Residents may need more training and education in skin cancer examination

Many residents had little or no training in skin cancer examinations and had never observed or practiced an examination, according to the results of a survey of residents conducted in November 2003.

Researchers distributed 454 surveys to residents in family medicine, pediatrics, obstetrics and gynecology, and internal medicine and specialists from seven medical schools and four residency programs. The response rate for completed surveys was 75.3%.

The survey asked respondents about their training and experience with skin cancer examinations and about their skill level at performing a skin cancer examination.

About 56% of respondents had not taken a dermatology elective in medical school and 80% had not done so during their residency either; 41.8% had never received training for skin cancer examination in medical school.

Clinical training was infrequent as well: 55.3% had never observed a skin cancer examination; 75.8% had never been trained in one; and 57.4% had never practiced one.

Only 10.2% of respondents discussed the ABCDs — asymmetry, border irregularity, color viability and diameter larger than a pencil eraser — of melanoma; 18.3% asked about changing moles or skin lesions; and 12.7% asked about family history of melanoma. The proportion of residents who reported routine examination of patient skin was less than one-third.

Overall, only 15.9% of residents reported being somewhat to very skilled in skin cancer examination, while 27.1% reported being neither skilled nor unskilled. Family medicine residents and residents who treated more whites were more likely to report being somewhat or very skilled. No differences were found, however, for other variables, including age, sex or postgraduate level.

For incorporation of skin cancer examination into the curriculum, 127 residents preferred core curriculum sessions, 60 preferred departmental sessions and 30 preferred grand rounds sessions.

“Residency programs and medical schools may have neither the time nor the infrastructure to teach an expert, comprehensive examination to all physicians in training. However, the basic ability to recognize potentially suspicious lesions and triage persons with such lesions should be a vital and key component of both training programs,” the researchers wrote.

Wise E. Arch Dermatol. 2009;145:1131-1136.