We Need to Nail It: Dermatology Resident Survey Highlighting Lack of Education for Nail Matrix Biopsies

Dermatologists are experts in the skin, hair, and nails. However, it is the authors' perception that many dermatologists lack comfort in performing nail matrix biopsies. Concerned for inadequate training, we surveyed US dermatology residents to assess their exposure to this procedure. Of the 130 respondents, 43 were PGY4 residents. Of these, 37.21% had never observed and 62.79% had never performed a nail matrix tangential shave biopsy. Similarly, 32.56% had never observed and 58.14% had never performed a nail matrix punch biopsy. Overall, 83.8% of all residents did not feel comfortable with and 71.5% did not anticipate feeling comfortable with performing nail matrix biopsies by residency completion. Interestingly, size of the training program and presence of a nail expert at the institution did not increase comfort levels in performing nail matrix biopsies (p = 0.348 and p = 1.0, respectively). Additionally, the presence of a nail expert did not affect the number of biopsies observed or performed by residents. The only statistically significant associations were between year of training (p < 0.001) and having a formalized curriculum and comfort with nail matrix biopsies (p = 0.002). Our survey highlights a potential lack of instruction in performing nail matrix biopsies in US dermatology residencies and calls for improved resident education.