditions like eczema, psoriasis, scabies, and drug eruptions were cited as being referred inappropriately.

Conclusions: Foundation doctors reported limited confidence in fundamental dermatological assessment and management skills, reflecting inadequate undergraduate dermatology training. Dermatologists observed corresponding deficiencies in referral quality. This mismatch may lead to suboptimal patient management and unnecessary specialist referrals. Improving dermatology education for medical students and resident doctors is recommended, alongside clearer referral guidelines and continued dermatologist feedback.