Skin cancer is the most common malignancy in the world, and melanoma is responsible for the majority of deaths attributed to it. Yet a new study from Lebanon suggests that even the people who will one day be counseling patients about sun safety are failing to protect themselves. In a large survey of more than a thousand medical students and residents, three out of four reported using sunscreen, but nearly four in five also reported having been sunburned at some point in their lives. The findings, published in BMC Cancer, expose a striking gap between what future physicians know about ultraviolet radiation and what they actually do when they step outside.
The research, led by Tia El Kazzi of the Lebanese University with co-authors Nazek Mansour and Mirna N. Chahine, set out to measure knowledge, attitudes, and practices related to sunscreen use, sun-protective behavior, and skin cancer among the country’s medical trainees. The team surveyed 1,063 participants between April 29 and June 15, 2023, drawing respondents from all eight medical faculties in Lebanon: the seven private schools, the American University of Beirut, Beirut Arab University, the Lebanese American University, Saint George University of Beirut, Holy Spirit University of Kaslik, the University of Balamand, and Saint Joseph University, along with the public Lebanese University. Because the sample spanned every medical school in the country, the authors argue it offers an unusually broad picture of how Lebanon’s next generation of doctors approaches photoprotection.
Participants were recruited through an English-language online questionnaire distributed via WhatsApp and Instagram using snowball sampling, a technique in which early respondents forward the survey to their peers. The instrument was designed around established behavioral frameworks. Sun-protective behavior was assessed using the stages-of-change construct from the Transtheoretical Model, which classifies individuals along a continuum from not considering a behavior to maintaining it consistently. Attitudes were captured with two validated instruments: the Decisional Balance Scale, which weighs the perceived pros and cons of adopting sun protection, and the Self-Efficacy Scale, which measures confidence in one’s ability to perform protective behaviors across different situations. Knowledge of sunscreen and skin cancer was tested with dedicated items, and the team used multivariate linear regression to identify independent predictors of the three main outcome scores.
The headline numbers reveal a paradox. On one hand, 75.2 percent of participants said they used sunscreen, a figure that might seem encouraging at first glance. On the other hand, 78.6 percent reported having experienced a prior sunburn, the single best-documented behavioral risk factor for later melanoma and other skin cancers. In other words, the majority of these future doctors had already sustained the kind of acute ultraviolet injury that dermatologists warn the public about, despite knowing precisely how such injury occurs and how to prevent it. The authors describe this as a clear disconnect between knowledge and preventive behavior, one that persists even in a group with privileged access to medical education.
The quantitative scores reinforce that impression. Participants demonstrated moderate knowledge, averaging 53.23 percent with a standard deviation of 14.31. Decisional balance scores averaged 14.15 out of a possible 20, and self-efficacy scores averaged 26.39 out of 45, both indicating middling rather than strong attitudinal readiness. Notably, the three measures were positively correlated with one another, with correlation coefficients ranging from 0.219 to 0.547 and all reaching statistical significance at p less than 0.001. This interdependence matters theoretically: it suggests that knowing more about skin cancer, feeling more confident about sun protection, and perceiving greater benefits from it tend to travel together, forming a psychological cluster that could be targeted as a whole rather than piecemeal.
The regression models, which adjusted for multiple variables simultaneously, identified who scored highest on each dimension. Higher knowledge was independently associated with being further along in medical training, having experienced a prior sunburn, higher self-efficacy, higher household income, attendance at a private university, and being at an advanced stage of sunscreen adoption; this model explained 21.4 percent of the variance in knowledge scores. Higher decisional balance scores were linked to higher self-efficacy, sunscreen use, female gender, higher knowledge, and advanced behavioral stage, with the model accounting for 40.5 percent of the variance. Higher self-efficacy, in turn, was predicted by higher decisional balance, sunscreen use, and advanced behavioral stage, explaining 36.6 percent of the variance. The pattern is consistent: behavioral readiness, attitudinal confidence, and factual knowledge reinforce one another in a loop, and academic progression only partially breaks through.
Several of these predictors deserve closer attention. The association between higher academic year and greater knowledge is reassuring in one sense, since it suggests that medical education does incrementally deliver content about skin cancer and photoprotection. But the fact that knowledge remained only moderate even among senior trainees hints that this content is thin, fragmented, or delivered too late. The link between prior sunburn and higher knowledge is equally double-edged: it may reflect heightened awareness after a personal scare, but it also means that the educational system is being outpaced by ultraviolet exposure itself. Socioeconomic gradients, visible in the independent effects of household income and private university affiliation, point to structural inequities in access to both information and protective products, a reminder that sun safety is not only a matter of individual willpower.
The role of self-efficacy emerges as perhaps the most actionable finding. In behavioral science, self-efficacy, the belief that one can successfully carry out a behavior in real-world conditions, is often the strongest lever for change, because knowledge alone rarely translates into action. Here, self-efficacy was independently tied to both knowledge and decisional balance, and it clustered tightly with advanced stages of sunscreen adoption. Participants who believed they could apply sunscreen before class, reapply it during hospital shifts, or seek shade during long outdoor commitments were far more likely to actually do so. This suggests that interventions should go beyond lecturing about ultraviolet radiation and instead build practical confidence: rehearsing routines, addressing barriers specific to hospital life, and normalizing sun protection as part of professional identity.
The authors argue that the findings carry implications well beyond Lebanon. Medical students and residents occupy a dual role in skin cancer prevention: they are future counselors who will advise patients on sunscreen, protective clothing, and skin checks, and they are role models whose own behavior shapes what patients perceive as normal. A physician who preaches daily sunscreen but arrives at clinic sunburned undermines the message before saying a word. The study’s conclusion is that preventive competencies are strongly associated with academic progression, behavioral readiness, and self-efficacy, and that integrating structured, stage-specific sun protection education early in medical training could improve trainees’ own behaviors while strengthening their capacity to guide patients. Stage-specific means matching the intervention to where the learner sits on the Transtheoretical Model continuum, nudging precontemplators toward awareness and helping maintainers sustain their habits.
For a country with abundant sunshine and a Mediterranean climate, the stakes are concrete. Lebanon’s medical trainees will spend decades working under high ultraviolet conditions and treating a population similarly exposed. The study, which received no external funding and was approved by the Institutional Review Board of Al-Zahraa Hospital University Medical Center, offers a baseline that other countries in the region could replicate. Its core message is deceptively simple: knowing about skin cancer is not the same as preventing it, even for people trained to do exactly that. Closing that gap, the authors contend, requires embedding sun protection into the earliest years of medical curricula, treating it not as an optional dermatology footnote but as a core preventive skill that future physicians must first practice on themselves.
Subject of Research: Knowledge, attitudes, and practices regarding sunscreen use, sun protection, and skin cancer prevention among medical students and residents in Lebanon
Article Title: Knowledge, attitude, and practice towards sunscreen use, sun protective behavior, and skin cancer among Lebanese medical students and residents
Article References: El Kazzi, T., Mansour, N., & Chahine, M. N. (2026). Knowledge, attitude, and practice towards sunscreen use, sun protective behavior, and skin cancer among Lebanese medical students and residents. BMC Cancer. https://doi.org/10.1186/s12885-026-17074-z
Image Credits: AI Generated
DOI: 10.1186/s12885-026-17074-z
Keywords: skin cancer, sunscreen, sun protection, medical students, residents, self-efficacy, Transtheoretical Model, melanoma, Lebanon, health behavior, cancer prevention, dermatology
News Source: Nathaniel Bowman. (October 8, 2026). Future Doctors Know the Risks but Still Get Sunburned, Lebanese Study Finds. Scienmag.
