Confidence level in diagnosing and treating skin disorders among Palestinian physicians: a cross- sectional study

BACKGROUND: Skin disorders are among the most prevalent conditions encountered in primary care, yet dermatology remains underrepresented in medical curricula worldwide. Non-dermatologist physicians frequently manage these conditions with limited training and exposure, potentially compromising diagnostic accuracy and patient outcomes. This study aimed to assess the level of confidence among Palestinian physicians in diagnosing and managing skin disorders and to identify the training-related factors associated with higher diagnostic self-efficacy. METHODS: A cross-sectional study was conducted among 246 licensed medical doctors practicing in the West Bank, Palestine. Participants were recruited through convenience sampling via professional networks and selected healthcare facilities, with the sample predominantly comprising younger and early-career physicians. Data were collected using a structured, validated self-administered questionnaire through mixed modes (electronic and paper-based). The instrument assessed sociodemographic and professional characteristics, dermatology exposure and training, and diagnostic self-efficacy using Likert-scale items. Diagnostic self-efficacy was dichotomized into below average versus average or above. Descriptive statistics, chi-square tests, and multivariable logistic regression were performed using SPSS version 22. Ethical approval was obtained from AlQuds University Institutional Review Board. RESULTS: Of 246 participating physicians, 74.4% were aged 30 years or younger and 58.9% were male. The majority were general practitioners (54.1%) working in hospital settings (79.7%). Most participants (58.9%) reported no formal dermatology training, and 42.3% encountered fewer than 10 dermatological cases in their careers. Most physicians rated their diagnostic skills as average (62.6%), with a mean diagnostic self-efficacy score of 2.92 ± 0.78. No meaningful associations were observed between most sociodemographic characteristics and diagnostic self- efficacy. Training-related factors significantly associated with higher self-efficacy included: dermatology training during medical school (81.2% vs. 64.3%; p = 0.038), exposure to more than three training methods (91.6% vs. 73.3%; p = 0.006), and confidence gained after training (85.6% vs. 63.9%; p = 0.003). In multivariable logistic regression, confidence after training remained an independent predictor of higher self-efficacy (OR = 3.21, 95% CI 1.29-8.11; p = 0.011). Dermatology rotations and lectures were identified as the most effective and most recommended training modalities. CONCLUSIONS: Palestinian physicians demonstrate only moderate diagnostic self-efficacy in dermatology, largely attributable to limited training and clinical exposure. Dermatology training, particularly when it meaningfully boosts confidence, is the most important predictor of diagnostic self-efficacy, irrespective of sociodemographic background. Integrating structured, multimodal dermatology education into undergraduate and postgraduate curricula is essential to improving physician competence and ultimately enhancing patient care in primary care settings.