Learning to detect, categorize, and identify skin lesions: a meta-analysis.

IMPORTANCE: Educators use a variety of practices to train laypersons, medical students, residents, and primary care providers to diagnose skin lesions. Researchers have described these methods for decades, but there have been few attempts to catalog their scope or effectiveness. OBJECTIVE: To determine the scope and effectiveness of educational practices to improve the detection, categorization, and identification of skin lesions. DATA SOURCES: Literature indexed in MEDLINE, EMBASE, CINAHL, ERIC, PsycINFO, and BIOSIS Previews from inception until April 1, 2014, using terms cognate with skin disease, diagnosis, and education. STUDY SELECTION: Studies in which the educational objective was operationalized as the ability to detect, categorize, or identify skin lesions, and the intervention was evaluated through comparisons of participants' abilities before and after the intervention. DATA EXTRACTION AND SYNTHESIS: Information about trainees, educational practices, educational outcomes, and study quality was extracted; it was synthesized through meta-analysis using a random effects model. Effect sizes were calculated by dividing the differences between preintervention and postintervention means by the pooled standard deviation (ie, standardized mean difference [SMD]). Heterogeneity was assessed using an I2 statistic. MAIN OUTCOMES AND MEASURES: Pooled effect size across all studies and separate effect sizes for each of the educational practices. RESULTS: Thirty-seven studies reporting 47 outcomes from 7 educational practices met our inclusion criteria. The pooled effect of the practices on participants' abilities was large, with an SMD of 1.06 (95% CI, 0.81-1.31) indicating that posttest scores were approximately 1 SD above pretest scores. Effect sizes varied categorically between educational practices: the dermatology elective (SMD = 1.64; 95% CI, 1.17-2.11) and multicomponent interventions (SMD = 2.07; 95% CI, 0.71-3.44) had large effects; computer-based learning (SMD = 0.64; 95% CI, 0.36-0.92), lecture (SMD = 0.59; 95% CI, 0.28-0.90), pamphlet (SMD = 0.47; 95% CI, -0.11 to 1.05), and audit and feedback (SMD = 0.58; 95% CI, 0.10-1.07) had moderate effects; and moulage had a small effect (SMD = 0.15; 95% CI, -0.26 to 0.57). CONCLUSIONS AND RELEVANCE: A number of approaches are used to improve participants' abilities to diagnose skin lesions; some are more effective than others. The most effective approaches engage participants in a number of coordinated activities for an extended period, providing learners with the breadth of knowledge and practice required to change the mechanisms underlying performance.