Melanoma simulation model: promoting opportunistic screening and patient counseling

JAMA Dermatol. 2013 Jun;149(6):710-6. doi: 10.1001/jamadermatol.2013.2882.

Abstract

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, χ2 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, χ2 test). Detection of the melanoma moulage on the standardized patient occurred more often by trained students (P < .05, χ2 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.

Trial registration: clinicaltrials.gov Identifier: NCT01191294.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Biopsy / methods
  • Clinical Clerkship
  • Clinical Competence
  • Competency-Based Education / methods*
  • Counseling / methods
  • Education, Medical, Undergraduate / methods*
  • Female
  • Humans
  • Male
  • Mass Screening / methods
  • Melanoma / diagnosis*
  • Melanoma / pathology
  • Models, Biological
  • Skin Neoplasms / diagnosis*
  • Skin Neoplasms / pathology
  • Students, Medical*
  • Videotape Recording
  • Young Adult

Associated data

  • ClinicalTrials.gov/NCT01191294