Web-Based Course Failed to Change PCP Melanoma Detection

PROVIDENCE, RI – Can a Web-based learning program be an effective way to improve melanoma detection by primary care physicians (PCPs)?

That is a question raised by a recent study from the Providence, RI, VAMC and Brown University. Background in the article, published recently in the Family Medicine Journal, pointed out that PCPs are “uniquely positioned to detect melanoma” and that effective educational interventions targeted at them could improve early melanoma detection.1

A previous in-person Basic Skin Cancer Triage (BSCT) two-hour course demonstrated significant short-term improvement in provider practices, attitudes, ability, confidence, and knowledge, according to the authors, who said they conducted a randomized trial to test the efficacy of the BSCT course implemented as a Web-based learning program. It was compared to a similar (control) Web-based course on weight assessment.

The study included 57 PCPs and 3,341 of their patients from four geographically diverse centers. At baseline, one to two months into the study and a year after course completions, skin cancer control activities by PCPs were assessed by physician surveys as well as by chart reviews and patient telephone interviews about their recent visit to their PCPs.

“Some effect of intervention on skin cancer parameters was self-reported by physicians; this was not confirmed by patient survey or chart-extracted data,” according to the report, which also pointed out that rates of skin cancer control practices by PCPs were low across both groups before and after intervention.

Overall, the reported positive changes in physician behaviors – i.e., performing total body skin examination, discussion of skin cancer detection, office practices and knowledge – were not matched by patient reports nor did they persist in a longer term follow-up, according to the report.

Study authors attributed those changes to “physician recall bias due to the experience of the course or desire to please study investigators and were less dramatic as compared to our previously reported in-person BSCT intervention. Thus this approach by itself appears unlikely to result in improved PCP handling of skin cancer issues.”

The researchers suggested that, because the in-person course was so successful, Web-based learning still holds out promise to be an effective tool for medical education but that different approaches should be attempted.

  1. Markova A, Weinstock MA, Risica P, Kirtania U, Shaikh W, Ombao H, Chambers CV, Kabango ML, Kallail JK, Post D. Effect of a web-based curriculum on primary care practice: basic skin cancer triage trial. Fam Med. 2013 Sep;45(8):558-68. PubMed PMID: 24129868.

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