A skin cancer training programme: evaluation of a postgraduate training for family doctors

Abstract

This study aimed to evaluate the effectiveness of a postgraduate skin cancer training programme in improving family doctors' levels of knowledge and clinical practice. Forty-one of 59 family doctors (69% consent) who enrolled in the training programme agreed to participate in its evaluation. Approximately half of the doctors were allocated to the 'intervention' group, and the others were in the 'waiting-list' control group. Pre-and post-test data were collected to assess changes in doctors' knowledge, perceived confidence and clinical practice. The training programme involved three sessions, including an information/education session, a practical session at the local Melanoma Unit, and a practical surgical procedures session. There were significant improvements in the proportion of (i) accurate diagnoses, which were made when lesions were presented on colour slides with an accompanying case history; (ii) lesions presented on colour slides in which the correct management of the lesion was identified; and (iii) doctors who felt very or extremely confident in their ability to advise patients on screening frequency, to advise patients on the signs of skin cancer, and to decide whether changes in lesions were malignant. The only improvement observed in the doctors' clinical practice was a significant increase from pre-to post-test in the proportion of pathology request forms on which a diagnosis of the specimen was attempted by doctors in the intervention group compared to those in the control group. The results of this study indicate that whilst significant improvements in knowledge are achievable through postgraduate programmes, clinical practice is much more difficult to change.Postgraduate training in skin cancer AfafGirgis et al.

Interventions to reduce primary care delay in cancer referral: a systematic review

“…The RCTs included used a variety of educational interventions including lectures, videos, and an internet triage package. 18,19,21,22 The interventions were compared to control groups that received no intervention. They were of mixed quality and provided inconsistent evidence.…”

“…The two studies that reported a positive outcome of improved diagnosis and management did not see the improvement continue to the end of the study period. 21,22 Overall, studies rated as high quality reported poorer outcomes than those rated as low quality, and positive outcomes were only seen in the short term.…”

“…Some studies had a high risk of selection bias, [13][14][15][16][17]19,20,22,24,25,27,[29][30][31] with little information given (if any) about whether those who participated were different from those who chose not to take part. Almost all studies reported a follow-up period of less than 1 year; 11,14,[17][18][19]21,23,24,27,28,31,33 several tested participants straight after the intervention; 15,16,29,30 and some did not include or state any follow-up period.…”

“…Almost all studies reported a follow-up period of less than 1 year; 11,14,[17][18][19]21,23,24,27,28,31,33 several tested participants straight after the intervention; 15,16,29,30 and some did not include or state any follow-up period. 20,22,25,32 Therefore, it cannot be determined whether any of the reported improvements persisted. Less than half of the 22 studies included recruited more than 100 participants, 11,15,17,21,23,24,26,29,30,32 and several studies suffered from a high dropout rate, 18,19,28,32,33 with only 18% of participants in 6 months.…”

“…Among the RCTs, the randomisation process of some studies was either poorly reported or inadequate. 13,18,21,22,25,26,28 In some cases, the control group may also have been sensitised to cancer through participation in the study, 18,19 in that their participation heightened their awareness of the topic. Generally, not enough detail was provided in the studies, especially with regard to information about the intervention and participants, to be able to assess the potential risk of bias.…”