‘I Didn't Know, I Definitely Guessed.’ Exploring Pre‐Registration Podiatry Students' Approach to Identifying Dermatological Conditions in Different Skin Tones, a Mixed Methods Study

BACKGROUND: Research suggests that healthcare professionals find it more difficult to correctly diagnose dermatological conditions in the nonwhite patient demographic. People of colour experience higher rates of delayed and misdiagnosis, contributing to an increased mortality risk and increased health inequalities that remain widespread throughout the health care setting. This study aimed to investigate podiatry student's ability, confidence, approaches and perceptions in diagnosing dermatology pathologies in different skin tones. METHODS: A mixed methods explanatory sequential design was undertaken with pre-registration podiatry students from universities across South-central England. Participants completed a validated pictorial multiple-choice questionnaire comprising six images of either eczema or psoriasis in three different skin tone categories: light, medium or dark. Results were used to inform focus groups and a process of thematic analysis explored participants perceptions surrounding their diagnostic approaches and underpinning confidence. RESULTS: The medium skin tone (Fitzpatrick groups III/IV) was associated with the most correct responses for psoriasis (69%) followed by light skin tone (Fitzpatrick groups I/II) with 48%. Psoriasis in darker skin tones (Fitzpatrick groups V/VI) received the least correct responses (3%). In eczema, results were more evenly spread with darker skin tones (Fitzpatrick groups V/VI), receiving a slightly higher percentage of correct diagnoses (39%). Qualitative analysis revealed two emergent themes: (i) reports on confidence and apprehension and (ii) limitations in education provision: each with a series of sub-themes. Participants reported barriers to their diagnostic ability included an underrepresentation of dark skin tones in medical images and inadequate exposure to pathology on patients with dark skin tones. CONCLUSIONS: There was a notable lack of confidence in participants' ability to correctly diagnose dermatological pathology, particularly in dark skin tones. This study addresses the research gap in podiatric health inequalities and pinpoints the associated educational shortcomings from the podiatry education perspective.