Melanoma simulation model: Promoting opportunistic screening and patient counseling

Importance: Lack of training hampers melanoma recognition by physicians. Objective: To evaluate a melanoma simulation model to teach visual assessment and counseling skills. Design and Setting: Simulation model study in an academic research setting. Participants: A convenience sample of third-year medical students was randomly assigned to receive the intervention before or after a standardized patient. Intervention: During the primary care clerkship, medical students participated in melanoma skills training using 2 simulation models replicating melanomas and abnormal or benign nevi. Scoring threshold rules for visual assessment and management of pigmented lesions and videos of patient counseling were provided. Main Outcome Measures: Identifying a melanoma moulage and counseling the standardized patient. Secondary measures were preintervention and 2-week postintervention knowledge, attitudes about and confidence in their ability to perform opportunistic surveillance and counseling, as well as identification on the model of clinically suspicious pigmented lesions, lesions needing a biopsy, and lesions to be monitored for change. Results: Among 74 students, confidence in their ability to perform opportunistic surveillance improved significantly after skills training (P<.05, X² test). Monitoring clinically suspicious lesions for change decreased from 16% (12 of 74) to 3% (2 of 74) and performing a biopsy increased from 80% (59 of 74) to 96% (71 of 74), monitoring benign lesions for change decreased from 43% (32 of 74) to 3% (2 of 74), and biopsying melanoma in situ increased from 10% (7 of 74) to 26% (20 of 74) (P<.05 for all, X² test). Detection of the melanoma moulage on the standardized patient occurred more often by trained students (P<.05, X² test). Conclusion and Relevance: A 1-hour melanoma simulation education and skills training experience improved performance of opportunistic surveillance, management, and patient counseling by third-year medical students.