1. Teaching dermatologic lesion identification and diagnosis through a formal dermatology elective or by using a multi-component approach improved knowledge-base the most.
2. Teaching from a pamphlet or using a moulage, a prosthetic simulator that mimics pathologic lesions, were least efficacious in improving knowledge-base.
Evidence Rating Level: 2 (Good)
Study Rundown: Educating patients and non-dermatologist healthcare workers is of critical importance in order to accurately detect problematic skin lesions, especially in those groups who are at high-risk for skin cancer or who treat high-risk patients. Prior studies have shown that these skills in lay-people, medical students, and primary care physicians (PCPs) are underdeveloped. Furthermore, there is no consensus on the best approach to teaching these skills. This study aimed to determine the scope and efficacy of teaching practices associated with skin lesion diagnosis. Authors found approaches that were hands-on, comprehensive, and varied were the most efficacious. This analysis reviewed a large set of studies; however the exclusion criteria limited qualitative studies, which may have been helpful anecdotally, because they could not be included in the statistical analysis.
In-Depth [meta-analysis]: This study selected 37 articles for inclusion from a total of 2758. The included study population consisted of lay-people, medical students, residents, and PCPs. The educational objectives assessed were the ability to detect, categorize, and accurately diagnose skin lesions. Study quality was assessed using the validated and reliable Medical Education Research Study Quality instrument. The total pooled effect of all studies to improve knowledge base was large, with a standardized mean difference (SMD) of 1.06 between pre- and post-tests (95% CI, 0.81-1.31). The largest effect was observed with multi-component interventions that used a variety of approaches to re-enforce learning, and with a dermatology elective (SMD = 2.07; 95% CI, 0.71-3.44 and SMD = 1.64; 95% CI, 1.17-2.11, respectively). Computer-based learning, lecture, audit and feedback, and pamphlet all had progressively less efficacy [SMD = 0.64; 95% CI, 0.36-0.92, SMD = 0.59; 95% CI, 0.28-0.90, SMD = 0.58; 95% CI, 0.10-1.07, SMD = 0.47; 95% CI, –0.11 to 1.05, respectively]. With the smallest improvement observed when teaching using a moulage (SMD = 0.15; 95% CI, –0.26 to 0.57).
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