OBJECTIVE:To determine whether a brief, multicomponent intervention could improve the skin cancer diagnosis and evaluation planning performance of primary care residents to a level equivalent to that of dermatologists. PARTICIPANTS:Fifty-two primary care residents (26 in the control group and 26 in the intervention group) and 13 dermatologists completed a pretest and posttest. DESIGN:A randomized, controlled trial with pretest and posttest measurements of residents' ability to diagnose and make evaluation plans for lesions indicative of skin cancer. INTERVENTION:The intervention included face-to-face feedback sessions focusing on residents' performance deficiencies; an interactive seminar including slide presentations, case examples, and live demonstrations; and the Melanoma Prevention Kit including a booklet, magnifying tool, measuring tool, and skin color guide. MEASUREMENTS AND MAIN RESULTS:We compared the abilities of a control and an intervention group of primary care residents, and a group of dermatologists to diagnose and make evaluation plans for six categories of skin lesions including three types of skin cancer-malignant melanoma, squamous cell carcinoma, and basal cell carcinoma. At posttest, both the intervention and control group demonstrated improved performance, with the intervention group revealing significantly larger gains. The intervention group showed greater improvement than the control group across all six diagnostic categories (a gain of 13 percentage points vs 5, p Ͻ .05), and in evaluation planning for malignant melanoma (a gain of 46 percentage points vs 36, p Ͻ .05) and squamous cell carcinoma (a gain of 42 percentage points vs 21, p Ͻ .01). The intervention group performed as well as the dermatologists on five of the six skin cancer diagnosis and evaluation planning scores with the exception of the diagnosis of basal cell carcinoma. I n the United States, managed care organizations currently rely on primary care physicians to triage for many specialized areas of medicine, including dermatology. Successful triaging involves screening, making correct initial diagnosis and evaluation planning decisions, and appropriately referring to specialists. Because many of these managed care organizations use financial incentives and administrative mechanisms to encourage generalists to limit referrals to specialists, 1 we must ensure that primary care physicians can screen, diagnose, and evaluate effectively with reduced access to specialists. In dermatology, primary care physicians may not need to be as skilled as dermatologists at diagnosing and planning treatment for the approximately 2,000 named skin diseases, 2 but, at a minimum, they need to proficiently screen, diagnose, and evaluate lesions indicative of skin cancer. 3 In this study, we focused on improving primary care residents' performance on diagnosing and making evaluation plans for lesions indicative of skin cancer. CONCLUSIONS:Primary care physicians have the opportunity to play a major role in the early detection of skin cancer. Up...

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Abstract:The purpose of this paper is to describe some of the challenges encountered and lessons learned while providing and evaluating a violence-prevention program for and with ethnically diverse populations in child care settings. The paper discusses Safe Start, a violence prevention education program for child care staff and parents, and the evaluation of the program. Safe Start was designed to include culturally relevant content to increase cultural awareness for child care staff and parents from diverse ethnic backgrounds. The evaluation project enrolled child care centers with families representing the ethnically diverse communities in which they were located. Violence prevention research involving children from diverse ethnic backgrounds presents new methodologic challenges, but also provides new opportunities for creative, novel methods. This paper describes some of the challenges encountered with curriculum development, staff recruitment, instrument selection, and data collection procedures. Medical

An entering class of medical students is compared with an entering class of law students on attitudes toward self-responsibility for health and reported health behaviors. Students' health behavior patterns are contrasted with those of practicing physicians and lawyers. Data were collected by self-administered questionnaires. Results indicated that medical students were stronger on self-responsibility and also reported more often engaging in health promoting behavior than law students. The same pattern of differences was reported for practicing physicians and lawyers. (Am J Public Health 1982; 72:725-727.) This paper reports a comparison of a class of first year medical students with a class of first year law students on attitudes toward self-responsibility for health and reported health-promoting behavior. The study was suggested by a published report that compared health-promoting behaviors of samples of practicing physicians and lawyers.' Materials and MethodsData were collected by means of self-administered questionnaires during the first week of class for first year medical students and first year law students in the same midwestern, private university. Usable questionnaires were returned from 217 freshman law students (100 per cent) and 152 freshman medical students (98 per cent).The questionnaires were identical in questions asking for demographic information (age, sex, race, social class), opinions on health issues, a six-item index to assess attitude toward self-responsibility for health, a measure of personality type, and reported health behaviors. Questions which measured perspective on their profession differed only in the referent, i.e., questions referring to medicine or physicians were asked of medical students and questions about law and lawyers were asked of law students. Data were analyzed by chi square and correlational techniques.