IMPROVING PRIMARY-CARE RESIDENTS PROFICIENCY IN THE DIAGNOSIS OF SKIN-CANCER

OBJECTIVE: To determine whether a brief, multicomponent intervention c ould improve the skin cancer diagnosis and evaluation planning perform ance of primary care residents to a level equivalent to that of dermat ologists. PARTICIPANTS: Fifty-two primary care residents (26 in the co ntrol group and 26 in the intervention group) and 13 dermatologists co mpleted a pretest and posttest. DESIGN:A randomized, controlled trial with pretest and posttest measurements of residents' ability to diagno se and make evaluation plans for lesions indicative of skin cancer, IN TERVENTION: The intervention included face-to-face feedback sessions f ocusing 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, MEASUREMENTS AND MAIN RESULTS: We compared the abilities of a control and an intervention group of p rimary care residents, and a group of dermatologists to diagnose and m ake evaluation plans for six categories of skin lesions including thre e types of skin cancer-malignant melanoma, squamous cell carcinoma, an d 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 gr eater improvement than the control group across all six diagnostic cat egories (a gain of 13 percentage points vs 5, p < .05), and in evaluat ion planning for malignant melanoma (a gain of 46 percentage points vs 36, p < .05) and squamous cell carcinoma (a gain of 42 percentage poi nts vs 21, p < .01). The intervention group performed as well as the d ermatologists on five of the six skin cancer diagnosis and evaluation planning scores with the exception of the diagnosis of basal cell carc inoma. CONCLUSIONS:Primary care residents can diagnose and make evalua tion plans for cancerous shin lesions, including melanoma, at a level equivalent to that of dermatologists if they receive relevant, targete d education.