A structured curriculum and procedure clinic to help family medicine residents diagnose and treat skin cancer  <span class="so-article-trans-title" dir="auto"> Translated title: Un programme d&apos;enseignement clinique structuré pour aider les résidents en médecine familiale à diagnostiquer et à traiter le cancer de la peau </span>

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Implication Statement

Melanoma is a potentially deadly type of skin cancer that has been increasing in incidence but is curable if found in the early stages. Family physicians are in an ideal situation to examine the skin during routine visits, but studies indicate they are not well trained to detect or treat skin cancers. We piloted a structured, longitudinal, hands-on procedural curriculum to improve family medicine residents’ ability to identify and manage skin cancers. Family medicine residency programs wishing to improve the diagnosis and management of skin cancer by family physicians might consider trialing our structured curriculum and procedure clinic.

Énoncé des implications de la recherche

Le mélanome est un type de cancer de la peau potentiellement mortel qui est de plus en plus fréquent, mais qui est guérissable sous réserve d'une détection précoce. La visite de routine chez le médecin de famille est l’occasion idéale pour examiner la peau. Les études indiquent toutefois que les médecins de famille n'ont pas le niveau de formation nécessaire pour détecter et traiter les cancers de la peau. Nous avons piloté un programme structuré longitudinal axé sur la pratique visant à améliorer la capacité des résidents en médecine familiale à identifier et à traiter ce type de cancer. Nous invitons les responsables de programmes de résidence en médecine familiale qui souhaitent améliorer le diagnostic et la prise en charge des cancers cutanés par les médecins de famille à expérimenter notre programme structuré sur les procédures cliniques.

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Most cited references 6

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Skin cancer education for primary care physicians: a systematic review of published evaluated interventions.

Jacqueline M Goulart, Elizabeth A Quigley, Stephen Dusza … (2011)

Early detection of melanoma may provide an opportunity to positively impact melanoma mortality. Numerous skin cancer educational interventions have been developed for primary care physicians (PCPs) to improve diagnostic accuracy. Standardized training is also a prerequisite for formal testing of melanoma screening in the primary care setting. We conducted a systematic review to determine the extent of evaluated interventions designed to educate PCPs about skin cancer, including melanoma. Relevant studies in the English language were identified through systemic searches performed in MEDLINE, EMBASE, BIOSIS, and Cochrane through December 2010. Supplementary information was obtained from corresponding authors of the included studies when necessary. Studies eligible for inclusion formally evaluated skin cancer education interventions and were designed primarily for PCPs. Excluded studies lacked a specified training intervention, used decision-making software, focused solely on risk factor identification, or did not directly educate or assess participants. Twenty studies met the selection criteria. Data were extracted according to intervention content and delivery format, and study outcomes. All interventions included instructions about skin cancer diagnosis, but otherwise varied in content. Curricula utilized six distinct educational techniques, usually incorporating more than one. Intervention duration varied from 12 min to over 6 h. Eight of the 20 studies were randomized trials. Most studies (18/20, 90%) found a significant improvement in at least one of the following five outcome categories: knowledge, competence, confidence, diagnostic performance, or systems outcomes. Competence was most commonly measured; no study evaluated all categories. Variability in study design, interventions, and outcome measures prevented correlation of outcomes with intervention characteristics. Despite the development of many isolated educational interventions, few have been tested rigorously or evaluated under sufficient standardized conditions to allow for quantitative comparison. Improved and rigorously tested skin cancer educational interventions for PCPs with outcome measures focusing on changes in performance are needed.

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Diagnostic and referral accuracy of family doctors in melanoma screening: effect of a short formal training.

P Carli, V De Giorgi, E Crocetti … (2005)

Little is known about ability of family doctors in the diagnosis and management (decision as to dermatologic referral) of pigmented skin lesions. We sought to evaluate the impact of a short formal training on diagnostic and referral accuracy of family doctors in melanoma screening. A formal 4-h training session was given to a sample of 41 practising family doctors working in the Florence health district, Tuscany, Italy. Before and after the course, a diagnostic test with a series of clinical images of pigmented skin lesions including four invasive melanomas (mean thickness, 1.5 mm; range, 0.8-2.2) was performed (open intervention study). Although only 46.8% of observations yielded a correct melanoma diagnosis at baseline, 96.1% of melanoma observations were correctly associated with intention to refer the lesion to dermatologist. After training, the percentage of correct melanoma diagnosis significantly increased (76.2%, P=0.01) while no further improvement was found as to sensitivity of referral (94.8%, P=0.58). Compared to baseline, post-training evaluation showed a significant reduction of benign lesions sent to dermatologist: the percentage lowered from 52.1 to 35.8% (P=0.0014) for melanocytic nevi and from 38.6 to 17.5% (P<0.001) for benign non-melanocytic lesions (pigmented seborrheic keratoses, dermatofibromas, and vascular lesions). Grouping these two diagnostic categories, the overall specificity in dermatology referral increased from 55.0% at baseline to 73.1% after training (P<0.001). In conclusion, attendance at a 4-h formal training session was able to increase the specificity of family doctors as to dermatologist referral of suspicious lesions (less false-positive referral of benign lesions) without significant loss in sensitivity concerning melanoma.

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2-Week wait referrals in suspected skin cancer: does an instructional module for general practitioners improve diagnostic accuracy?

Z. Shariff, A Roshan, A.M. Williams … (2010)

The two-week wait (2WW) scheme in the United Kingdom for suspected skin cancer has been criticised for having low pick up rates, with a high proportion of clinically benign lesions being referred as suspicious. We studied the referral patterns of skin cancer to our hospital under the 2WW initiative, and aimed to quantify the effect of a targeted continuing medical education (CME) module on improving diagnostic accuracy. All referrals to our hospital (dermatology and plastic surgery) under the 2WW rule were audited between July and September 2006. A targeted CME module was sent to GPs describing and illustrating common lesions. After 11 months, all 2WW referrals were prospectively studied between August and October 2007. The main outcome measure was the percentage of correctly referred squamous cell carcinomas (SCCs) and melanomas. 237 referrals were made between July and August 2006, and 223 referrals between August and October 2007. The proportion of appropriately referred skin cancers (SCCs and melanomas) was 23.2% before CME, and 20.6% after CME. There were no differences in pick up rates before and after the CME amongst suspected SCCs (21.1% vs. 29.7%) or melanomas (24.6% vs. 15.1% respectively). Referrals to Plastic Surgery were more likely to be confirmed histologically as melanomas or SCCs (23.6% and 33.7% respectively) than those made to Dermatology (17.5% and 15.3% respectively). The proportion of correctly suspected skin malignancies under the 2WW initiative remains low despite education. A targeted CME module sent to GPs fails to improve pick up rates. There is a need for continuing dermatology training amongst referring physicians.

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Author and article information

Journal

Journal ID (nlm-ta): Can Med Educ J

Journal ID (iso-abbrev): Can Med Educ J

Journal ID (publisher-id): CMEJ

Title: Canadian Medical Education Journal

Publisher: Canadian Medical Education Journal

ISSN (Electronic): 1923-1202

Publication date (Electronic preprint): 06 July 2021

Publication date (Electronic): 29 December 2021

Publication date Collection: December 2021

Volume: 12

Issue: 6

Pages: 108-111

Affiliations

[1 ]Department of Family Medicine, University of Ottawa, Ontario, Canada;

[2 ]Bruyère Research Institute, Ontario, Canada

Author notes

Correspondence to: Douglas Archibald Bruyère Research Institute, 85 Primrose Ave., Ottawa ON K1R 6M1; email: douglas.archibald@ 123456uottawa.ca

Article

Publisher ID: CMEJ-12-108

DOI: 10.36834/cmej.69825

PMC ID: 8740245

SO-VID: ce81f31e-9b24-4ee2-8ef0-41b3b039c444

License:

This is an Open Journal Systems article distributed under the terms of the Creative Commons Attribution License. ( https://creativecommons.org/licenses/by-nc-nd/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is cited.

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