Training Primary Care Physicians to Perform Melanoma Opportunistic Surveillance

Cutaneous melanoma is considered a potentially curable disease if detected early. Primary
care physicians (PCPs) are well positioned to detect early melanomas by performing
opportunistic melanoma surveillance on the at-risk population during physical examination.
Opportunistic surveillance means physician performance of visual inspection of skin exposed
during your physical examination focused on the presenting condition. Opportunistic
surveillance requires skills in both visual inspection of the skin and with magnification of
the skin by a hand-held device, a dermoscope. (This research aims to 1) develop an easily
disseminated, interactive melanoma early detection skills training program for PCPs and to 2)
to examine the clinical proficiency of PCPs regarding pigmented lesions.

The knowledge to be gained by PCPs is essential to the development and successful
introduction of a method for physicians to learn how to perform opportunistic surveillance
for melanoma. By evaluating means of encouraging and facilitating opportunistic surveillance
for melanoma, an educational program may eventually be brought into widespread use in
training PCPs.

In addition to a Pre-training Test and Post-training Test, each of the phases of the
educational training program is described below:

1. Knowledge Acquisition The Knowledge Acquisition phase will be delivered via personal
computer/tablet. It will take about one hour to complete. The one-hour course consists
of case histories and videos in which the following are presented: 1) threshold rules of
visual inspection, 2) benefit of magnification with dermoscopy to assist with diagnosis,
and 3) demonstration of the 3-point checklist of dermoscopy.

2. Skills Assessment The Skills Assessment phase will be delivered via smartphone. The
program may be intermittently accessed taking up to two weeks to complete. The PCP will
be asked to review and make simulated management decisions on 20 case vignettes with
clinical images of body surfaces and dermoscopy of individual lesions. Clinical practice
will be simulated with the requirement that you make a decision to refer to dermatology
or a decision that a referral is not needed. If a biopsy is performed in the case
vignette, the pathology report will be provided, and the PCP will be asked the next step
in the patient's care. Performance feedback will be provided.

3. Deliberate Practice The Deliberate Practice phase will be delivered via smartphone. It
will take between 1-8 weeks to complete. The PCP will be asked to review additional
cases with visual inspection and dermoscopy to improve aspects of your performance that
have demonstrated weakness. Individual strengths and weaknesses will be assessed, and
personalized feedback will be provided. After achieving competency with the simulated
cases, the research staff will provide the PCP with a DermScope device (a smartphone
fitted with a dermoscope) to use in the next phase.

4. Clinical Proficiency The Clinical Proficiency phase will take place in the clinical
practice of the PCP over the course of 1-8 weeks. The PCP will be asked to use the
DermScope to capture and transmit at least 12 lesions. Informed consent will be obtained
from each patient prior to obtaining the non-identifying images. During image capture,
each photograph is marked by the DermScope program with the date, time, and the clinical
assessment form (CAF). The image will be transmitted to the teleconsultant (PI), who
will assign a unique identification number to the image and the data. The PI will render
an opinion within 72 hours regarding the need to refer the patient to dermatology or
reassure the patient. The PCP will be asked to make a decision regarding the management
of the patient and communicate this decision as needed to the patient.

Inclusion Criteria for PCPs:

- is a practicing PCP in the section of General Internal Medicine of Northwestern
Medicine

Exclusion Criteria for PCPs:

- is NOT a practicing PCP in the section of General Internal Medicine of Northwestern
Medicine

Inclusion Criteria for Patients providing lesions to be photographed:

- is a patient of a PCP enrolled in the study

- is at least 18 years old

- able to read at a 6th grade level or higher

Exclusion Criteria for Patients providing lesions to be photographed:

- is NOT a patient of a PCP enrolled in the study

- under 18 years of age

- unable to read at a 6th grade level