The Skin Cancer Objective Structured Clinical Examination (SCOSCE): A multi-institutional collaboration to develop and validate a clinical skills assessment for melanoma.

BACKGROUND: Assessing medical students on core skills related to melanoma detection is challenging in the absence of a well-developed instrument. OBJECTIVE: We sought to develop an objective structured clinical examination for the detection and evaluation of melanoma among medical students. METHODS: This was a prospective cohort analysis of student and objective rater agreement on performance of clinical skills and assessment of differences in performance across 3 schools. RESULTS: Kappa coefficients indicated excellent agreement for 3 of 5 core skills including commenting on the presence of the moulage (k = 0.87, 95% confidence interval 0.77-0.96), obtaining a history for the moulage (k = 0.84, 95% confidence interval 0.74-0.94), and making a clinical impression (k = 0.80, 95% confidence interval 0.68-0.92). There were no differences in performance across schools with respect to 3 of 5 core skills: commenting on the presence of the moulage (P = .15), initiating a history (P = .53), and managing the suspicious lesion (P value range .07-.17). Overall, 54.2% and 44.7% of students commented on the presence of the moulage and achieved maximum performance of core skills, respectively, with no difference in performance across schools. LIMITATIONS: Limitations include overall sample size of students and schools. CONCLUSION: The Skin Cancer Objective Structured Clinical Examination represents a potentially important instrument to measure students' performance on the optimal step-by-step evaluation of a melanoma.

Factors Associated With Point-of-Care Treatment Decisions for Hidradenitis Suppurativa.

IMPORTANCE: Studies evaluating factors associated with disease severity in hidradenitis suppurativa (HS) are limited, and the existing data are controversial. It is also unclear whether severity assessed by HS scoring methods correlate with partnered decision-making on treatment strategies, and thus the clinical relevance of these severity assessments is unknown. OBJECTIVE: To assess factors associated with disease severity as measured by point-of-care decisions on receipt or escalation of treatment for HS. DESIGN, SETTING, AND PARTICIPANTS: The retrospective cohort comprised 437 patients with HS ages 18 to 64 years at enrollment with at least 5 monitoring periods of 3 months' duration. The study was performed at an academic medical center. MAIN OUTCOMES AND MEASURES: Receipt of treatment and treatment escalation. RESULTS: The average monitoring time of patients with HS was 4.2 person-years. The frequency of patients with HS with no treatment decreased over the monitoring period, while the frequency for receipt of treatment increased. Care by a dermatologist (odds ratio [OR], 6.7; 95% CI, 5.2-8.6) provided the strongest predictor of having received treatment for HS, and it was also associated with increased odds of escalating treatment (OR, 3.0; 95% CI, 2.4-3.7). Tobacco smoking was associated with treatment escalation (OR, 1.4; 95% CI, 1.1-1.7) over time, whereas obesity was not associated with treatment or escalation. The likelihood of receiving (OR, 1.4; 95% CI, 1.2-1.8) or escalating treatment (OR, 1.2; 95% CI, 1.0-1.4) was increased between ages 18 and 39 years. Male sex was not associated with treatment escalation. CONCLUSIONS AND RELEVANCE: Clinician type, tobacco smoking, and age may be important clinical factors that patients and clinicians may consider in developing partnered short- and long-term treatment strategies. Obesity and sex do not seem to influence treatment decisions for HS.

A critical evaluation of clinical research study designs.

Interventional and observational studies have important roles in dermatology. The results from any study must be put in the context of the appropriate research design selection. RCTs are most useful in determining causality and effectiveness of treatment. Observational studies provide information about epidemiology and possible links between exposure and disease. Understanding the fundamentals underlying the various study designs is critical to both investigators and clinicians alike.