Department of Dermatology , Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Department of Dermatology, Memorial Sloan-Kettering Cancer Center, Hauppauge, NY, USA.
J Gen Intern Med. 2018 Jun;33(6):855-862. doi: 10.1007/s11606-018-4311-3. Epub 2018 Feb 5.
Early detection of melanoma represents an opportunity to reduce the burden of disease among people at increased risk for melanoma.
To develop and demonstrate the efficacy of online training.
Randomized educational trial.
Primary care providers (PCPs).
Mastery learning course with visual and dermoscopic assessment, diagnosis and management, and deliberate practice with feedback to reach a minimum passing standard.
Pre-test/post-test diagnostic accuracy. Referral of concerning lesions for 3 months before and after the educational intervention.
Among the 89 PCPs, 89.8% were internal medicine physicians, and the remainder were physician assistants embedded in internists' practices. There were no differences between control and intervention groups regarding gender, age, race, or percentage of full-time PCPs. The control group had more PCPs who reported less than 5 years of practice (n = 18) than the intervention group (n = 6) (χ [6, n = 89] = 14.34, p = 0.03). PCPs in the intervention group answered more melanoma detection questions correctly on the post-test (M = 10.05, SE = 1.24) compared to control group PCPs (M = 7.11, SE = 0.24), and had fewer false-positive and no false-negative melanoma diagnoses (intervention, M = 1.09, SE = 0. 20; control, M = 3.1, SE = 0.23; ANCOVA, F[1,378] =27.86, p < 0.001; η = 0.26). PCPs who underwent training referred fewer benign lesions, including nevi, seborrheic keratoses, and dermatofibromas, than control PCPs (F[1,79] = 72.89, p < 0.001; η = 0.489; F[1,79] = 25.82, p < 0.001; η = 0.246; F[1,79] = 34.25, p < 0.001; η = 0.302; respectively). Those receiving training referred significantly more melanomas than controls (F[1,79] = 24.38, p < 0.001; η = 0.236). Referred melanomas (0.8 ± 0.07 per month for intervention, 0.17 ± 0.06 for control) were mostly located on the head and neck.
Mastery learning improved PCPs' ability to detect melanoma on a standardized post-test and may improve referral of patients with suspected melanoma. Further studies are needed to confirm this finding. ClinicalTrials.gov NCT02385253.
早期发现黑色素瘤为高危人群减轻疾病负担提供了机会。
开发和证明在线培训的效果。
随机教育试验。
初级保健提供者（PCP）。
掌握学习课程，包括视觉和皮肤镜评估、诊断和管理，以及通过反馈进行刻意练习，以达到最低通过标准。
预测试/后测试诊断准确性。在教育干预前后 3 个月内对可疑病变进行转诊。
在 89 名 PCP 中，89.8%为内科医生，其余为内科医生实践中的医师助理。对照组和干预组在性别、年龄、种族或全职 PCP 比例方面无差异。对照组中报告实践年限少于 5 年的 PCP（n=18）多于干预组（n=6）（χ[6，n=89]=14.34，p=0.03）。干预组的 PCP 在后测中答对了更多的黑色素瘤检测问题（M=10.05，SE=1.24），而对照组的 PCP 答对了 7.11（SE=0.24），并且干预组的 PCP 有更少的假阳性和没有假阴性黑色素瘤诊断（干预组 M=1.09，SE=0.20；对照组 M=3.1，SE=0.23；协方差分析，F[1，378]=27.86，p<0.001；η=0.26）。接受培训的 PCP 比对照组 PCP 转诊的良性病变（包括痣、脂溢性角化病和皮肤纤维瘤）更少（F[1，79]=72.89，p<0.001；η=0.489；F[1，79]=25.82，p<0.001；η=0.246；F[1，79]=34.25，p<0.001；η=0.302；分别）。接受培训的 PCP 转诊的黑色素瘤明显多于对照组（F[1，79]=24.38，p<0.001；η=0.236）。转诊的黑色素瘤（干预组每月 0.8±0.07，对照组 0.17±0.06）主要位于头颈部。
掌握学习提高了 PCP 在后测中识别黑色素瘤的能力，可能提高了对可疑黑色素瘤患者的转诊率。需要进一步研究来证实这一发现。ClinicalTrials.gov NCT02385253。
