By Melody J. Eide, MD, MPH
Here’s a shocking statistic: Although primary care physicians (PCPs) see more patients than any other physician group, less than 30 percent of primary care residents receive instruction on performing skin examinations during their medical training.
This lack of training has led to the inability of some PCPs to feel confident in examining the skin of their patients.
Improving these physicians’ skills to help them diagnose and manage skin lesions is an important way to improve care because patients frequently bring skin complaints to their family doctors. It is an important step in improving early diagnosis of melanoma and other cancers.
The study found that the 54 PCPs who took the online training course significantly improved their skill at properly diagnosing and managing benign and malignant lesions.
To improve detection by PCPs, our research team, led by Martin Weinstock, MD, PhD, professor of dermatology at Brown University, sought to evaluate whether PCPs could improve their skin cancer diagnostic skills if provided with targeted education.
The Internet Curriculum for Melanoma Early Detection (INFORMED) study tracked physician practice patterns as an outcome of an online skin cancer detection training course.
The study found that the 54 PCPs who took the online training course significantly improved their skills at properly diagnosing and managing benign and malignant lesions. These physicians’ enhanced skills also led to a reduction in unnecessary referrals to dermatology specialists without decreasing skin cancer diagnosis.
The key findings of the study include:
- Scores for diagnosing and managing all skin lesions increased 10 percent.
- Scores for diagnosing benign lesions increased 14 percent.
- Patient referrals for suspicious lesions or new visits to a dermatology specialist declined as the result of improved detection by primary care physicians.
- Physicians retained their improved skill several months later.
The findings were published in the November/December issue of the Journal of the American Board of Family Medicine.
The online course covers the three most common skin cancers — basal cell carcinoma, squamous cell carcinoma, and melanoma — and features 450 clinical images of lesions. Participants can choose from two Web options: A traditional textbook format and case-based format, and these take about two to three hours to complete. The case-based format, which was the format the majority of study participants preferred, features nine case studies with interactive self-assessment tests and immediate feedback.
Before taking the course in 2011, participants took a pre-test of 25 images of skin lesions in which they had to choose a diagnosis and course of action: Reassure or refer. Participants completed a post-test immediately after taking the course, and then repeated it six months later.
Their post-test scores were much higher than their pre-test scores. The scores suggest that prior to taking the course, the participants had the most difficulty distinguishing between benign and malignant skin lesions. Taking the course improved their ability to do so.
Online course available at no cost
To help educate PCPs across the country and improve the early diagnosis of skin cancer, we are making the course available at no cost, indefinitely. I encourage my colleagues in dermatology to inform PCPs in their areas about the availability of the course. Not only will it help reduce unnecessary referrals and improve skin cancer detection, it will help you solidify your relationships with local PCPs, which are more important than ever in the new health care landscape.
The INFORMED study, which was funded by the Melanoma Research Alliance, involved nine health care institutions: Henry Ford Hospital, Kaiser Permanente, Harvard Medical School, Harvard Pilgrim Health Care Institute, Harvard School of Public Health, Memorial Sloan-Kettering Cancer Center, Veterans Affairs Medical Center, Rhode Island Hospital, and Brown University. The course is available at no cost to physicians here.
Dr. Eide is a dermatologist and a public health researcher at Henry Ford Hospital, Departments of Dermatology and Public Health Sciences. She was lead author of the INFORMED study. She is a member of the AAD’s Clinical Guidelines Committee, Needs Assessment and Outcomes Committee, and the Congressional Policy Committee.
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