Casas Rachel S, Ramachandran Ambili, Gunn Christine M, Weinberg Janice M, Shaffer Kitt
Assistant Professor, Department of Medicine, Pennsylvania State University College of Medicine.
Assistant Professor, Department of Medicine, University of Texas Health San Antonio.
MedEdPORTAL. 2017 Nov 21;13:10654. doi: 10.15766/mep_2374-8265.10654.
High breast density is an independent risk factor for breast cancer and can decrease the sensitivity of mammography. However, evidence surrounding recommendations for patient risk stratification and supplemental screening is evolving, and providers receive limited training on breast density counseling.
We implemented an introductory, interactive workshop about breast density including current evidence behind supplemental screening and risk stratification. Designed for providers who counsel women on breast health, this workshop was evaluated with internal medicine providers, primary care residents, and radiology residents. We surveyed participants about knowledge and attitudes at baseline, postintervention (residents and providers), and 3-month follow-up (providers only). We compared baseline and postintervention scores and postintervention and 3-month follow-up scores using paired tests and McNemar's tests.
Internal medicine providers had significant gains in knowledge when comparing baseline to postintervention surveys (6.5-8.5 on a 10-point scale, < .0001), with knowledge gains maintained when comparing postintervention to 3-month follow-up surveys ( = .06). Primary care and radiology residents also had significant gains in knowledge when comparing baseline to postintervention surveys ( < .004 for both). All learner groups reported increases in their confidence regarding counseling women about breast density and referring for supplemental screening.
Through this breast density session, we showed trends for increased knowledge and change in attitudes for multiple learner groups. Because we aim to prepare providers with the best currently available recommendations, these materials will require frequent updating as breast density evidence and national consensus evolve.
乳腺密度高是乳腺癌的一个独立危险因素，并且会降低乳房X线摄影的敏感性。然而，关于患者风险分层和补充筛查建议的相关证据仍在不断发展，而医疗服务提供者在乳腺密度咨询方面接受的培训有限。
我们开展了一个关于乳腺密度的入门互动研讨会，内容包括补充筛查和风险分层背后的当前证据。该研讨会是为向女性提供乳腺健康咨询的医疗服务提供者设计的，由内科医疗服务提供者、初级保健住院医师和放射科住院医师参与评估。我们在基线、干预后（住院医师和医疗服务提供者）以及3个月随访（仅医疗服务提供者）时对参与者的知识和态度进行了调查。我们使用配对t检验和 McNemar检验比较了基线和干预后的分数以及干预后和3个月随访的分数。
与基线相比，内科医疗服务提供者在干预后的知识水平有显著提高（10分制下从6.5分提高到8.5分，P<0.0001），与3个月随访相比，知识水平保持提高（P = 0.06）。与基线相比，初级保健和放射科住院医师在干预后的知识水平也有显著提高（两者P均<0.004）。所有学习者群体都表示，他们在为女性提供乳腺密度咨询和推荐补充筛查方面的信心有所增强。
通过这次乳腺密度课程，我们展示了多个学习者群体知识增加和态度改变的趋势。由于我们的目标是让医疗服务提供者掌握当前最佳的可用建议，随着乳腺密度证据和国家共识的发展，这些材料需要经常更新。
