A Randomized Trial on the Efficacy of Mastery Learning for Primary Care Provider Melanoma Opportunistic Screening Skills and Practice

Abstract

Background: Early detection of melanoma represents an opportunity to reduce the burden of disease among people at increased risk for melanoma.

Objective: To develop and demonstrate the efficacy of online training.

Design: Randomized educational trial.

Participants: Primary care providers (PCPs).

Intervention: Mastery learning course with visual and dermoscopic assessment, diagnosis and management, and deliberate practice with feedback to reach a minimum passing standard.

Main measures: Pre-test/post-test diagnostic accuracy. Referral of concerning lesions for 3 months before and after the educational intervention.

Key results: Among the 89 PCPs, 89.8% were internal medicine physicians, and the remainder were physician assistants embedded in internists' practices. There were no differences between control and intervention groups regarding gender, age, race, or percentage of full-time PCPs. The control group had more PCPs who reported less than 5 years of practice (n = 18) than the intervention group (n = 6) (χ2 [6, n = 89] = 14.34, p = 0.03). PCPs in the intervention group answered more melanoma detection questions correctly on the post-test (M = 10.05, SE = 1.24) compared to control group PCPs (M = 7.11, SE = 0.24), and had fewer false-positive and no false-negative melanoma diagnoses (intervention, M = 1.09, SE = 0. 20; control, M = 3.1, SE = 0.23; ANCOVA, F[1,378] =27.86, p < 0.001; ηp2 = 0.26). PCPs who underwent training referred fewer benign lesions, including nevi, seborrheic keratoses, and dermatofibromas, than control PCPs (F[1,79] = 72.89, p < 0.001; ηp2 = 0.489; F[1,79] = 25.82, p < 0.001; ηp2 = 0.246; F[1,79] = 34.25, p < 0.001; ηp2 = 0.302; respectively). Those receiving training referred significantly more melanomas than controls (F[1,79] = 24.38, p < 0.001; ηp2 = 0.236). Referred melanomas (0.8 ± 0.07 per month for intervention, 0.17 ± 0.06 for control) were mostly located on the head and neck.

Conclusions: Mastery learning improved PCPs' ability to detect melanoma on a standardized post-test and may improve referral of patients with suspected melanoma. Further studies are needed to confirm this finding. ClinicalTrials.gov NCT02385253.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Figure 1

Triage algorithm for dermoscopic assessment of skin lesions that appeared to be pigmented on visual inspection.

Figure 2

CONSORT diagram.

Figure 3

Percentage of correct responses on diagnostic assessment of control and intervention groups at pre- and post-tests.

Figure 4

Number of referrals for seborrheic keratosis per month in the 3 months prior to training and 3 months after training for the control and intervention groups.

Figure 5

Number of referrals for melanoma per month in the 3 months prior to training and 3 months after training for the control and intervention groups.