A multifaceted intervention: no increase in general practitioners' competence to diagnose skin cancer (minSKIN) - randomized controlled trial.

BACKGROUND: General practitioners (GPs) play crucial roles in early detection of skin cancer. A pilot-study found a positive short-term effect of a 1-day dermatologic education programme on GPs' diagnostic competence. OBJECTIVE: To determine effects of a multifaceted intervention, including technical equipment and continuing feedback by a dermatologist, on GPs' diagnostic skills regarding skin cancer. METHODS: Randomized controlled trial with 78 GPs of the Canton of Zurich, Switzerland. INTERVENTION: GPs in intervention group received a 1-day training, a Lumio (magnifying glass with polarized light, 3Gen), a Nikon digital camera and - during 1 year - feedback on skin lesion pictures sent to the dermatologist. GPs in control group only received the 1-day training. PRIMARY OUTCOME: structured assessment of GP's diagnostic skills in correctly diagnosing images of skin lesions regarding skin cancer. At baseline prior to intervention (T0), after the full-day training course in both groups (T1), and after 1 year of continuing feedback (T2) to the intervention group. MEASURES: Non-parametric unpaired (Wilcoxon-Mann-Whitney) tests were used to compare numbers of correctly classified skin lesions between both groups at T2 and for the change between T1 and T2. RESULTS: At T0, both groups classified a median of 23 skin lesions of the 36 images correctly. This value rose to 28 for both groups at T1 and fell to 24 for both groups at T2. No difference between control and intervention group at T2. Furthermore, we compared differences in the sum scores per GP between T1 and T2 for each group. Also in this comparison, no difference between control and intervention group was found. CONCLUSION AND RELEVANCE: No long-term effect of the multifaceted intervention was found on the competence to diagnose skin cancer by GPs. The positive short-term effect of the 1-day dermatologic education programme did not persist over 12 months.

[Vocational training of future GPs in Swiss hospitals: the view of chief physicians]. / Weiterbildung von angehenden Hausärzten an stationären Weiterbildungsstellen: Sicht der Chefärzte.

BACKGROUND: We sought to assess the way future general practitioners are promoted by their chief physicians. METHODS: Semi quantitative questionnaires sent to 54 chief physicians (hospitals in cantons Zurich and Berne). RESULTS: 42 (77.8%) questionnaires were returned. 41 (97.6%) chief physicians asked the assistant physicians about their intended career. 23 (54.8%) discussed with future general practitioners (GPs) specific learning objectives. 32 (76.2%) chief physicians would have appreciated an official catalogue of learning objectives for future GPs. A GP-specific traineeship was lacking in most of the hospitals. CONCLUSIONS: The upcoming shortage of future GPs could be inhibited by an appropriate GP curriculum during the vocational training.

[Vocational training of future GPs in Swiss hospitals: the view of assistant physicians]. / Weiterbildung von angehenden Hausärzten an stationären Weiterbildungsstellen: Sicht der Assistenzärzte.

BACKGROUND: We sought to assess views of young physicians, performing vocational training in hospitals, regarding primary care. METHODS: Semi quantitative questionnaires sent to 535 assistant physicians (hospitals in cantons Zurich and Berne). RESULTS: 318 (62.4%) questionnaires were returned. 143 (45.0%) of the assistant physicians considered becoming a general practitioner (GP). There from, 58 (40.3%) decided in their undergraduate phase, 56 (38.9%) decided postgraduate. They felt generally supported by supervisors. A lack of specific learning objectives and hospital GP-traineeships were revealed. CONCLUSIONS: Our study shows that the decision for a career in primary care is made in equal parts undergraduate and postgraduate. These future and potential GPs should be attracted by an appropriate GP curriculum during their vocational training.