Capsule Commentary on Robinson et al.: A Randomized Trial on the Efficacy of Mastery Learning on Primary Care Providers’ Melanoma Opportunistic Screening Skills and Practice
Capsule Commentary on Robinson et al.: A Randomized Trial on the Efficacy of Mastery Learning on Primary Care Providers' Melanoma Opportunistic Screening Skills and Practice
Ambarish M. Athavale 0 1
J Gen Intern Med 0 1
0 Compliance with Ethical Standards:
1 Division of Nephrology, Core Faculty, Internal Medicine Residency Program, John H. Stroger Jr. Hospital of Cook County , Chicago, IL , USA
his randomized educational trial by Robinson et al.1
assessed the efficacy of Mastery learning course to
improve Primary Care Physicians (PCPs) accuracy in diagnosing
skin lesions with emphasis on melanoma detection. The
Mastery learning course included Bvisual and dermoscopic
assessment, diagnosis and management, and deliberate practice with
feedback to reach a minimum passing standard^.1 PCPs in the
intervention arm detected more melanomas on standardized
posttest and referred more melanomas and fewer benign
lesions than in control group.
Prior studies have shown improvement in PCP skills with
education focused on unaided visual assessment.2 This study
demonstrates that PCPs can be effectively trained in
dermoscopy (× 10 magnification) in addition to unaided visual
inspection. Trained PCPs had greater diagnostic accuracy for
referred lesions; however lesions not referred were not
assessed for diagnostic accuracy and is a source of bias in this
study. Assessment of knowledge/skill retention was not an
objective of this study and it is not known how frequently
PCPs need to be trained to maintain competency in screening.
Further research in these areas is needed prior to routine
adoption of this tool in clinical training/practice.
Incidence of melanoma has been increasing and the annual
visit to the PCP is a good opportunity to screen for skin
cancer.3 PCP diagnosed melanomas tend to be smaller, early
stage and have better prognosis.3 However, prior studies have
shown that PCPs feel that their training is inadequate and are
not confident of their skills in diagnosing skin lesions.4 From
the providers’ perspective, educational interventions like the
Mastery learning course fulfill a perceived need by providing
an online self-paced learning tool. Such interventions are also
likely to be cost-effective by increasing referral of early lesions
and decreasing referral of benign lesions.
Conflict of Interest: The author declares that there is no conflict of
1. Robinson JK , Jain N , Marghoob AA , McGaghie W , MacLean M , Gerami P , Hultgren B , Turrisi R , Mallett K , Martin GJ . A Randomized Trial on the Efficacy of Mastery Learning on Primary Care Providers' Melanoma Opportunistic Screening Skills and Practice . J Gen Intern Med . DOI: https://doi.org/10.1007/s11606-018-4311-3
2. Swetter SM , Chang J , Shaub AR , Weinstock MA , Lewis ET , Asch SM . Primary Care-Based Skin Cancer Screening in a Veterans Affairs Health Care System . JAMA Dermatol . 2017 ; 153 ( 8 ): 797 - 801 .
3. Mariah M Johnson , Sancy A Leachman, Lisa G Aspinwall, Lee D Cranmer, Clara Curiel-Lewandrowski et al . Skin cancer screening: recommendations for data-driven screening guidelines and a review of the US Preventive Services Task Force controversy . Melanoma Manag . 2017 ; 4 ( 1 ): 13 - 37 .
4. Friedman KP , Whitaker-Worth DL , Grin C , Grant-Kels JM . Melanoma screening behavior among primary care physicians . Cutis . 2004 ; 74 ( 5 ): 305 - 11 .