# A nationwide French cohort study on 3154 patients with atopic dermatitis and psoriasis to assess patients perception of dermatology residents

A. Faugeroux, R. Salle, C. Skayem, R. Samaran, A. Teboul, P. Hamann, C.

Taieb, U. Heller

► To cite this version:

A. Faugeroux, R. Salle, C. Skayem, R. Samaran, A. Teboul, et al. A nationwide French cohort study on 3154 patients with atopic dermatitis and psoriasis to assess patients perception of dermatology residents. Journal of the European Academy of Dermatology and Venereology, 2023, 37 (7), 10.1111/jdv.18976. hal-04237738

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Submitted on 22 May 2025

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## LETTER TO THE EDITOR

# A nationwide French cohort study on 3154 patients with atopic dermatitis and psoriasis to assess patients' perception of dermatology residents

Dear Editor,

In France, throughout their training, residents are an integral part of the national healthcare system. They represent 44% of healthcare professionals in public hospitals.¹,² In dermatology, the most common inflammatory dermatoses requiring long-term management are atopic dermatitis and psoriasis.³ In this context, patients suffering from these skin conditions are regularly seen by dermatology residents during their visits. Previous studies have demonstrated that most patients were satisfied with dermatology resident care in outpatient clinics.⁴,⁵ Recent studies have also evaluated patients' satisfaction in cosmetic procedures performed by dermatology residents.⁶

In this setting, the aim of our study was to evaluate the perception of patients with chronic inflammatory dermatoses (atopic dermatitis and psoriasis) regarding dermatology residents. A questionnaire was distributed by mail and social networks to all patients in France Pso association and French association of eczema between October 2020 and February 2021.

A total of 3154 patients completed the questionnaire (Tables 1 and 2). Factors associated with a good experience were correlated with the fact that the resident was fully autonomous, introduced him/herself, was a good listener, explained disease and treatment, knew well the patient's file and seemed competent in chronic inflammatory dermatoses ($p < 0.001$).

This study shows that around a quarter of patients report being managed by residents. Since residents in France account to 44% of healthcare professionals, we believe that patients do not always know the seniority of the dermatologist providing their care. In fact most patients have a misperception of the level of training of their doctors. Most residents do not introduce their trainee status, by fear of triggering anxiety around their competence or undermining confidence in their abilities.⁷ However, in our study, introducing the training level was associated with a good experience. Thus, we recommend residents to mention their seniority level when introducing themselves to patients. Explaining

<table><caption>TABLE 1 Population characteristics.</caption><thead><tr><th></th><th></th></tr></thead><tbody><tr><td>Characteristics</td><td>N = 3154</td></tr><tr><td>Age, [median (IQR)]</td><td>43 (3355)</td></tr><tr><td>Diagnosis</td><td>n (%)</td></tr><tr><td>Atopic dermatitis</td><td>2428 (77%)</td></tr><tr><td>Psoriasis</td><td>726 (23%)</td></tr><tr><td>Patients report that their doctor was a resident</td><td></td></tr><tr><td>Yes</td><td>836 (27%)</td></tr><tr><td>No</td><td>1865 (59%)</td></tr><tr><td>Healthcare setting</td><td></td></tr><tr><td>Hospital</td><td></td></tr><tr><td>Day care hospital</td><td>170 (20%)</td></tr><tr><td>Emergency consultation at hospital</td><td>197 (24%)</td></tr><tr><td>Consultation at the hospital by resident replacing attending dermatologist</td><td>210 (25%)</td></tr><tr><td>Consultation at the hospital with resident and attending dermatologist</td><td>83 (9.9%)</td></tr><tr><td>Private practice</td><td></td></tr><tr><td>Consultation in private practice with resident replacing private dermatologist</td><td>88 (11%)</td></tr><tr><td>Consultation in private practice with resident and attending dermatologist</td><td>88 (11%)</td></tr></tbody></table>

disease and treatment, and having attentive listening were also associated with good patient satisfaction. This shows the importance of fostering communication skills in dermatology residents, especially low-rated skills like allowing the patient to share their narrative thread, summarizing the patient's history from the provider and assessing patient understanding.⁸ Using visual arts education can also benefit clinical communication with patients having chronic diseases. Patients prefer to be treated by dermatologists who are attentive listeners. In fact, those who actively take part in taking decisions regarding their medical care reach better clinical outcomes and show higher levels of satisfaction

<footnote>This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.</footnote>

<footnote>© 2023 The Authors. *Journal of the European Academy of Dermatology and Venereology* published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology.</footnote>
<table><caption>TABLE 2 Factors associated with good or bad experience of patients managed by dermatology residents.</caption><thead><tr><th rowspan="2"></th><th rowspan="2">Number</th><th>Good experience</th><th>Bad experience</th><th rowspan="2">p-value<sup>b</sup></th></tr><tr><th>N = 559 (67%)<sup>a</sup></th><th>N = 193 (23.4%)<sup>a</sup></th></tr></thead><tbody><tr><td>Residents were fully autonomous</td><td>733</td><td></td><td></td><td>&lt;0.001</td></tr><tr><td>Yes</td><td></td><td>398 (73%)</td><td>68 (36%)</td><td></td></tr><tr><td>No</td><td></td><td>145 (27%)</td><td>122 (64%)</td><td></td></tr><tr><td>Residents were good listeners</td><td>741</td><td></td><td></td><td>&lt;0.001</td></tr><tr><td>Yes</td><td></td><td>506 (91%)</td><td>70 (38%)</td><td></td></tr><tr><td>No</td><td></td><td>50 (9.0%)</td><td>115 (62%)</td><td></td></tr><tr><td>Knowledge of the medical history of patients coming for follow-up</td><td>730</td><td></td><td></td><td>&lt;0.001</td></tr><tr><td>Yes</td><td></td><td>419 (77%)</td><td>44 (23%)</td><td></td></tr><tr><td>No</td><td></td><td>123 (23%)</td><td>144 (77%)</td><td></td></tr><tr><td>Residents seemed competent in inflammatory dermatoses</td><td>735</td><td></td><td></td><td>&lt;0.001</td></tr><tr><td>Yes</td><td></td><td>488 (88%)</td><td>42 (23%)</td><td></td></tr><tr><td>No</td><td></td><td>65 (12%)</td><td>140 (77%)</td><td></td></tr><tr><td>Residents explained disease and treatment</td><td>741</td><td></td><td></td><td>&lt;0.001</td></tr><tr><td>Yes</td><td></td><td>482 (87%)</td><td>49 (26%)</td><td></td></tr><tr><td>No</td><td></td><td>71 (13%)</td><td>139 (74%)</td><td></td></tr><tr><td>Residents introduced their training grade</td><td>733</td><td></td><td></td><td>&lt;0.001</td></tr><tr><td>Yes</td><td></td><td>339 (62%)</td><td>65 (35%)</td><td></td></tr><tr><td>No</td><td></td><td>209 (38%)</td><td>120 (65%)</td><td></td></tr></tbody></table>

with the care provided by their doctors.⁹,¹⁰ Knowing the medical history of patients presenting for a follow-up was also associated with good satisfaction. Thus, we insist that dermatology residents read the medical history of a patient before the consultation instead of searching for the history while consulting the patient. Consistent with the results of studies in other medical disciplines, our study demonstrated a good patient satisfaction regarding the participation of dermatology residents in their care.⁴ Previous studies have assessed satisfaction of residents in outpatient dermatology departments and in cosmetic procedures. We have focused our study on chronic inflammatory dermatoses like psoriasis and atopic dermatitis because these dermatology patients have a particular profile. In order to optimize medical consultation outcomes and ensure good satisfaction in all branches of dermatology, it would be interesting to conduct further studies evaluating perception of residents in onco-dermatology and dermatologic surgeries.

### ACKNOWLEDGEMENTS

France Pso, French association of eczema.

### FUNDING INFORMATION

None.

### CONFLICT OF INTEREST STATEMENT

None to declare.

### DATA AVAILABILITY STATEMENT

Data sets related to this article are available on request to the corresponding author. The data are not publicly available because they contain information that could compromise the privacy of research participants.

A. Faugeroux¹,² ID

R. Salle¹,² ID

C. Skayem¹ ID

C. Taieb³ ID

U. Heller⁴

R. Samaran²,⁵ ID

A. Teboul²,⁶ ID

P. Hamann²,⁷ ID

¹Department of General and Oncologic Dermatology, USQY, EA4340-BECCOH, AP-HP, Ambroise-Paré Hospital, Université Paris-Saclay, Boulogne-Billancourt, France

²Association Futurs Dermato-Vénéréologues de France (FDVF), Paris, France

³Patient Priority Department, EMMA, Fontenay-sous-Bois, France

⁴Service de Chirurgie Maxillo-Faciale, Hôpital Beaujon, APHP, Clichy, France

⁵Service de Dermatologie, Centre Hospitalier Le Mans, Le Mans, France

<footnote><sup>a</sup>n (%).</footnote>

<footnote><sup>b</sup>Pearson's Chi squared test.</footnote>
⁶Service de Dermatologie et Allergologie, AP-HP,
Hôpital Tenon, Sorbonne Université, Paris, France

⁷Service de Dermatologie, Institut Gustave Roussy,
Université Paris-Saclay, Villejuif, France

Correspondence

P. Hamann, Service de Dermatologie, Institut Gustave
Roussy, 114 rue Edouard Vaillant, 94805 Villejuif,
France.

Email: pierre.hamann@u-psud.fr

ORCID

A. Faugeroux https://orcid.org/0000-0001-8178-8300

R. Salle https://orcid.org/0000-0003-4411-7289

C. Skayem https://orcid.org/0000-0002-4498-0683

C. Taieb https://orcid.org/0000-0002-5142-2479

A. Teboul https://orcid.org/0000-0002-4757-9158

P. Hamann https://orcid.org/0000-0003-3445-6586

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