Gerbert B, Bronstone A, Wolff M, Maurer T, Berger T, Pantilat S, McPhee S J
Department of Dental Public Health, School of Dentistry, University of California, San Francisco, 94111, USA.
J Gen Intern Med. 1998 Feb;13(2):91-7. doi: 10.1046/j.1525-1497.1998.00024.x.
To determine whether a brief, multicomponent intervention could improve the skin cancer diagnosis and evaluation planning performance of primary care residents to a level equivalent to that of dermatologists.
Fifty-two primary care residents (26 in the control group and 26 in the intervention group) and 13 dermatologists completed a pretest and posttest.
A randomized, controlled trial with pretest and posttest measurements of residents' ability to diagnose and make evaluation plans for lesions indicative of skin cancer.
The intervention included face-to-face feedback sessions focusing on residents' performance deficiencies; an interactive seminar including slide presentations, case examples, and live demonstrations; and the Melanoma Prevention Kit including a booklet, magnifying tool, measuring tool, and skin color guide.
We compared the abilities of a control and an intervention group of primary care residents, and a group of dermatologists to diagnose and make evaluation plans for six categories of skin lesions including three types of skin cancer-malignant melanoma, squamous cell carcinoma, and basal cell carcinoma. At posttest, both the intervention and control group demonstrated improved performance, with the intervention group revealing significantly larger gains. The intervention group showed greater improvement than the control group across all six diagnostic categories (a gain of 13 percentage points vs 5, p < .05), and in evaluation planning for malignant melanoma (a gain of 46 percentage points vs 36, p < .05) and squamous cell carcinoma (a gain of 42 percentage points vs 21, p < .01). The intervention group performed as well as the dermatologists on five of the six skin cancer diagnosis and evaluation planning scores with the exception of the diagnosis of basal cell carcinoma.
Primary care residents can diagnose and make evaluation plans for cancerous skin lesions, including malignant melanoma, at a level equivalent to that of dermatologists if they receive relevant, targeted education.
确定一种简短的多成分干预措施能否将初级保健住院医师的皮肤癌诊断和评估计划能力提高到与皮肤科医生相当的水平。
52名初级保健住院医师（26名在对照组，26名在干预组）和13名皮肤科医生完成了一项前测和后测。
一项随机对照试验，对住院医师诊断和制定皮肤癌相关病变评估计划的能力进行前测和后测。
干预包括针对住院医师表现缺陷的面对面反馈会议；一个互动研讨会，包括幻灯片展示、案例分析和现场演示；以及黑色素瘤预防工具包，其中包括一本手册、一个放大镜工具、一个测量工具和一本肤色指南。
我们比较了初级保健住院医师对照组和干预组以及一组皮肤科医生对六类皮肤病变（包括三种皮肤癌——恶性黑色素瘤、鳞状细胞癌和基底细胞癌）进行诊断和制定评估计划的能力。在后测中，干预组和对照组的表现均有所改善，干预组的进步更为显著。在所有六个诊断类别中，干预组的改善均大于对照组（提高了13个百分点，而对照组提高了5个百分点，p < 0.05），在恶性黑色素瘤（提高了46个百分点，而对照组提高了36个百分点，p < 0.05）和鳞状细胞癌（提高了42个百分点，而对照组提高了21个百分点，p < 0.01）的评估计划方面也是如此。除了基底细胞癌的诊断外，干预组在六项皮肤癌诊断和评估计划评分中的五项上表现与皮肤科医生相当。
如果接受相关的针对性教育，初级保健住院医师能够以与皮肤科医生相当的水平诊断和制定皮肤癌病变（包括恶性黑色素瘤）的评估计划。
