Expert Consensus Statement on Proficiency Standards for Dermoscopy Education in Primary Care.

BACKGROUND: Primary care providers (PCPs) frequently address dermatologic concerns and perform skin examinations during clinical encounters. For PCPs who evaluate concerning skin lesions, dermoscopy (a noninvasive skin visualization technique) has been shown to increase the sensitivity for skin cancer diagnosis compared with unassisted clinical examinations. Because no formal consensus existed on the fundamental knowledge and skills that PCPs should have with respect to dermoscopy for skin cancer detection, the objective of this study was to develop an expert consensus statement on proficiency standards for PCPs learning or using dermoscopy. METHODS: A 2-phase modified Delphi method was used to develop 2 proficiency standards. In the study's first phase, a focus group of PCPs and dermatologists generated a list of dermoscopic diagnoses and associated features. In the second phase, a larger panel evaluated the proposed list and determined whether each diagnosis was reflective of a foundational or intermediate proficiency or neither. RESULTS: Of the 35 initial panelists, 5 PCPs were lost to follow-up or withdrew; 30 completed the fifth and last round. The final consensus-based list contained 39 dermoscopic diagnoses and associated features. CONCLUSIONS: This consensus statement will inform the development of PCP-targeted dermoscopy training initiatives designed to support early cancer detection.

Effects of Clinic First Educational Interventions on Resident Wellness and Engagement.

BACKGROUND AND OBJECTIVES: Tensions between clinical and hospital training, along with dysfunctional family medicine training clinics, have resulted in continuity clinic being the least favorite part of training for some residents. These factors are all contributors to burnout. We hypothesized that following Clinic First action steps to prioritize and enhance outpatient clinic would positively affect resident wellness and clinic engagement. This study describes our interventions and their effects within the Oregon Health & Science University (OHSU) Family Medicine 4-year Portland residency program. METHODS: In July 2017 the Oregon Health & Science University Family Medicine Portland residency program implemented scheduling and curricular interventions inspired by the Clinic First model. We conducted a mixed-methods cross-sectional study using focus groups and surveys to understand the effects of these interventions on resident wellness and engagement. RESULTS: Clinic First-inspired interventions, particularly a 2+2 scheduling model, decreased transitions within the day, and a clinic immersion month were associated with improved residents' perception of wellness. These interventions had variable effects on clinic engagement. Eighty-eight percent of interns surveyed about the month-long clinic orientation in the beginning of residency reported that they felt prepared managing continuity patients in the clinic setting and their upcoming rotations. CONCLUSIONS: This study demonstrates that Clinic First-inspired structural changes can be associated with improvement in resident perceptions of wellness and aspects of clinic engagement. This can give educators a sense of hope as well as tangible steps to take to improve these difficult and important issues.

Introducing an evidence-based medicine curriculum into a family practice residency--is it effective?

PURPOSE: To investigate whether teaching an evidence-based medicine (EBM) curriculum increased the knowledge and use of EBM principles in residents' continuity clinics. METHOD: In 1999, the authors performed a needs assessment with residents and faculty of Cascades East Family Practice Residency in Oregon and constructed a ten-session EBM workshop series that was introduced into the curriculum in 2000. Resident-preceptor interactions during outpatient continuity clinic were tape-recorded prior to and six months following introduction of the curriculum. A 50-item, multiple-choice examination was administered before and after the workshop series. Residents at another FP residency at the same university served as a control group. The same assessments were applied to the experimental and control groups. The tape recordings were analyzed for interactions that contained key EBM phrases or words. RESULTS: Pre-intervention multiple-choice test results were similar (control mean 56%, experimental 53%, p >.22 NS). Post-intervention test scores for the experimental group were significantly improved (mean 72%, p <.001). There was no significant improvement in test results among members of the control group (p >.05 NS). In the recorded resident-preceptor interactions, a marked increase in the use of EBM terms indicated awareness and/or use of EBM in the experimental group. In 1,165 minutes recorded prior to the workshops, EBM terms were used in a total of ten events. In 735 minutes recorded after the workshops, EBM terms were recorded in 67 events. A reduced number of EBM terms were recorded in the control group. CONCLUSION: Administering a structured EBM curriculum increased residents' knowledge and use of EBM constructs during patient care.