ArticleJAAD international2026
Diagnostic accuracy and metacognition in dermatology: A cross-sectional analysis of confidence and decision-making.
Article in JAAD international, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Diagnostic accuracy in dermatology requires both visual expertise and metacognitive skills such as confidence, calibration, and decision-making under uncertainty. Miscalibration may lead to diagnostic error, unnecessary testing, and unsafe management. Objective: Assess how confidence, response time, and decision behavior vary across levels of dermatologic experience and how these factors relate to diagnostic accuracy and efficiency. Methods: This cross-sectional study included 68 participants (medical students, resident physicians, and board-certified dermatologists) who completed a multiple-choice diagnostic task with 50 diverse dermatologic images. Participants selected a diagnosis option, rated their confidence, and decided regarding additional inspection. Results: Diagnostic accuracy and confidence increased with experience. Board-certified dermatologists were most accurate when responding quickly, but not after longer deliberation, which did not hold true for residents. Medical students displayed significant overconfidence and poor alignment between confidence and decisions. Across all groups, 12% of melanomas were dismissed/overlooked. Limitations: Small sample size limits subgroup comparisons. A simulated setting may not fully capture clinical complexity. Conclusion: Metacognitive skills differ by experience and influence diagnostic accuracy and efficiency. Training should support calibration and adaptive decision-making.
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