Department of Dermatology, Hofstra North Shore Long Island Jewish School of Medicine, Hempstead, New York.
Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts.
JAMA Dermatol. 2014 Aug;150(8):850-5. doi: 10.1001/jamadermatol.2013.8723.
As medical school curricula become progressively integrated, a need exists to optimize education related to the skin cancer examination (SCE) for melanoma, a relevant competency gap that influences secondary prevention efforts.
To identify curricular factors associated with medical students' confidence, intent, and performance regarding the SCE.
DESIGN, SETTING, AND PARTICIPANTS: Survey-based cross-sectional study from the Integrated Skin Exam Consortium at accredited US medical schools among a volunteer sample of second-year students representing 8 geographically varied public and private institutions. Students were administered a questionnaire to assess characteristics, curricular exposures, and educational and practical experiences related to skin cancer, as well as knowledge of melanoma risk and a detection method.
Primary outcomes were confidence in performing the SCE, intent to perform an integrated skin examination, and actual performance of the SCE.
Physical diagnosis session and clinical encounter were most predictive of confidence in performance of the SCE (odds ratios [ORs], 15.35 and 11.48, respectively). Other curricular factors associated with confidence included instruction time of at least 60 minutes on skin cancer (OR, 6.35), lecture on the SCE (OR, 7.54), knowledge of melanoma risk (OR, 3.71), and at least 1 opportunity to observe the SCE (OR, 2.70). Physical diagnosis session and at least 4 opportunities to observe the SCE were most predictive of intent to perform an integrated skin examination (ORs, 4.84 and 4.72, respectively). Other curricular factors associated with intent included knowledge of melanoma risk (OR, 1.83), clinical encounter (OR, 2.39), and at least 1 opportunity to observe the SCE (OR, 1.95). Clinical encounter, physical diagnosis session, and at least 1 opportunity to observe the SCE were most predictive of performance of the SCE (ORs, 21.67, 15.48, and 9.92, respectively). Other curricular factors associated with performance included instruction time of at least 60 minutes on skin cancer (OR, 2.42) and lecture on the SCE (OR, 5.04).
To augment the practice of the SCE among medical students, course directors may design an integrated curriculum that includes at least 60 minutes of instruction related to melanoma and the SCE, a description of the integrated skin examination as part of the physical diagnosis course, and education on high-risk demographic groups and anatomic sites specific to men and women and on the ABCDEs of melanoma, and at least 1 opportunity to observe the SCE.
随着医学院课程的不断整合，需要优化与黑色素瘤相关的皮肤癌检查 (SCE) 教育，这是一个相关的能力差距，影响着二级预防工作。
确定与医学生对 SCE 的信心、意向和表现相关的课程因素。
设计、地点和参与者：来自美国认可的医学院的综合皮肤检查联盟的基于调查的横断面研究，对来自 8 个地理位置不同的公立和私立机构的代表二年级学生的志愿者样本进行调查。学生们接受了一份问卷，以评估与皮肤癌相关的特征、课程接触以及教育和实践经验，以及对黑色素瘤风险和检测方法的了解。
主要结果是对进行 SCE 的信心、进行综合皮肤检查的意向以及实际进行 SCE 的表现。
物理诊断课程和临床接触是对 SCE 表现信心的最具预测性因素（优势比[OR]，分别为 15.35 和 11.48）。与信心相关的其他课程因素包括至少 60 分钟的皮肤癌教学时间（OR，6.35）、关于 SCE 的讲座（OR，7.54）、对黑色素瘤风险的了解（OR，3.71）和至少 1 次观察 SCE 的机会（OR，2.70）。物理诊断课程和至少 4 次观察 SCE 的机会是进行综合皮肤检查意向的最具预测性因素（OR，分别为 4.84 和 4.72）。与意向相关的其他课程因素包括对黑色素瘤风险的了解（OR，1.83）、临床接触（OR，2.39）和至少 1 次观察 SCE 的机会（OR，1.95）。临床接触、物理诊断课程和至少 1 次观察 SCE 是对 SCE 表现的最具预测性因素（OR，分别为 21.67、15.48 和 9.92）。与表现相关的其他课程因素包括至少 60 分钟的皮肤癌教学时间（OR，2.42）和关于 SCE 的讲座（OR，5.04）。
为了提高医学生进行 SCE 的实践能力，课程负责人可以设计一个综合课程，包括至少 60 分钟的黑色素瘤和 SCE 相关教学、作为物理诊断课程一部分的综合皮肤检查描述、对高危人群和男女特定解剖部位以及 ABCDEs 的黑色素瘤教育，以及至少 1 次观察 SCE 的机会。
