Assessing students' ability to detect melanomas using standardized patients and moulage

Abstract

Background: Detection of melanoma by physicians via opportunistic surveillance during focused physical examinations may reduce mortality. Medical students may not encounter a clinical case of melanoma during a dermatology clerkship.

Objective: This study examined the proficiency of fourth-year University of Illinois at Chicago medical students at detecting melanomas.

Methods: Melanoma moulages were applied to the second digit of the left hand of standardized patients (SPs) participating in a wrist pain scenario during a required clinical skills examination. An observer reviewed videotapes of the examination, written SP checklists, and student notes for evidence that the student noticed the moulage, obtained a history, or provided counseling.

Results: Among the 190 fourth-year medical students, 56 students were observed noticing the lesion; however, 13 failed to write it in their notes or advise the patient. The detection rate was 22.6% (43 of 190 students). Students who detected the probable melanoma consistently inquired about changes in the lesion and symptoms, but did not examine the rest of the skin or regularly palpate for adenopathy.

Limitations: Testing one class of students from a single medical school with a time-restricted SP encounter while focusing the students' attention toward a different presenting symptom may hinder exploration of medical issues.

Conclusion: The low detection rate and failure of students who noticed the moulage to identify the lesion as atypical represents a lost opportunity to provide a patient intervention. Use of SP examinations may help physicians in training build confidence and competence in cutaneous malignancy screening.