Abstract
Background: Early detection of melanoma represents an opportunity to reduce the burden of disease among people at increased risk for melanoma. Objective: To develop and demonstrate the efficacy of online training. Design: Randomized educational trial. Participants: Primary care providers (PCPs). Intervention: Mastery learning course with visual and dermoscopic assessment, diagnosis and management, and deliberate practice with feedback to reach a minimum passing standard. Main Measures: Pre-test/post-test diagnostic accuracy. Referral of concerning lesions for 3 months before and after the educational intervention. Key Results: 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) (χ2 [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; ηp 2 = 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; ηp 2 = 0.489; F[1,79] = 25.82, p < 0.001; ηp 2 = 0.246; F[1,79] = 34.25, p < 0.001; ηp 2 = 0.302; respectively). Those receiving training referred significantly more melanomas than controls (F[1,79] = 24.38, p < 0.001; ηp 2 = 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. Conclusions: 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.
Original language | English (US) |
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Pages (from-to) | 855-862 |
Number of pages | 8 |
Journal | Journal of general internal medicine |
Volume | 33 |
Issue number | 6 |
DOIs | |
State | Published - Jun 1 2018 |
Funding
Acknowledgements This study was supported by R21CA182725 from the National Cancer Institute (Dr. Robinson). Support for the pilot research to develop the library of curated images was provided by Cures Within Reach through a grant from Margaret Christie. Drs. Kelsey Flood and Stephanie Wang assisted in the validation of the images. Yasmeen Ali, MD, and Katie Reidy, MS, served as research assistants and were supported by R21CA182725. The website was developed and maintained by Canfield Scientific, Inc., Fairfield, NJ.
ASJC Scopus subject areas
- Internal Medicine