Use of simulators to explore specialty recommendation for a palpable breast mass

Sensor-Based Discovery of Search and Palpation Modes in the Clinical Breast Examination

PURPOSE

Successful implementation of precision education systems requires widespread adoption and seamless integration of new technologies with unique data streams that facilitate real-time performance feedback. This paper explores the use of sensor technology to quantify hands-on clinical skills. The goal is to shorten the learning curve through objective and actionable feedback.

METHOD

A sensor-enabled clinical breast examination (CBE) simulator was used to capture force and video data from practicing clinicians (N = 152). Force-by-time markers from the sensor data and a machine learning algorithm were used to parse physicians' CBE performance into periods of search and palpation and then these were used to investigate distinguishing characteristics of successful versus unsuccessful attempts to identify masses in CBEs.

RESULTS

Mastery performance from successful physicians showed stable levels of speed and force across the entire CBE and a 15% increase in force when in palpation mode compared with search mode. Unsuccessful physicians failed to search with sufficient force to detect deep masses ( F [5,146] = 4.24, P = .001). While similar proportions of male and female physicians reached the highest performance level, males used more force as noted by higher palpation to search force ratios ( t [63] = 2.52, P = .014).

CONCLUSIONS

Sensor technology can serve as a useful pathway to assess hands-on clinical skills and provide data-driven feedback. When using a sensor-enabled simulator, the authors found specific haptic approaches that were associated with successful CBE outcomes. Given this study's findings, continued exploration of sensor technology in support of precision education for hands-on clinical skills is warranted.

A Description of Breast Models Used to Teach Clinical Skills

Background: Health care trainees lack opportunities to practice breast assessment and clinical skills with patients, making breast models significant for hands-on training. Insufficient training leads to low competence across practitioners in breast health areas of practice, including clinical lactation. The aim of this review was to describe types of breast models used to teach clinical skills of the breast across breast health areas. The secondary aims were to describe education interventions that included each model and identify whether multiple skin tones were available in models. Methods: Authors conducted a scoping review to identify which types of breast models are used to teach clinical skills across breast health areas of practice and determine gaps in literature regarding how clinical lactation skills are taught. The literature search was conducted in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, MedLine, and ProQuest. Inclusion criteria were students/professionals engaging in breast model simulation. Eighteen studies were reviewed. Authors extracted data on participants, breast health area, breast model, intervention, evaluation, general outcomes, skin tone, and research design. Results: The most common skill area was clinical breast exam (n = 7), while least was breastfeeding education (n = 1). Most models were commercial (n = 12). Zero studies described skin tone. Generally, breast model simulations were correlated with increased clinical skills and confidence regardless of model used. Conclusions: Despite demonstrated gain of skills, this review reveals inconsistent use of breast models and evaluation, exclusion of diverse skin tones, and lack of breast models reported to teach clinical lactation skills.

Breast Cancer Detection: The Development and Pilot Study of a "Tactile Landscape" as a Standardized Testing Tool

INTRODUCTION

There is still a need for competent breast lump detection palpation skills, especially in developing countries. Our goal is to design, develop, and establish a test to determine whether students can, by touch alone, identify and discriminate between a range of different simulated lesions at different adiposity levels.

METHODS

Common lesions, breast cancers, and cysts were physically simulated and hidden in a test object referred to as the "tactile landscape" (TL). Ribs, intercostal muscle, and nodularity-normal anatomical features-increased their realistic complexity. Varying depths of features simulated varying degrees of adiposity. A testing protocol was created to determine the testee's ability to identify and discriminate different commonly occurring breast masses using palpation. Five experts (four breast surgeons and one general practitioner) and 20 inexperienced medical students were recruited and tested. Results were compared.

RESULTS

The TL has been based on previously verified breast models and has softness similar to 53% of women's breasts and nodularity similar to 60% as assessed in a breast clinic by breast surgeons. The five experts indicated that the simulated lesions felt like those they might encounter in clinical practice and all of them identified the lesions and nonlesions hidden in the TL 100% correctly, thus indicating the value of the model. In contrast, only one student was able to identify all the lesions. One student identified none of them. The remaining students mean score was 65%.

CONCLUSIONS

All students but one performed poorly in comparison to the experts. This indicates that the test could be useful to test students' ability to identify and discriminate breast masses. If successful, it will add previously missing capability to the mix of assessment instruments already used, thus potentially improving clinical breast examination training and assessment.

Comparison of Direct and Indirect Methods of Teaching Breast Self-Examination – Influence on Knowledge and Attitudes of Iranian Nursing and Midwifery Personnel

Background:

Breast cancer is the most common cancer in women. Monthly breast self-examination (BSE) has been presented as one of the best screening methods available. The aim of this study was to compare effects of both direct and indirect methods of teaching of BSE on knowledge and attitudes of nursing and midwifery personnel.

Materials and Methods:

The present study was performed on 89 nursing and midwifery personnel in Valiasr hospital of Borujen city. Participants were randomly divided into a direct and an indirect training group. Researcher-designed BSE knowledge and attitude and demographic information questionnaires were used for data collection.

Results:

Before the education intervention, the mean levels of knowledge and attitude were 9.82±2.79 and 56.5±6.21 in the direct training group and 9.59±2.71 and 54.5±4.51 in the indirect training group; after the intervention, they reached 19.2±0.96 and 62.9±4.21, and 11.0±2.58 and 59.0±3.44, respectively. The difference in the mean levels of knowledge and attitude were significantly higher in the direct training group post intervention (P<0.05).

Conclusion:

It appears that educational planners and hospital personnel education officials should seek to teach aspects of crucial health behavior to female personnel using cooperative and direct training methods.