A Randomized Trial on the Efficacy of Mastery Learning for Primary Care Provider Melanoma Opportunistic Screening Skills and Practice

June K. Robinson, Namita Jain, Ashfaq A. Marghoob, William McGaghie, Michael MacLean, Pedram Gerami, Brittney Hultgren, Robert J. Turrisi, Kimberly Anne Mallett, Gary J. Martin

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Early detection of melanoma represents an opportunity to reduce the burden of disease among people at increased risk for melanoma. Objective: To develop and demonstrate the efficacy of online training. Design: Randomized educational trial. Participants: Primary care providers (PCPs). Intervention: Mastery learning course with visual and dermoscopic assessment, diagnosis and management, and deliberate practice with feedback to reach a minimum passing standard. Main Measures: Pre-test/post-test diagnostic accuracy. Referral of concerning lesions for 3 months before and after the educational intervention. Key Results: Among the 89 PCPs, 89.8% were internal medicine physicians, and the remainder were physician assistants embedded in internists’ practices. There were no differences between control and intervention groups regarding gender, age, race, or percentage of full-time PCPs. The control group had more PCPs who reported less than 5 years of practice (n = 18) than the intervention group (n = 6) (χ2 [6, n = 89] = 14.34, p = 0.03). PCPs in the intervention group answered more melanoma detection questions correctly on the post-test (M = 10.05, SE = 1.24) compared to control group PCPs (M = 7.11, SE = 0.24), and had fewer false-positive and no false-negative melanoma diagnoses (intervention, M = 1.09, SE = 0. 20; control, M = 3.1, SE = 0.23; ANCOVA, F[1,378] =27.86, p < 0.001; ηp 2 = 0.26). PCPs who underwent training referred fewer benign lesions, including nevi, seborrheic keratoses, and dermatofibromas, than control PCPs (F[1,79] = 72.89, p < 0.001; ηp 2 = 0.489; F[1,79] = 25.82, p < 0.001; ηp 2 = 0.246; F[1,79] = 34.25, p < 0.001; ηp 2 = 0.302; respectively). Those receiving training referred significantly more melanomas than controls (F[1,79] = 24.38, p < 0.001; ηp 2 = 0.236). Referred melanomas (0.8 ± 0.07 per month for intervention, 0.17 ± 0.06 for control) were mostly located on the head and neck. Conclusions: Mastery learning improved PCPs’ ability to detect melanoma on a standardized post-test and may improve referral of patients with suspected melanoma. Further studies are needed to confirm this finding. ClinicalTrials.gov NCT02385253.

Original languageEnglish (US)
Pages (from-to)855-862
Number of pages8
JournalJournal of general internal medicine
Volume33
Issue number6
DOIs
StatePublished - Jun 1 2018

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Melanoma
Primary Health Care
Learning
Control Groups
Referral and Consultation
Seborrheic Keratosis
Benign Fibrous Histiocytoma
Physician Assistants
Aptitude
Nevus
Practice Management
Internal Medicine
Routine Diagnostic Tests
Neck
Head
Physicians

All Science Journal Classification (ASJC) codes

  • Internal Medicine

Cite this

Robinson, June K. ; Jain, Namita ; Marghoob, Ashfaq A. ; McGaghie, William ; MacLean, Michael ; Gerami, Pedram ; Hultgren, Brittney ; Turrisi, Robert J. ; Mallett, Kimberly Anne ; Martin, Gary J. / A Randomized Trial on the Efficacy of Mastery Learning for Primary Care Provider Melanoma Opportunistic Screening Skills and Practice. In: Journal of general internal medicine. 2018 ; Vol. 33, No. 6. pp. 855-862.
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title = "A Randomized Trial on the Efficacy of Mastery Learning for Primary Care Provider Melanoma Opportunistic Screening Skills and Practice",
abstract = "Background: Early detection of melanoma represents an opportunity to reduce the burden of disease among people at increased risk for melanoma. Objective: To develop and demonstrate the efficacy of online training. Design: Randomized educational trial. Participants: Primary care providers (PCPs). Intervention: Mastery learning course with visual and dermoscopic assessment, diagnosis and management, and deliberate practice with feedback to reach a minimum passing standard. Main Measures: Pre-test/post-test diagnostic accuracy. Referral of concerning lesions for 3 months before and after the educational intervention. Key Results: Among the 89 PCPs, 89.8{\%} were internal medicine physicians, and the remainder were physician assistants embedded in internists’ practices. There were no differences between control and intervention groups regarding gender, age, race, or percentage of full-time PCPs. The control group had more PCPs who reported less than 5 years of practice (n = 18) than the intervention group (n = 6) (χ2 [6, n = 89] = 14.34, p = 0.03). PCPs in the intervention group answered more melanoma detection questions correctly on the post-test (M = 10.05, SE = 1.24) compared to control group PCPs (M = 7.11, SE = 0.24), and had fewer false-positive and no false-negative melanoma diagnoses (intervention, M = 1.09, SE = 0. 20; control, M = 3.1, SE = 0.23; ANCOVA, F[1,378] =27.86, p < 0.001; ηp 2 = 0.26). PCPs who underwent training referred fewer benign lesions, including nevi, seborrheic keratoses, and dermatofibromas, than control PCPs (F[1,79] = 72.89, p < 0.001; ηp 2 = 0.489; F[1,79] = 25.82, p < 0.001; ηp 2 = 0.246; F[1,79] = 34.25, p < 0.001; ηp 2 = 0.302; respectively). Those receiving training referred significantly more melanomas than controls (F[1,79] = 24.38, p < 0.001; ηp 2 = 0.236). Referred melanomas (0.8 ± 0.07 per month for intervention, 0.17 ± 0.06 for control) were mostly located on the head and neck. Conclusions: Mastery learning improved PCPs’ ability to detect melanoma on a standardized post-test and may improve referral of patients with suspected melanoma. Further studies are needed to confirm this finding. ClinicalTrials.gov NCT02385253.",
author = "Robinson, {June K.} and Namita Jain and Marghoob, {Ashfaq A.} and William McGaghie and Michael MacLean and Pedram Gerami and Brittney Hultgren and Turrisi, {Robert J.} and Mallett, {Kimberly Anne} and Martin, {Gary J.}",
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A Randomized Trial on the Efficacy of Mastery Learning for Primary Care Provider Melanoma Opportunistic Screening Skills and Practice. / Robinson, June K.; Jain, Namita; Marghoob, Ashfaq A.; McGaghie, William; MacLean, Michael; Gerami, Pedram; Hultgren, Brittney; Turrisi, Robert J.; Mallett, Kimberly Anne; Martin, Gary J.

In: Journal of general internal medicine, Vol. 33, No. 6, 01.06.2018, p. 855-862.

Research output: Contribution to journalArticle

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T1 - A Randomized Trial on the Efficacy of Mastery Learning for Primary Care Provider Melanoma Opportunistic Screening Skills and Practice

AU - Robinson, June K.

AU - Jain, Namita

AU - Marghoob, Ashfaq A.

AU - McGaghie, William

AU - MacLean, Michael

AU - Gerami, Pedram

AU - Hultgren, Brittney

AU - Turrisi, Robert J.

AU - Mallett, Kimberly Anne

AU - Martin, Gary J.

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Background: Early detection of melanoma represents an opportunity to reduce the burden of disease among people at increased risk for melanoma. Objective: To develop and demonstrate the efficacy of online training. Design: Randomized educational trial. Participants: Primary care providers (PCPs). Intervention: Mastery learning course with visual and dermoscopic assessment, diagnosis and management, and deliberate practice with feedback to reach a minimum passing standard. Main Measures: Pre-test/post-test diagnostic accuracy. Referral of concerning lesions for 3 months before and after the educational intervention. Key Results: Among the 89 PCPs, 89.8% were internal medicine physicians, and the remainder were physician assistants embedded in internists’ practices. There were no differences between control and intervention groups regarding gender, age, race, or percentage of full-time PCPs. The control group had more PCPs who reported less than 5 years of practice (n = 18) than the intervention group (n = 6) (χ2 [6, n = 89] = 14.34, p = 0.03). PCPs in the intervention group answered more melanoma detection questions correctly on the post-test (M = 10.05, SE = 1.24) compared to control group PCPs (M = 7.11, SE = 0.24), and had fewer false-positive and no false-negative melanoma diagnoses (intervention, M = 1.09, SE = 0. 20; control, M = 3.1, SE = 0.23; ANCOVA, F[1,378] =27.86, p < 0.001; ηp 2 = 0.26). PCPs who underwent training referred fewer benign lesions, including nevi, seborrheic keratoses, and dermatofibromas, than control PCPs (F[1,79] = 72.89, p < 0.001; ηp 2 = 0.489; F[1,79] = 25.82, p < 0.001; ηp 2 = 0.246; F[1,79] = 34.25, p < 0.001; ηp 2 = 0.302; respectively). Those receiving training referred significantly more melanomas than controls (F[1,79] = 24.38, p < 0.001; ηp 2 = 0.236). Referred melanomas (0.8 ± 0.07 per month for intervention, 0.17 ± 0.06 for control) were mostly located on the head and neck. Conclusions: Mastery learning improved PCPs’ ability to detect melanoma on a standardized post-test and may improve referral of patients with suspected melanoma. Further studies are needed to confirm this finding. ClinicalTrials.gov NCT02385253.

AB - Background: Early detection of melanoma represents an opportunity to reduce the burden of disease among people at increased risk for melanoma. Objective: To develop and demonstrate the efficacy of online training. Design: Randomized educational trial. Participants: Primary care providers (PCPs). Intervention: Mastery learning course with visual and dermoscopic assessment, diagnosis and management, and deliberate practice with feedback to reach a minimum passing standard. Main Measures: Pre-test/post-test diagnostic accuracy. Referral of concerning lesions for 3 months before and after the educational intervention. Key Results: Among the 89 PCPs, 89.8% were internal medicine physicians, and the remainder were physician assistants embedded in internists’ practices. There were no differences between control and intervention groups regarding gender, age, race, or percentage of full-time PCPs. The control group had more PCPs who reported less than 5 years of practice (n = 18) than the intervention group (n = 6) (χ2 [6, n = 89] = 14.34, p = 0.03). PCPs in the intervention group answered more melanoma detection questions correctly on the post-test (M = 10.05, SE = 1.24) compared to control group PCPs (M = 7.11, SE = 0.24), and had fewer false-positive and no false-negative melanoma diagnoses (intervention, M = 1.09, SE = 0. 20; control, M = 3.1, SE = 0.23; ANCOVA, F[1,378] =27.86, p < 0.001; ηp 2 = 0.26). PCPs who underwent training referred fewer benign lesions, including nevi, seborrheic keratoses, and dermatofibromas, than control PCPs (F[1,79] = 72.89, p < 0.001; ηp 2 = 0.489; F[1,79] = 25.82, p < 0.001; ηp 2 = 0.246; F[1,79] = 34.25, p < 0.001; ηp 2 = 0.302; respectively). Those receiving training referred significantly more melanomas than controls (F[1,79] = 24.38, p < 0.001; ηp 2 = 0.236). Referred melanomas (0.8 ± 0.07 per month for intervention, 0.17 ± 0.06 for control) were mostly located on the head and neck. Conclusions: Mastery learning improved PCPs’ ability to detect melanoma on a standardized post-test and may improve referral of patients with suspected melanoma. Further studies are needed to confirm this finding. ClinicalTrials.gov NCT02385253.

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