Improving dermatology tele-expertise through physician training: evidence from a large real-world cohort

Tele-expertise (TE) has emerged as a key strategy to address limited access to dermatological care. However, its performance may depend on the quality of requests submitted by primary care physicians. To evaluate dermatological TE activity in a regional network and to assess the impact of continuing education in dermatology and dermoscopy on the quality and efficiency of TE requests. We conducted a retrospective single-centre study of all TE requests received between January 1, 2022 and December 31, 2024 at the Centre Hospitalier Intercommunal d'Alençon-Mamers using the Omnidoc platform. After standardization, 3,266 TE cases were analysed. Data from TE requests were cross-referenced with patient records when in-person consultation occurred. Request quality and TE performance were compared between trained and untrained general practitioners. General practitioners accounted for 99.2% of TE requests, mainly for diagnostic purposes (92.4%). The most frequent indications were skin cancer screening (59.6%), inflammatory dermatoses (9.7%), and infections (9.5%). TE provided rapid specialist input (median response time: 13 hours), with only 4% of requests rejected due to insufficient information. TE avoided face-to-face consultations in 51% of cases, with high diagnostic concordance (92.4%). Training significantly improved request quality. This resulted in more efficient specialist responses. TE is an effective tool to optimize dermatological care pathways but is highly dependent on the requesting physician's level of training. Integrating structured education in dermatology and dermoscopy transforms TE into a high-performance, learning healthcare model. Investment in training is therefore essential to maximize the clinical impact of TE.