Effects on Skills and Practice from a Web-Based Skin Cancer Course for Primary Care Providers

Abstract

Background: Melanoma incidence and mortality is a growing concern. Better recognition and management of skin cancer by primary care providers (PCPs) could help, but studies suggest they would benefit from additional education. Effective educational programs are needed.Methods: We developed and conducted a voluntary before-and-after evaluation of a 1-to 2-hour interactive, web-based course in skin cancer detection for practicing, board-certified PCPs (http:// www.skinsight.com/info/for_professionals/dermatology-education-resources). Voluntary participants' ability to diagnose and manage skin cancer was assessed using pretests, immediate tests, and 6-month posttests. The effect on actual practice patterns was assessed using participants' patient panels: referrals or visits to dermatology and skin biopsies during the 6 months after the course were compared with those during the same period before the course.Results: The mean age of the 54 participants was 50.5 years (standard deviation, 11.1); 54% were women and 52% were Asian. The mean score for appropriate diagnosis and management increased from 36.1% to 46.7% (odds ratio, 1.6; 95% confidence interval, 1.4 -1.9), with greatest improvement in benign lesions, from 32.1% to 46.3% (odds ratio, 1.9; 95% confidence interval, 1.6 -2.4). Dermatology referrals for suspicious lesions or new visits by participants' patients decreased at both sites after the course (from 630 to 607 and from 726 to 266, respectively).Conclusions: This course improved skills in practicing PCPs. Improvement was greatest in the diagnosis and appropriate management of benign lesions and dermatology utilization decreased. (J Am Board Fam Med 2013;26:648 -657.)

Providers’ Experiences with a Melanoma Web-Based Course: a Discussion on Barriers and Intentions

“…Providers generally felt more comfortable with deciding what lesions were appropriate to be referred to dermatology, reinforcing the quantitative findings of improved confidence and attitude towards skin cancer identification [7]. Many participants desired more time with the curriculum and a few suggested having an expert-guided (dermatologist) curriculum so as to be able to ask questions and receive direct feedback.…”

“…Fifty-four percent were women and participants were diverse in race/ethnicity. Complete demographics have been previously published [7]. The 4 domains from feedback sessions are presented below, and representative quotations are presented in Tables 1–4.…”

“…Adoption of the web-based curriculum in primary care practices at Henry Ford Health Systems and Kaiser Permanente Northern California has also shown quantitative improvement in the diagnosis and management of skin lesions [7]. Participants completed pretest, immediate posttest, and a 6-month posttest, and demonstrated significant improvement in scores for correctly reassuring patients regarding suspicious lesions [7].…”

“…The INFORMED (INternet curriculum FOR Melanoma Early Detection) Group, a collaboration of dermatology specialists, primary care, epidemiology and behavioral science researchers, developed an interactive, online skills-based skin cancer curriculum that focuses on melanoma and skin cancer detection [7]. The curriculum was designed to inform practicing PCPs while improving confidence and skills for skin cancer detection.…”

Family Physicians Improve Patient Health Care Quality and Outcomes

“…Related to another cancer-melanoma-Roetzheim et al 2 showed that visiting a family physician compared with only a dermatologist before the diagnosis of melanoma was associated with a diagnosis of more thin melanomas and possibly a lower rate of mortality. To improve the accuracy of detection of skin cancers, Eide et al 3 tested an intriguing intervention using a readily available, 1-to 2-hour, interactive web-based course. In addition to evaluations after the course, this study considered referrals to dermatology before and after the course and diagnoses after the course.…”