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Table 1. School and Focus Group Characteristics
School and Focus Group Characteristics
Table 2. Current Skin Cancer Education at Participating Schools
Current Skin Cancer Education at Participating Schools
Table 3. Subjective Comments by Students in Response to Open-Ended Questions About Ways to Improve Dermatology Education
Subjective Comments by Students in Response to Open-Ended Questions About Ways to Improve Dermatology Education
Table 4. Educator Responses to Question of 3 to 5 Important Skills or Pieces of Knowledge About Skin Cancer That Every Medical Student Should Know When They Graduate
Educator Responses to Question of 3 to 5 Important Skills or Pieces of Knowledge About Skin Cancer That Every Medical Student Should Know When They Graduate
1.
Howe  HL, Wingo  PA, Thun  MJ,  et al.  Annual reports to the nation on the status of cancer (1973 though 1998), featuring cancers with recent increasing trends.  J Natl Cancer Inst. 2001;93:824-842. PubMedGoogle ScholarCrossref
2.
Koh  HK, Norton  LA, Geller  AC,  et al.  Evaluation of the American Academy of Dermatology's National Skin Cancer Early Detection and Screening Program.  J Am Acad Dermatol. 1996;34:971-978. PubMedGoogle ScholarCrossref
3.
Dolan  NC, Martin  GJ, Robinson  JK, Rademaker  AW.  Skin cancer control practices among physicians in a university general medicine practice.  J Gen Intern Med. 1995;10:515-519. PubMedGoogle ScholarCrossref
4.
Moore  M, Geller  AC, Zhang  Z,  et al.  Skin cancer examination teaching in US medical education.  Arch Dermatol. 2006;142:439-444. PubMedGoogle ScholarCrossref
5.
 FACTS—applicants, matriculants and graduates. Association of American Medical Colleges Web site. Available at: http://www.aamc.org/data/facts/2003/2003school.htm. Accessed July 19, 2004
Research Letter
April 2006

Improving Skin Cancer Prevention and Detection Education in US Medical Schools

Arch Dermatol. 2006;142(4):524-526. doi:10.1001/archderm.142.4.524

Early detection and excision of skin cancers has the potential to significantly improve health outcomes.1,2 Unfortunately, few primary care physicians perform skin cancer screening routinely. Inadequate training and low confidence in their ability to recognize skin cancer are potential barriers.3 Educating all physicians regarding skin cancer detection and prevention could have a profound public health impact; however, most medical students graduate without ever performing a skin cancer examination.4

This study describes current instruction about skin cancer obtained in discussion groups conducted in 2004 with medical students at Boston University School of Medicine, Boston, Mass; Harvard Medical School, Boston; Brown Medical School, Providence, RI; University of Massachusetts Medical School, Worcester; and Dartmouth Medical School, Hanover, NH. The chairs of dermatology at each of the 5 New England schools identified a faculty person primarily responsible for medical student dermatology education. Each educator enlisted a medical student to coordinate the student discussion group. The student coordinator was asked to recruit primarily second-, third-, and fourth-year students, including students interested in pursuing a career in dermatology, student leaders, and students not interested in pursuing a career in dermatology. The coordinator led the discussion group at each school.

A total of 24 students participated in the 5 discussion groups (Table 1). Of these, 1 (4%) was in year 1, 7 (29%) were in year 2, 13 (54%) were in year 3, and 3 (13%) were in year 4; 17 (71%) were women, with a mean age of 26 years. At least 1 student not interested in pursuing a career in dermatology participated in each discussion group.

Only school D required clinic time with a dermatologist, for up to 4 half-days during the internal medicine clerkship (Table 2). All schools had a 4-week clinical dermatology elective, and school A had introduced a 2- to 3-week elective during the third year. All schools had minimal elective exposure to skin cancer education beyond the clinical dermatology elective. School E offered a community dermatology elective, and school B had a community health elective for which students could opt to do a dermatology-related project.

Students were asked open-ended questions about ways to improve their dermatology education. Some of their subjective comments are given in Table 3. Multiple students expressed an interest in focusing their education on the most prevalent skin conditions that primary care physicians may treat and stressed the importance of repetition. Students were interested in more clinical dermatology exposure. Students at schools A, C, and E, however, questioned whether the dermatology clinics had the capacity to handle a large student volume. Students at schools B and E stressed a preference for learning the skin cancer examination in the clinical years. Students had additional ideas such as medical students visiting local schools to teach children about skin cancer prevention and awareness or a skin cancer prevention day at the medical school.

In addition to the student discussion groups, semi-structured in-person interviews were conducted with the faculty person responsible for medical student dermatology education. The faculty educators were asked to list 3 to 5 important skills or pieces of knowledge about skin cancer that every medical student should know when they graduate (Table 4). The dermatology educators were also asked to comment on the barriers and challenges to integrating new ideas into the medical school curriculum. Their responses included the following:

  • Faculty and student time constraints.

  • Already strenuous demands placed on medical students.

  • Feasibility of clinical exposure for all medical students owing to the small size of the dermatology clinics and the patient population.

  • Lack of dermatology faculty input into ongoing medical education reforms.5

This study expands on previous research by soliciting student perceptions of skin cancer education and ideas for improvement. Students stressed the value of repetition, exposure to dermatology during the clinical years, and interactive courses and workshops emphasizing skill development. Information collected for graduating students in 2002-2003 suggested that medical students do not have adequate opportunities to observe, learn, or practice the skin cancer examination.4 The data gathered herein confirm that not all students are being taught or given the opportunity to practice the skin cancer examination. The results from this study may be used to improve skin cancer education in medical schools. Improved communication between educators, both directly and through literature, would allow for schools to learn from the strengths and weaknesses of other curriculums. Each school will need to face barriers including limited resources, time constraints, and lack of importance placed on dermatology education.

Medical school education needs revision to ensure that medical students receive adequate training and graduate with specific competencies for skin cancer prevention and detection. Future studies should seek to develop and incorporate improved skin cancer instruction into the medical school curriculum and evaluate its effectiveness.

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Article Information

Correspondence: Mr Geller, Department of Dermatology, Boston University School of Medicine, 720 Harrison Ave, Doctor’s Office Building Room 801A, Boston, MA 02118 (ageller@bu.edu).

Financial Disclosure: None.

Funding/Support: This project was funded by a grant from the American Skin Association, New York, NY.

References
1.
Howe  HL, Wingo  PA, Thun  MJ,  et al.  Annual reports to the nation on the status of cancer (1973 though 1998), featuring cancers with recent increasing trends.  J Natl Cancer Inst. 2001;93:824-842. PubMedGoogle ScholarCrossref
2.
Koh  HK, Norton  LA, Geller  AC,  et al.  Evaluation of the American Academy of Dermatology's National Skin Cancer Early Detection and Screening Program.  J Am Acad Dermatol. 1996;34:971-978. PubMedGoogle ScholarCrossref
3.
Dolan  NC, Martin  GJ, Robinson  JK, Rademaker  AW.  Skin cancer control practices among physicians in a university general medicine practice.  J Gen Intern Med. 1995;10:515-519. PubMedGoogle ScholarCrossref
4.
Moore  M, Geller  AC, Zhang  Z,  et al.  Skin cancer examination teaching in US medical education.  Arch Dermatol. 2006;142:439-444. PubMedGoogle ScholarCrossref
5.
 FACTS—applicants, matriculants and graduates. Association of American Medical Colleges Web site. Available at: http://www.aamc.org/data/facts/2003/2003school.htm. Accessed July 19, 2004
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