Cyr Peggy R, Craig Wendy, Ahrns Hadjh, Stevens Kathryn, Wight Caroline, Seiverling Elizabeth
Department of Family Medicine, Maine Medical Center, Portland, ME | and Tufts University School of Medicine, Boston, MA.
Maine Medical Center, Portland, ME.
PRiMER. 2021 Feb 8;5:6. doi: 10.22454/PRiMER.2021.304379. eCollection 2021.
Early detection of melanoma skin cancer improves survival rates. Training family physicians in dermoscopy with the triage amalgamated dermoscopic algorithm (TADA) has high sensitivity and specificity for identifying malignant skin neoplasms. In this study we evaluated the effectiveness of TADA training among medical students, compared with practicing clinicians.
We incorporated the TADA framework into 90-minute workshops that taught dermoscopy to family physicians, primary care residents, and first- and second-year medical students. The workshop reviewed the clinical and dermoscopic features of benign and malignant skin lesions and included a hands-on interactive session using a dermatoscope. All participants took a 30-image pretest and a different 30-image posttest.
Forty-six attending physicians, 25 residents, and 48 medical students participated in the workshop. Mean pretest scores were 20.1, 20.3, and 15.8 for attending physicians, resident physicians and students, respectively (<.001); mean posttest scores were 24.5, 25.9, and 24.1, respectively (=.11). Pre/posttest score differences were significant ( <.001) for all groups. The medical students showed the most gain in their pretest and posttest scores.
After short dermoscopy workshop, medical students perform as well as trained physicians in identifying images of malignant skin lesions. Dermoscopy training may be a valuable addition to the medical school curriculum as this skill can be used by primary care physicians as well as multiple specialists including dermatologists, gynecologists, otolaryngologists, plastic surgeons, and ophthalmologists, who often encounter patients with concerning skin lesions.
早期发现皮肤黑色素瘤可提高生存率。采用分诊合并皮肤镜算法(TADA)对家庭医生进行皮肤镜培训,在识别恶性皮肤肿瘤方面具有较高的敏感性和特异性。在本研究中,我们评估了与执业临床医生相比,TADA培训在医学生中的效果。
我们将TADA框架纳入为时90分钟的研讨会,向家庭医生、初级保健住院医师以及大一和大二医学生传授皮肤镜检查知识。该研讨会回顾了良性和恶性皮肤病变的临床及皮肤镜特征,并包括使用皮肤镜的实践互动环节。所有参与者都进行了一次30张图像的预测试和一次不同的30张图像的后测试。
46名主治医师、25名住院医师和48名医学生参加了该研讨会。主治医师、住院医师和学生的预测试平均得分分别为20.1、20.3和15.8(<.001);后测试平均得分分别为24.5、25.9和24.1(=.11)。所有组的预/后测试得分差异均具有显著性(<.001)。医学生在预测试和后测试得分中提高最多。
经过简短的皮肤镜检查研讨会后,医学生在识别恶性皮肤病变图像方面的表现与受过培训的医生相当。皮肤镜检查培训可能是医学院课程中一项有价值的补充内容,因为这项技能可供初级保健医生以及包括皮肤科医生、妇科医生、耳鼻喉科医生、整形外科医生和眼科医生在内的多个专科医生使用,这些专科医生经常会遇到有可疑皮肤病变的患者。