Educational Interventions to Support Primary Care Provider Performance of Diagnostic Skin Cancer Examinations: A Systematic Literature Review

Posada, Eliza; Lauck, Kyle; Tran, Tiffaney; Krause, Kate; Nelson, Kelly C.

doi:10.1007/s13187-021-02118-8

Cited by 5 publications

(7 citation statements)

References 73 publications

(372 reference statements)

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“…Indeed, these tumours are primarily diagnosed by clinical examination. Therefore, the present ST provides consensus‐derived clinical skills with corrective learner feedback and measures outcomes such as competency/attitude using consensus validated instruments as recently recommended by Posada et al 58 …”

Section: Discussionmentioning

confidence: 99%

“…Indeed, these tumours are primarily diagnosed by clinical examination. Therefore, the present ST provides derived clinical skills with corrective learner feedback and measures outcomes such as competency/attitude using consensus validated instruments as recently recommended by Posada et al 58 To tackle the burden of skin cancers, it is essential that a large number of PCPs are trained in the early recognition of skin malignancies. To ensure that PCPs acquire basic knowledge in skin tumour diagnosis, such a short dermoscopy training could be taught to medical school students, as suggested by Cyr et al 59 However, it is to be feared that the training content will be quickly forgotten if not combined with regular use of dermoscopy in clinical practice and refreshing sessions.…”

Section: F I G U R Ementioning

confidence: 99%

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Evaluation of primary care physicians' competence in selective skin tumour triage after short versus long dermoscopy training: a randomized non‐inferiority trial

Harkemanne

Legrand²,

Sawadogo

et al. 2023

Acad Dermatol Venereol

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Background Although primary care physicians (PCPs) play a key role in skin cancer screening, their skills in detecting malignant tumours is suboptimal. Objectives To determine whether a short dermoscopy e‐learning course (4 h) in skin tumour diagnosis for PCPs is non‐inferior to a long course (12 h) in selective triage of skin lesions. Secondly, to evaluate whether regular refresher training sessions are necessary to maintain the PCPs' skills in the medium term. Methods A randomized 2 × 2 factorial non‐inferiority trial was conducted online over an 8‐month period among 233 PCPs including 126 certified general practitioners, 94 PCPs in training, and 13 occupational physicians, all without prior advanced dermoscopy training. Participants were randomized 1:1:1:1 to receive short training and mandatory refreshers (n = 58), short training and optional refreshers (n = 59), long training and mandatory refreshers (n = 58), or long training and optional refreshers (n = 58). PCPs' skills were evaluated before training (T0), immediately after training (T1) to test the non‐inferiority, and after 5 months (T2) to evaluate the impact of the refreshers. The primary endpoint was the difference in the change of score after short and long training. The non‐inferiority margin was set at −28%. Results Among the 233 randomized participants, 216 (93%) completed T1 and 197 (84.5%) completed T2. For short versus long training, the primary endpoint was 1.392 (95% CI: 0.138; 2.645) in the per‐protocol population (p < 0.001) and 1.016 (95% CI: −0.224; 2.256) in the modified intention‐to‐treat population (p < 0.001). After training, the type of refresher showed no impact on the score (p = 0.840). However, PCPs who completed all refreshers showed the best mean overall score at T2 (p < 0.001). Conclusions These findings confirm that short dermoscopy e‐learning is non‐inferior in training PCPs to triage skin lesions compared to long training. After training, regular refreshers are important to maintain the PCPs' acquired skills over time.

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Section: Discussionmentioning

confidence: 99%

Section: F I G U R Ementioning

confidence: 99%

Evaluation of primary care physicians' competence in selective skin tumour triage after short versus long dermoscopy training: a randomized non‐inferiority trial

Harkemanne

Legrand²,

Sawadogo

et al. 2023

Acad Dermatol Venereol

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“…The search strategy will be formulated, tested and refined for the individual databases by the lead researcher (NM) with the assistance of a Deakin University Health Liaison Librarian and the co-authors who have expertise in skin cancer research and training. Search terms, that is, subject headings and key words, will be based on the research question, condition (skin cancer), intervention type (training in dermoscopy) and study design (systematic or scoping review), and three a priori identified articles (‘gold set’) from the preliminary searches 21–23. The screening process will be used to identify possibly relevant reviews which include studies in the primary care setting and primary care providers.…”

Section: Methodsmentioning

confidence: 99%

“…While seeking effectiveness data to inform a cost-effectiveness analysis of training primary healthcare providers in dermoscopy for detecting skin cancer in Australia,20 it became evident there are at least four systematic and scoping reviews related to this topic 21–24. Review of reviews are particularly helpful when there are multiple reviews of unknown quality on a similar research question 25.…”

Section: Introductionmentioning

confidence: 99%

Protocol for a systematic review of reviews on training primary care providers in dermoscopy to detect skin cancers

McCaffrey,

Bucholc,

et al. 2023

BMJ Open

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IntroductionGlobally, incidence, prevalence and mortality rates of skin cancers are escalating. Earlier detection by well-trained primary care providers in techniques such as dermoscopy could reduce unnecessary referrals and improve longer term outcomes. A review of reviews is planned to compare and contrast the conduct, quality, findings and conclusions of multiple systematic and scoping reviews addressing the effectiveness of training primary care providers in dermoscopy, which will provide a critique and synthesis of the current body of review evidence.Methods and analysisFour databases (Cochrane, CINAHL, EMBASE and MEDLINE Complete) will be comprehensively searched from database inception to identify published, peer-reviewed English-language articles describing scoping and systematic reviews of the effectiveness of training primary care providers in the use of dermoscopy to detect skin cancers. Two researchers will independently conduct the searches and screen the results for potentially eligible studies using ‘Research Screener’ (a semi-automated machine learning tool). Backwards and forwards citation tracing will be conducted to supplement the search. A narrative summary of included reviews will be conducted. Study characteristics, for example, population; type of educational programme, including content, delivery method, duration and assessment; and outcomes for dermoscopy will be extracted into a standardised table. Data extraction will be checked by the second reviewer. Methodological quality will be evaluated by two reviewers independently using the Critical Appraisal Tool for Health Promotion and Prevention Reviews. Results of the assessments will be considered by the two reviewers and any discrepancies will be resolved by team consensus.Ethics and disseminationEthics approval is not required to conduct the planned systematic review of peer-reviewed, published articles because the research does not involve human participants. Findings will be published in a peer-reviewed journal, presented at leading public health, cancer and primary care conferences, and disseminated via website postings and social media channels.PROSPERO registration numberCRD42023396276.

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“…Before this study, no formal consensus existed on the fundamental competencies that PCPs should have with respect to dermoscopy for skin cancer detection. 19,20 While a foundational dermoscopy proficiency standard has been developed for dermatology residents, 21 the practice needs of PCPs differ from those of dermatologists, warranting a focused effort tailored to the primary care context. Therefore, the objective of this study was to develop an expert consensus statement on proficiency standards for PCPs learning or using dermoscopy.…”

Section: Introductionmentioning

confidence: 99%

Expert Consensus Statement on Proficiency Standards for Dermoscopy Education in Primary Care

Tran

Cyr²,

Verdieck³

et al. 2023

J Am Board Fam Med

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Background: Primary care providers (PCPs) frequently address dermatologic concerns and perform skin examinations during clinical encounters. For PCPs who evaluate concerning skin lesions, dermoscopy (a noninvasive skin visualization technique) has been shown to increase the sensitivity for skin cancer diagnosis compared with unassisted clinical examinations. Because no formal consensus existed on the fundamental knowledge and skills that PCPs should have with respect to dermoscopy for skin cancer detection, the objective of this study was to develop an expert consensus statement on proficiency standards for PCPs learning or using dermoscopy.Methods: A 2-phase modified Delphi method was used to develop 2 proficiency standards. In the study's first phase, a focus group of PCPs and dermatologists generated a list of dermoscopic diagnoses and associated features. In the second phase, a larger panel evaluated the proposed list and determined whether each diagnosis was reflective of a foundational or intermediate proficiency or neither.Results: Of the 35 initial panelists, 5 PCPs were lost to follow-up or withdrew; 30 completed the fifth and last round. The final consensus-based list contained 39 dermoscopic diagnoses and associated features.Conclusions: This consensus statement will inform the development of PCP-targeted dermoscopy training initiatives designed to support early cancer detection.

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Educational Interventions to Support Primary Care Provider Performance of Diagnostic Skin Cancer Examinations: A Systematic Literature Review

Cited by 5 publications

References 73 publications

Evaluation of primary care physicians' competence in selective skin tumour triage after short versus long dermoscopy training: a randomized non‐inferiority trial

Evaluation of primary care physicians' competence in selective skin tumour triage after short versus long dermoscopy training: a randomized non‐inferiority trial

Protocol for a systematic review of reviews on training primary care providers in dermoscopy to detect skin cancers

Expert Consensus Statement on Proficiency Standards for Dermoscopy Education in Primary Care

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