Training general practitioners in melanoma diagnosis: a scoping review of the literature

Abstract

BackgroundGeneral practitioners (GPs) play a key role in early melanoma detection. To help GPs deal with suspicious skin lesions, melanoma diagnostic training programmes have been developed. However, it is unclear whether these programmes guarantee the acquisition of skills that will be applied by GPs in their daily clinical practice and maintained over time.ObjectivesThis scoping review aimed to examine and compare educational programmes designed to train GPs in melanoma diagnosis using clinical (naked eye) examination alone or dermoscopy±clinical examination, and sought to inform on the long-term sustainability of the GPs’ acquired skills.Eligibility criteriaStudies eligible for inclusion evaluated educational programmes for teaching diagnosis of melanoma to GPs. MEDLINE, EMBASE and Cochrane databases were searched for relevant articles from 1995 to May 2020.ResultsForty-five relevant articles were found assessing 31 educational programmes. Most programmes that improved the diagnostic accuracy and long-term performances of the GPs, that is, increase in confidence, decrease in dermatologist referral for benign skin lesions and improvement in the benign/malignant ratio of excised skin lesions, trained the GPs in clinical diagnosis, followed by dermoscopy. To maintain long-term performances, these programmes provided refresher training material.ConclusionThis review shows that studies generally report positive outcomes from the training of GPs in melanoma diagnosis. However, refresher training material seemed necessary to maintain the acquired skills. The optimal form and ideal frequency for these updates have yet to be defined.

Dermoscopy use in primary care: a qualitative study with general practitioners

“…In particular participants thought dermoscopy training needed to be hands-on, practical, and that short one-off training was inadequate. This concurs with the results of a scoping review looking at programs to train GPs in melanoma diagnosis, which found that the programs that led to sustained improvement in GPs’ clinical practice included refresher training material [ 42 ]; moreover the effectiveness of ongoing dermoscopy training for GPs delivered via distance learning has shown promising potential. [ 43 ] Conversely, a questionnaire study carried out among GPs with an interest in dermatology found that the majority reported feeling confident using dermoscopy after short-term training [ 27 ].…”

Stage IA melanoma follow‐up: Exploring the level of confidence of South Australian general practitioners in undertaking surveillance skin checks including considerations for shared care

“…A recent scoping review of the literature published in 2021 also suggests that training modality does not influence the overall acquired performance of GPs while longer-term sustainability of performance is achieved with programmes that provide refresher training material. 26 While ensuring ongoing education and upskilling are important steps when implementing models of shared care, support for GPs should also be taken into consideration and this could be in the form of rapid access to dermatology referral pathways as indicated by study respondents. At present, triage criteria and pathways are already in place at tertiary centres in South Australia.…”

Towards successful implementation of artificial intelligence in skin cancer care: a qualitative study exploring the views of dermatologists and general practitioners

“…In line with this, providing post-graduate skin cancer education to GPs has demonstrated to improve the diagnostic accuracy of primary care physicians [ 25 – 27 ]. However, post-graduate training of GPs typically involves dermatologists to provide education, which can be labor-intensive and costly, and refresher material seems critical to maintaining acquired skills [ 28 ]. AI may be a useful complementary educational tool in addition to human teaching, which may prove helpful to scale post-graduate education of GPs and can be used according to their individual needs.…”