Use of simulators to explore specialty recommendation for a palpable breast mass

Abstract

Background The study aim was to evaluate recommendation patterns of different specialties for the work-up of a palpable breast mass using simulated scenarios and clinical breast examination (CBE) models. Methods Study participants were a convenience sample of physicians (n=318) attending annual surgical, family practice and obstetrics and gynecology (OB/GYN) conferences. Two different silicone-based breast models (superficial mass vs chest wall mass) were used to test CBE skills and recommendation patterns (imaging, tissue sampling, and follow-up). Results Participants were more likely to recommend mammography (p<.001) and core biopsy (p<.0001) and less likely to recommend needle aspiration (p<.043) and 1-month follow up (p<.001) for the chest wall mass compared to the superficial mass. Family practitioners were less likely to recommend ultrasound (p<.001) and OB/GYNs were less likely to recommend mammogram (p<.006) across models. Surgeons were more likely to recommend core biopsy and less likely to recommend needle aspiration across models (p<.001) Conclusions Recommendation patterns differed across the two models in line with existing practice guidelines. Additionally, differences in practice patterns between primary care and specialty providers may represent varying clinician capabilities, health care resources, and individual preferences. Our work shows that simulation may be used to track adherence to practice guidelines for breast masses.

Sensor-Based Discovery of Search and Palpation Modes in the Clinical Breast Examination

“…Together with previous results from this lab, [13][14][15] the present findings can be used in developing detailed and actionable assessment metrics for haptic techniques used in other physical examinations and hands-on skills in procedural medicine. The overarching goal is to address the gap in our ability to accurately assess hand movements and kinematic forces that are necessary in improving diagnosis during clinical exams.…”

“…In model C, the mass was made from hard clay, while in model D, it was molded from silicone and was thus softer. The models are presented in more detail elsewhere 14,15 . Because of the similarity in models A and B and in models C and D, and in order to simplify the presentation of the data, in the analysis we combined the data of models A and B (termed superficial mass) and the data of models C and D (termed deep mass).…”

“…In our prior work, we used a sensor-enabled CBE simulator, along with video recordings, to assess physician competency. 11,[14][15][16] In addition to identifying a variety of haptic palpation techniques based on force and video data, we found that use of low forces (<10 N) was associated with significant risk of missing deep lesions near the chest wall. 11 Further work used video data recordings to characterize differences in CBE haptic exploration techniques when searching the breast compared with hand movements that occur subsequent to detection of an abnormality.…”

“…While the CBE has been used for over a century, 13 we are still trying to figure out how to give feedback and ensure physician competency. In our prior work, we used a sensor-enabled CBE simulator, along with video recordings, to assess physician competency 11,14–16 . In addition to identifying a variety of haptic palpation techniques based on force and video data, we found that use of low forces (<10 N) was associated with significant risk of missing deep lesions near the chest wall 11 .…”

Breast Cancer Detection

“…5 However, there has been no agreement on standardization of CBE and trainees are exposed to differing techniques. 9 In addition to IDBM through CBE, the learner should demonstrate that their technique can be modified to accommodate variation such as large breasts and normal variation in nodularity in breasts. However, current testing for IDBM proficiency does not test for these skills.…”