A Clinical Aid for Detecting Skin Cancer: The Triage Amalgamated Dermoscopic Algorithm (TADA).

PURPOSE: Family physicians (FPs) frequently evaluate skin lesions but may not have the necessary training to accurately and confidently identify lesions that require skin biopsy or specialist referral. We evaluated the diagnostic performance of a new, simplified dermoscopy algorithm for skin cancer detection. METHODS: In this cross-sectional, observation study, attendees of a dermoscopy course evaluated 50 polarized dermoscopy images of skin lesions (27 malignant and 23 benign) using the Triage Amalgamated Dermoscopic Algorithm (TADA). The dermoscopic criteria of TADA include architectural disorder (ie, disorganized or asymmetric distribution of colors and/or structures), starburst pattern, blue-black or gray color, white structures, negative network, ulcer, and vessels. The study occurred after 1 day of basic dermoscopy training. Clinical information related to palpation (ie, firm, dimpling) was provided when relevant. RESULTS: Of 200 course attendees, 120 (60%) participated in the study. Participants included 64 (53.3%) dermatologists and 41 (34.2%) primary care physicians, 19 (46.3%) of whom were FPs. Fifty-two (43%) individuals had no previous dermoscopy training. Overall, the sensitivity and specificity of TADA for malignant skin lesions was 94.8% and 72.3%, respectively. Previous dermoscopy training and years of dermoscopy experience were not associated with diagnostic sensitivity (P = .13 and P = .05, respectively) or specificity (P = .36 and P = .21, respectively). Specialty type was not associated with sensitivity (P = .37) but dermatologists had a higher specificity than nondermatologists (79% v. 72%, P = .008). CONCLUSIONS: After basic instruction, TADA may be a useful dermoscopy algorithm for FPs who examine skin lesions as it has a high sensitivity for detecting skin cancer.

Web-based education in family medicine predoctoral programs.

BACKGROUND AND OBJECTIVES: New technologies and widespread Internet access make Web-based education feasible for family medicine predoctoral programs. Offering educational activities and resources through the Web can support community-based education and improve communication. We assessed the status of Web-based education nationally and explored the interest and opportunities for collaboration. METHODS: A survey assessed the inclusion of Web-based educational methods in family medicine predoctoral programs and school-wide programs, the level of national interest in collaborative development, and common obstacles to progress. The survey was mailed to all US family medicine predoctoral directors. RESULTS: The response rate was 61%. Results showed nearly universal use of e-mail and Web pages. The most common educational use of the Internet was posting text information. One third of the responding programs used the Web for evaluation. Barriers to development of Web-based educational programs are faculty time and funding. Most respondents were interested in collaborative Web development and would value a national, Society of Teachers of Family Medicine-based network for this purpose. CONCLUSIONS: Web-based educational activities are commonly offered by family medicine programs. To realize the full potential of Web-based education, collaborative development of new methods and materials will be needed to overcome the limiting factors of faculty time and funding.

A comparative study of measures to evaluate medical students' performance.

PURPOSE: To assess how new National Board of Medical Examiners (NBME) performance examinations--computerbased case simulations (CBX) and standardized patient exams (SPX)-compare with each other and with traditional internal and external measures of medical students' performances. Secondary objectives examined attitudes of students toward new and traditional evaluation modalities. METHOD: Fourth-year students (n = 155) at the University of California, Los Angeles, School of Medicine (including joint programs at Charles R. Drew University of Medicine and Science and University of California, Riverside) were assigned two days of performance examinations (eight SPXs, ten CBXs, and a self-administered attitudinal survey). The CBX was scored by the NBME and the SPX by a NBME/Macy consortium. Scores were linked to the survey and correlated with archival student data, including traditional performance indicators (licensing board scores, grade-point averages, etc.). RESULTS: Of the 155 students, 95% completed the testing. The CBX and the SPX had low to moderate statistically significant correlations with each other and with traditional measures of performance. Traditional measures were intercorrelated at higher levels than with the CBX or SPX. Students' perceptions of the various evaluation methods varied based on the assessment. These findings are consistent with the theoretical construct for development of performance examinations. For example, to assess clinical decision making, students rated the CBX best, while they rated multiple-choice examinations best to assess knowledge. CONCLUSION: Examination results and student perception studies provide converging evidence that performance examinations measure different physician competency domains and support using multipronged assessment approaches.

Time-efficient preceptors in ambulatory care settings.

PURPOSE: With increasing amounts of medical education occurring in ambulatory care and managed care settings, time-efficient and educationally effective teaching methods are in high demand. To identify such methods, four exemplary preceptors who taught in a family medicine clerkship in the context of their managed care clinics were observed in two consecutive years. The purpose of this second observational case study was to look at the teaching and practice strategies of these four exemplary preceptors in more detail and to directly measure the use of strategies that have previously been identified. METHOD: Observation of 44 patient encounters by four exemplary preceptors in ambulatory managed-care settings. RESULTS: On average, these preceptors spent one minute per patient more when the student was involved. With students present, the preceptors saved 3.3 minutes per patient in charting time, while spending 2.2 minutes more listening to student presentations and 1.6 minutes more in pure teaching time. The preceptors spent half a minute less time in direct contact with each patient when a student was present. However, the patients received 12.4 additional minutes from the health-care team. CONCLUSION: Time savings from student charting may allow preceptors to teach and care for patients without losing valuable practice time.

Pearls in the management of acne: an advanced approach.

Acne is a common condition of the sebaceous follicle. The primary care physician can have a large impact on patients with acne by properly classifying the type of acne (obstructive versus inflammatory) and successfully treating the acne based on its severity. Reduction of acne lesions by appropriate topical and oral medications provides great psychological and physical benefits to these patients. By understanding how acne develops and its many manifestations and treatment options, the primary care physician can become an expert in acne diagnosis and treatment.