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Assessing students’ ability to detect melanomas using standardized patients and moulage - 09/02/13

Doi : 10.1016/j.jaad.2011.10.032 
Claudia Hernandez, MD a, , Robin Mermelstein, PhD b, June K. Robinson, MD c, Rachel Yudkowsky, MD, MHPE d
a Department of Dermatology, University of Illinois at Chicago, Chicago, Illinois 
b Institute for Health Research and Policy and Department of Psychology, University of Illinois at Chicago, Chicago, Illinois 
d Department of Medical Education, University of Illinois at Chicago, Chicago, Illinois 
c Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 

Correspondence to: Claudia Hernandez, MD, Department of Dermatology (MC 624), University of Illinois at Chicago, 808 S Wood St, Room 376 CME, Chicago, IL 60612.

Abstract

Background

Detection of melanoma by physicians via opportunistic surveillance during focused physical examinations may reduce mortality. Medical students may not encounter a clinical case of melanoma during a dermatology clerkship.

Objective

This study examined the proficiency of fourth-year University of Illinois at Chicago medical students at detecting melanomas.

Methods

Melanoma moulages were applied to the second digit of the left hand of standardized patients (SPs) participating in a wrist pain scenario during a required clinical skills examination. An observer reviewed videotapes of the examination, written SP checklists, and student notes for evidence that the student noticed the moulage, obtained a history, or provided counseling.

Results

Among the 190 fourth-year medical students, 56 students were observed noticing the lesion; however, 13 failed to write it in their notes or advise the patient. The detection rate was 22.6% (43 of 190 students). Students who detected the probable melanoma consistently inquired about changes in the lesion and symptoms, but did not examine the rest of the skin or regularly palpate for adenopathy.

Limitations

Testing one class of students from a single medical school with a time-restricted SP encounter while focusing the students’ attention toward a different presenting symptom may hinder exploration of medical issues.

Conclusion

The low detection rate and failure of students who noticed the moulage to identify the lesion as atypical represents a lost opportunity to provide a patient intervention. Use of SP examinations may help physicians in training build confidence and competence in cutaneous malignancy screening.

Le texte complet de cet article est disponible en PDF.

Key words : assessment, detection rate, medical students, melanoma, skin surveillance, standardized patients


Plan


 Dr Hernandez is the recipient of the Dermatology Foundation Women’s Health Career Development Award, which partially supported this research.
 Conflicts of interest: None declared.
 Reprints not available from the authors.


© 2011  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 68 - N° 3

P. e83-e88 - mars 2013 Retour au numéro
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