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Ntessalen M, Krasniqi A, Murchie P. Development and piloting of an online course to improve knowledge, confidence and attitudes towards triaging images of skin lesions submitted online in primary care. BMC MEDICAL EDUCATION 2024; 24:839. [PMID: 39103798 DOI: 10.1186/s12909-024-05840-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/30/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Melanoma is the 5th commonest cancer in the UK and survivors require frequent and thorough skin checks. During the Achieving Self-directed Integrated Cancer Aftercare (ASICA) trial, melanoma survivors used an app to submit images of concerning lesions for assessment by a dermatology nurse. In the past, online courses have been used to train non-specialist primary care practitioners (PCPs) in this skill. OBJECTIVES This study aimed to determine whether an online course could increase knowledge, confidence, and attitudes towards skin image triage in PCPs in the Grampian area. METHODS Preliminary discussions were held with PCPs to determine the need for an online course. The course was designed at the University of Aberdeen and included an introduction to the skin, case studies and quizzes on a variety of skin conditions based on melanoma survivors' submissions via the ASICA app. Two pre- and post-course questionnaires were administered to all participants to (1) assess knowledge gained and (2) assess any improvements in confidence and attitudes towards triaging skin lesions that could be indicative of skin cancer. All PCPs in the Grampian area were invited to participate with almost 70 medical practices contacted. Results were analysed using a paired sample T-test. RESULTS The course was advertised to all GP practices in the Grampian area and 38 PCPs completed all its stages. Undertaking the course improved all PCPs' confidence and attitudes towards triaging (p < 0.001). It also improved knowledge in all non-GP PCPs (p = 0.01). Most participants found the course useful; thought it was at the right level of difficulty, right format and thought the design was good. CONCLUSIONS Our online course in triaging skin lesions submitted digitally to PCPs was able to improve knowledge, confidence, and attitudes towards triaging. The course was acceptable in its design and was deemed useful and applicable to practice. Further research should investigate the effect the course has on secondary care referral numbers.
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Affiliation(s)
- Maria Ntessalen
- Academic Primary Care Research Group, Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, AB25 2ZD, Aberdeen, Scotland
| | - Albana Krasniqi
- Academic Primary Care Research Group, Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, AB25 2ZD, Aberdeen, Scotland
| | - Peter Murchie
- Academic Primary Care Research Group, Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, AB25 2ZD, Aberdeen, Scotland.
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Alotaibi HM, Alruwaili ZM, Dilli AA, Altaleb AA, Asiri MM, Alwadani OJ, Alshaalan ZM, Dar UF. Assessment of Primary Care Physicians' Expertise of Common Dermatological Conditions in the Jouf Region, Saudi Arabia: A Mixed Methods Study. Healthcare (Basel) 2023; 11:1705. [PMID: 37372823 DOI: 10.3390/healthcare11121705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
Primary care physicians (PCPs) are the first line of defense for the management of common dermatological conditions (DCs). This study aimed to assess how dermatological diseases are identified, managed, and referred to in primary healthcare centers (PHCs). This was a mixed methods study comprising a cross-sectional survey and semi-structured interviews recruited through PHCs across the Jouf region of Saudi Arabia. Sixty-one PCPs completed the data, and eight participants were interviewed. A survey based on a sample of 22 photographs of common DCs in the Kingdom was administered to the participants to answer questions about the correct diagnosis, appropriate management, referral strategy, and encounter rate. In our sampled population, the mean overall knowledge level on a scale of 10 was 7.08 (±1.3). Among participants that had good to acceptable scores, 51 (83.6%) were in the overall knowledge parameter, 46 (75.4%) in the diagnosis parameter, and 49 (80.3%) in the management parameter. PCPs with five years or more of experience were found to have significantly higher overall knowledge and management scores. Most of our PCPs demonstrated sufficient knowledge of common DCs and had good to acceptable scores in all parameters. However, educational and regulatory aspects of PCPs' clinical management were identified. Focused training, provision of workshops, and improving medical school curricula regarding common DCs are recommended.
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Affiliation(s)
- Hatem M Alotaibi
- College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia
| | | | - Ahmed A Dilli
- College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia
| | | | - Mohanad M Asiri
- College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia
| | - Osama J Alwadani
- College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia
| | - Ziad M Alshaalan
- Division of Dermatology, Department of Medicine, College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia
| | - Umar-Farooq Dar
- Department of Family & Community Medicine, College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia
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3
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Oldfield LE, Jones V, Gill B, Kodous N, Fazelzad R, Rodin D, Sandhu H, Umakanthan B, Papadakos J, Giuliani ME. Synthesis of Existent Oncology Curricula for Primary Care Providers: A Scoping Review With a Global Equity Lens. JCO Glob Oncol 2023; 9:e2200298. [PMID: 37141562 DOI: 10.1200/go.22.00298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
PURPOSE Global increases in cancer, coupled with a shortage of cancer specialists, has led to an increasing role for primary care providers (PCP) in cancer care. This review aimed to examine all extant cancer curricula for PCPs and to analyze the motivations for curriculum development. METHODS A comprehensive literature search was conducted from inception to October 13, 2021, with no language restrictions. The initial search yielded 11,162 articles and 10,902 articles underwent title and abstract review. After full-text review, 139 articles were included. Numeric and thematic analyses were conducted and education programs were evaluated using Bloom's taxonomy. RESULTS Most curricula were developed in high-income countries (HICs), with 58% in the United States. Cancer-specific curricula focused on HIC priority cancers, such as skin/melanoma, and did not represent the global cancer burden. Most (80%) curricula were developed for staff physicians and 73% focused on cancer screening. More than half (57%) of programs were delivered in person, with a shift toward online delivery over time. Less than half (46%) of programs were codeveloped with PCPs and 34% did not involve PCPs in the program design and development. Curricula were primarily developed to improve cancer knowledge, and 72 studies assessed multiple outcome measures. No studies included the top two levels of Bloom's taxonomy of learning (evaluating; creating). CONCLUSION To our knowledge, this is the first review to assess the current state of cancer curricula for PCPs with a global focus. This review shows that extant curricula are primarily developed in HICs, do not represent the global cancer burden, and focus on cancer screening. This review lays a foundation to advance the cocreation of curricula that are aligned to the global cancer burden.
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Affiliation(s)
| | - Vivien Jones
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Bhajan Gill
- Cancer Education, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Nardeen Kodous
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Rouhi Fazelzad
- Library and Information Services, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Danielle Rodin
- Royal College of Surgeons in Ireland, Dublin, Ireland
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Ben Umakanthan
- Cancer Education, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Janet Papadakos
- Cancer Education, Princess Margaret Cancer Centre, Toronto, ON, Canada
- The Institute for Education Research, University Health Network, Toronto, ON, Canada
| | - Meredith Elana Giuliani
- Cancer Education, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
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4
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Posada EL, Lauck KC, Tran T, Krause KJ, Nelson KC. Educational Interventions to Support Primary Care Provider Performance of Diagnostic Skin Cancer Examinations: A Systematic Literature Review. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1579-1588. [PMID: 35040018 PMCID: PMC8763425 DOI: 10.1007/s13187-021-02118-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 06/14/2023]
Abstract
To our knowledge, there is no available standardized educational curriculum designed to promote the incorporation of skin cancer examinations and procedures into general practice. To explore the contemporary training landscape, we conducted a systematic review of educational interventions designed to support skin cancer diagnostic examinations by primary care providers (PCPs). Our review uniquely encompasses all PCPs, including practicing physicians, residents, and advanced practice practitioners (APPs). The objective of this study is to review and synthesize worldwide data on educational interventions addressing PCP performance of skin cancer diagnostic examinations. A systematic review was performed in MEDLINE, Cochrane, EMBASE, and Scopus for English language articles worldwide published from 2000 onwards. Articles were screened for eligibility, and possibly overlapping datasets were resolved. Data extracted included curriculum content, delivery format, and educational outcomes. This review followed the PRISMA guidelines. A total of 63 studies were selected for data inclusion with one addressing training for resident physicians, 4 for APPs, and the remainder for practicing physicians. Educational interventions included in this review reflect the pre-SARS-CoV-2 pandemic educational environment: half provided live/synchronous instruction of about 5-h duration on average, and a quarter featured interactive components. Less than a quarter of interventions included practice change as a specific reported outcome. Without sustainable practice change, the anticipated long-term benefits of early cancer detection in patients remain limited. Previous and existing educational interventions designed to support skin cancer detection by PCPs demonstrate heterogeneous curriculum content, delivery methods, and educational outcomes. An ideal intervention would teach consensus-derived clinical competencies, provide meaningful learner feedback, and measure outcomes, such as knowledge/competency, confidence/attitudes, and practice change, using validated instruments.
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Affiliation(s)
- Eliza L Posada
- The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kyle C Lauck
- Department of Internal Medicine, The University of Texas Health Science Center, Houston, TX, USA
| | - Tiffaney Tran
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kate J Krause
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kelly C Nelson
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Harkemanne E, Duyver C, Leconte S, Sawadogo K, Baeck M, Tromme I. Short- and Long-Term Evaluation of General Practitioners' Competences After a Training in Melanoma Diagnosis: Refresher Training Sessions May Be Needed. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1928-1941. [PMID: 34704171 PMCID: PMC8547729 DOI: 10.1007/s13187-021-02063-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/27/2021] [Indexed: 06/13/2023]
Abstract
General practitioners (GPs) are first-line clinicians in melanoma diagnosis. It is, therefore, important to ensure that they maintain their melanoma diagnostic accuracy over time. The objective of this study was to assess the short- and long-term competences of GPs after a training session in naked-eye melanoma diagnosis. An interventional prospective study was conducted whereby, over a 6-month period, GPs attended a 1-h melanoma diagnostic training session. To assess their acquired competences, GPs were asked to fill in a questionnaire on basic melanoma knowledge and to evaluate 10 clinical images of pigmented skin lesions prior to training, immediately after and 1 year later. In total, 89 GPs completed the questionnaire prior and immediately after training. As expected, the number of GPs who appropriately managed [Formula: see text] 50% of the melanoma cases increased after training (P < 0.001). One year after training, only 27 (30%) of the 89 GPs completed the questionnaire. This number of participants was too low to obtain significant figures but the GPs' mean overall score of appropriately managed clinical cases was much lower than in the immediate post-test. In conclusion, although this short training improved the GPs' diagnostic accuracy and management of melanoma in the short-term, participating GPs do not seem to have maintained these competences in the long-term. Further studies are needed to assess whether refresher training sessions are able to sustain acquired diagnostic and management skills.
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Affiliation(s)
- Evelyne Harkemanne
- Dermatology Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, B-1200, Brussels, Belgium.
- Institute of Experimental and Clinical Research (IREC), UCLouvain, Brussels, Belgium.
| | - Corentin Duyver
- Centre Académique de Médecine Générale (CAMG), UCLouvain, Brussels, Belgium
| | - Sophie Leconte
- Centre Académique de Médecine Générale (CAMG), UCLouvain, Brussels, Belgium
| | - Kiswendsida Sawadogo
- Statistical Support Unit, King Albert II Cancer and Hematology Institute, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Marie Baeck
- Dermatology Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, B-1200, Brussels, Belgium
- Institute of Experimental and Clinical Research (IREC), UCLouvain, Brussels, Belgium
| | - Isabelle Tromme
- Dermatology Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, B-1200, Brussels, Belgium
- King Albert II Cancer and Hematology Institute, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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6
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Gonna N, Tran T, Bassett RL, Farris DP, Nelson KC. Sensitivity and Specificity for Skin Cancer Diagnosis in Primary Care Providers: a Systematic Literature Review and Meta-analysis of Educational Interventions and Diagnostic Algorithms. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1563-1572. [PMID: 35834156 DOI: 10.1007/s13187-022-02194-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND In areas without convenient access to dermatology care, primary care providers (PCPs) serve as an important patient resource for early skin cancer detection. To determine the most effective strategy for skin cancer detection training in PCPs, we conducted a systematic review of educational interventions and performed a meta-analysis on sensitivity and specificity outcomes in PCPs. OBJECTIVES To summarize data on skin cancer sensitivity and specificity outcomes for PCP-targeted training programs and diagnostic algorithms. Our PCP cohort included practicing physicians, trainee physicians, and advanced practice practitioners. METHODS A literature search was performed in MEDLINE, Embase, Web of Science, and the Cochrane Library for relevant English-language articles published worldwide from 2000 onward. Results were screened for eligibility, and overlapping datasets were reconciled. Data extracted included the educational intervention, diagnostic algorithm, and outcomes of interest (sensitivity and specificity). Outcomes were pooled across interventions that taught the same diagnostic algorithm. A bivariate model was fit to compare different interventions/algorithms. This review followed the PRISMA guidelines. RESULTS In total, 21 articles were included in this review, encompassing over 58,610 assessments of skin lesions by about 1529 participants worldwide. Training programs that implemented the triage-amalgamated dermoscopic algorithm (TADA) demonstrated high pooled sensitivity (91.7%) and high pooled specificity (81.4%) among PCPs. CONCLUSIONS AND RELEVANCE Overall, this systematic review and meta-analysis showed that dermoscopy training in PCPs was generally associated with gains in skin cancer sensitivity without loss of specificity. Clinically, this correlates with fewer skin cancers overlooked by PCPs and fewer excisions of benign lesions.
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Affiliation(s)
- Nadeen Gonna
- John P. and Kathrine G. McGovern Medical School, Houston, TX, USA
| | - Tiffaney Tran
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1452, Houston, TX, 77030, USA
| | - Roland L Bassett
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David P Farris
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kelly C Nelson
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1452, Houston, TX, 77030, USA.
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Harkemanne E, Goublomme N, Sawadogo K, Tromme I. Early Melanoma Detection in Primary Care: Clinical Recognition of Melanoma is Not Enough, One Must Also Learn the Basics. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:898-904. [PMID: 33073347 DOI: 10.1007/s13187-020-01897-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/09/2020] [Indexed: 06/11/2023]
Abstract
To improve early melanoma detection, educational programs have been developed for general practitioners (GPs). This study aimed to determine whether the adjunct of teaching basic knowledge of pigmented skin lesions (PSL) to the training in melanoma diagnosis improves the GPs' diagnostic accuracy of melanoma. An interventional prospective study was conducted over a 3-month period where GPs attended a 2-h training course. The 1st session taught clinical melanoma recognition and the 2nd session instructed basic knowledge of PSL. Prior to training, after the 1st, and after the 2nd session, GPs were asked to select the malignant or benign nature of 15 clinical images associated to their clinical history. In total, 56 GPs participated in this study. The number of GPs identifying correctly ≥ 50% of the melanomas increased the most after the 1st session from 15 (26.8%; CI = (15.2; 38.4)) to 44 (78.6%; CI = (67.8; 89.3)) GPs (P < 0.001). The number of GPs correctly identifying ≥ 50% of the benign PSL only increased after completing the entire training, going from 10 (17.9%; CI = [(7.8; 27.9)) GPs to 50 (89.3%; CI = (81.2; 97.4)) GPs (P < 0.001). In this study, GPs identified benign PSL most accurately after the 2nd session. This suggested that teaching GPs the basics of PSL would especially improve their diagnostic accuracy for benign PSL, which could reduce unnecessary referrals to dermatologists. Teaching basic knowledge of PSL in addition to melanoma recognition seemed to enable GPs to triage skin lesions more effectively than when they were only trained to recognize melanoma.
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Affiliation(s)
- Evelyne Harkemanne
- Dermatology Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, B-1200, Brussels, Belgium.
- Institute of Experimental and Clinical Research (IREC), UCLouvain, Brussels, Belgium.
| | - Noémie Goublomme
- General Practice in Centre Médical Chrysalide, Pironchamps, Belgium
| | - Kiswendsida Sawadogo
- Statistical Support Unit, King Albert II Cancer and Hematology Institute, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Isabelle Tromme
- Dermatology Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, B-1200, Brussels, Belgium
- King Albert II Cancer and Hematology Institute, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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8
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Brown AE, Najmi M, Duke T, Grabell DA, Koshelev MV, Nelson KC. Skin Cancer Education Interventions for Primary Care Providers: A Scoping Review. J Gen Intern Med 2022; 37:2267-2279. [PMID: 35710666 PMCID: PMC9202989 DOI: 10.1007/s11606-022-07501-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 03/23/2022] [Indexed: 11/19/2022]
Abstract
Primary care physicians (PCPs) are often the first line of defense against skin cancers. Despite this, many PCPs do not receive a comprehensive training in skin conditions. Educational interventions aimed at skin cancer screening instruction for PCPs offer an opportunity to detect skin cancer at earlier stages and subsequent improved morbidity and mortality. A scoping review was conducted to collect data about previously reported skin cancer screening interventions for PCPs. A structured literature search found 51 studies describing 37 unique educational interventions. Curriculum elements utilized by the interventions were divided into categories that would facilitate comparison including curriculum components, delivery format, delivery timing, and outcome measures. The interventions varied widely in design, including literature-based interventions, live teaching sessions, and online courses with durations ranging from 5 min to 24 months. While several interventions demonstrated improvements in skin cancer knowledge and competency by written exams, only a few revealed positive clinical practice changes by biopsy review or referral analysis. Examining successful interventions could aid in developing a skin cancer detection curriculum for PCPs that can produce positive clinical practice and population-based changes in the management of skin cancer.
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Affiliation(s)
- Ashley E Brown
- Department of Dermatology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Maleka Najmi
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA.
| | - Taylor Duke
- Department of Dermatology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Daniel A Grabell
- Department of Dermatology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Misha V Koshelev
- Department of Dermatology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Kelly C Nelson
- Department of Dermatology, MD Anderson Cancer Center, Houston, TX, USA
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9
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Harkemanne E, Duyver C, Leconte S, Bugli C, Thomas L, Baeck M, Tromme I. Melanoma Diagnostic Practices of French-Speaking Belgian General Practitioners and the Prospective Study of Their Pigmented Skin Lesion Diagnostic Accuracy and Management. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:1316-1324. [PMID: 32448923 DOI: 10.1007/s13187-020-01770-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
General practitioners (GPs) are among the main actors involved in early melanoma diagnosis. However, melanoma diagnostic accuracy and management are reported to be insufficient among GPs in Europe. The primary aim of this observational prospective study was to shed light on melanoma diagnostic practices among French-speaking Belgian GPs. The second aim was to specifically analyse these GPs' pigmented skin lesion diagnostic accuracy and management. GPs from the five French-speaking districts of Belgium were asked to complete a questionnaire, before taking part in a melanoma diagnostic training session. First, we assessed the GPs' current melanoma diagnostic practices. Then, their pigmented skin lesion diagnostic accuracy and management were evaluated, through basic theoretical questions and clinical images. These results were subsequently analysed, according to the GPs' sociodemographic characteristics and medical practice type. In total, 89 GPs completed the questionnaire. Almost half of the GPs (43%; CI = [33;54]) were confronted with a suspicious skin lesion as the main reason for consultation once every 3 months, while 33% (CI = [24;43]) were consulted for a suspicious lesion as a secondary reason once a month. Prior to training, one-third of the GPs exhibited suboptimal diagnostic accuracy in at least one of six "life-threatening" clinical cases among two sets of 10 clinical images of pigmented skin lesions, which can lead to inadequate patient management (i.e. incorrect treatment and/or inappropriate reinsurance). This study underlines the need to train GPs in melanoma diagnosis. GPs' pigmented skin lesion diagnostic accuracy and management should be improved to increase early melanoma detection.
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Affiliation(s)
- E Harkemanne
- Dermatology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
- Institute of Experimental and Clinical Research (IREC), UCLouvain, Brussels, Belgium.
| | - C Duyver
- Centre Académique de Médecine Générale (CAMG), UCLouvain, Brussels, Belgium
| | - S Leconte
- Centre Académique de Médecine Générale (CAMG), UCLouvain, Brussels, Belgium
| | - C Bugli
- Statistical Methodology and Computing Service (SMCS), Louvain-la-Neuve, Belgium
| | - L Thomas
- Dermatology Department, Lyon Cancer Research Center INSERM, Université Lyon 1, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - M Baeck
- Dermatology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institute of Experimental and Clinical Research (IREC), UCLouvain, Brussels, Belgium
| | - I Tromme
- Dermatology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institute of Experimental and Clinical Research (IREC), UCLouvain, Brussels, Belgium
- King Albert II Cancer and Hematology Institute, Cliniques universitaires Saint-Luc, Brussels, Belgium
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10
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Abstract
BACKGROUND General practitioners (GPs) play a key role in early melanoma detection. To help GPs deal with suspicious skin lesions, melanoma diagnostic training programmes have been developed. However, it is unclear whether these programmes guarantee the acquisition of skills that will be applied by GPs in their daily clinical practice and maintained over time. OBJECTIVES This scoping review aimed to examine and compare educational programmes designed to train GPs in melanoma diagnosis using clinical (naked eye) examination alone or dermoscopy±clinical examination, and sought to inform on the long-term sustainability of the GPs' acquired skills. ELIGIBILITY CRITERIA Studies eligible for inclusion evaluated educational programmes for teaching diagnosis of melanoma to GPs. MEDLINE, EMBASE and Cochrane databases were searched for relevant articles from 1995 to May 2020. RESULTS Forty-five relevant articles were found assessing 31 educational programmes. Most programmes that improved the diagnostic accuracy and long-term performances of the GPs, that is, increase in confidence, decrease in dermatologist referral for benign skin lesions and improvement in the benign/malignant ratio of excised skin lesions, trained the GPs in clinical diagnosis, followed by dermoscopy. To maintain long-term performances, these programmes provided refresher training material. CONCLUSION This review shows that studies generally report positive outcomes from the training of GPs in melanoma diagnosis. However, refresher training material seemed necessary to maintain the acquired skills. The optimal form and ideal frequency for these updates have yet to be defined.
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Affiliation(s)
- Evelyne Harkemanne
- Service de dermatologie, Cliniques universitaires Saint-Luc, Bruxelles, Belgique
- Pôle de pneumologie et dermatologie, Institut de Recherche Expérimentale et Clinique, UCLouvain, Bruxelles, Belgique
| | - Marie Baeck
- Service de dermatologie, Cliniques universitaires Saint-Luc, Bruxelles, Belgique
- Pôle de pneumologie et dermatologie, Institut de Recherche Expérimentale et Clinique, UCLouvain, Bruxelles, Belgique
| | - Isabelle Tromme
- Service de dermatologie, Cliniques universitaires Saint-Luc, Bruxelles, Belgique
- Clinique du mélanome, Institut Roi Albert II, Cliniques universitaires Saint-Luc, Bruxelles, Belgique
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11
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Singhal RR, Talati KN, Gandhi BP, Shinde MK, Nair PA, Phatak AG. Prevalence and Pattern of Skin Diseases in Tribal Villages of Gujarat: A Teledermatology Approach. Indian J Community Med 2020; 45:199-203. [PMID: 32905082 PMCID: PMC7467180 DOI: 10.4103/ijcm.ijcm_76_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 12/26/2019] [Indexed: 11/04/2022] Open
Abstract
Background The prevalence and pattern of skin diseases are influenced by the overall ecosystem of the region. There is a dearth of research about prevalence, health-care seeking, compliance, and treatment outcome in skin diseases among scheduled tribes. Objectives The aim of this study is to understand the magnitude of skin diseases in tribal area of Dahod, Gujarat using a simple "Store and Forward" technique of teledermatology. Materials and Methods A cross-sectional study was conducted in 10 randomly selected villages of Dahod and Jhalod blocks of Dahod district of Gujarat during June-August 2017. Trained surveyors visited households randomly in different localities (called Faliya) of each village ensuring representativeness. Survey responses were captured on mobile-based MAGPI portal, and images of skin conditions were capture on smart phones, and de-identified images were transferred over WhatsApp. Results A total of 781 households were approached in 10 villages and 2214 participants consented. Among them, 549 were identified with suspected skin diseases, but 520 consented for photograph. The skin diseases were more prevalent among males, children, and elderly. Of 520, 44 (8.5%) could not be assess due to poor quality photograph and 35 (6.7%) did not have any clinically significant condition. Thus, of 2214 participants, 441 (20%) had skin diseases, and infections and eczema were major conditions constituting two-third of the skin diseases in the study population. The treatment-seeking behavior and compliance to treatment was poor. Conclusion Considering the high prevalence of skin diseases in tribal villages of Dahod, Gujarat coupled with limited availability of trained dermatologist, new innovative avenues like teledermatology should be explored.
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Affiliation(s)
- Rochit Rajesh Singhal
- Department of Dermatology, Venereology and Leprosy, Pramukhswami Medical College, Charutar Arogya Mandal, Karamsad, Anand, Gujarat, India
| | - Kandarp Narendra Talati
- Department of Interdisciplinary Research, Foundation for Diffusion of Innovations, Vadodara, Gujarat, India
| | | | - Mayur Kiran Shinde
- Central Research Services, Charutar Arogya Mandal, Karamsad, Anand, Gujarat, India
| | - Pragya A Nair
- Department of Dermatology, Venereology and Leprosy, Pramukhswami Medical College, Charutar Arogya Mandal, Karamsad, Anand, Gujarat, India
| | - Ajay Gajanan Phatak
- Central Research Services, Charutar Arogya Mandal, Karamsad, Anand, Gujarat, India
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de Carvalho TM, Noels E, Wakkee M, Udrea A, Nijsten T. Development of Smartphone Apps for Skin Cancer Risk Assessment: Progress and Promise. JMIR DERMATOLOGY 2019. [DOI: 10.2196/13376] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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