Article Figures & Data
Figures
- Figure 1.
Overall mean (± standard deviation) test scores for pretest, immediate posttest, and 6-month posttest among participants by initial quartile of performance.
- Figure 2.
Dermatology referrals/new visits of participants' patients during the last 6 months of 2010 (before the course) and 2011 (after the course) with skin biopsies and cancers at sites A and B. NMSC, nonmelanoma skin cancer.
Tables
- Table 1. Characteristics of Participants and Eligible Nonparticipants in the Study's Practice Settings
Characteristics Participants (n = 54) Eligible Nonparticipants (n = 186)* Age (years) <39 16 30 NA NA 40–49 11 20 NA NA 50–59 19 35 NA NA 60–69 8 15 NA NA Sex Male 25 46 68 37 Female 29 54 118 63 Race White 21 39 59 32 Black 2 4 6 3 Asian 28 52 101 54 Unknown 3 6 20 11 Ethnicity Hispanic/Latino 1 2 NA NA Not Hispanic/Latino 50 93 NA NA Unknown 3 6 NA NA Provider degree MD 51 94 173 93 DO 2 4 10 5 NP 1 2 3 2 School location Domestic 28 52 109 59 Foreign 23 43 68 37 Unknown/NA 3 6 9 5 Clinical specialty† Family physician 9 17 14 8 General internist 43 80 167 90 Other 2 2 2 1 Years in practice <5 6 11 7 4 5–9 8 15 29 16 10–19 18 33 84 45 20–29 12 22 44 24 ≥30 10 19 19 1 Prior skin cancer training Medical/nursing school 33 61 NA NA Residency 32 59 NA NA Live CME 8 15 NA NA Web-based course 4 7 NA NA - Table 2. Mean Pretest, Immediate Posttest, and 6-Month Posttest Scores of 25 Skin Lesions*
Test Component Pretest Mean Score (%) Immediate Posttest Mean Score 6-Month Posttest Mean Score % OR† (95% CI) % OR (95% CI) Overall score‡ All lesions (n = 25) 36.1 46.7 1.6 (1.4–1.9) 41.3 1.3 (1.1–1.5) Malignant (n = 15) 38.7 46.9 1.5 (1.2–1.8) 43.1 1.2 (1.0–1.5) Benign (n = 10) 32.1 46.3 1.9 (1.6–2.4) 38.6 1.4 (1.0–1.8) Diagnosis score All lesions (n = 25) 41.5 51.9 1.6 (1.4–1.8) 44.8 1.1 (1.0–1.4) Malignant (n = 15) 39.4 48.8 1.5 (1.3–1.9) 44.0 1.2 (1.0–1.5) Benign (n = 10) 44.8 56.7 1.7 (1.3–2.1) 46.0 1.0 (0.8–1.4) Management score All lesions (n = 25) 72.9 78.4 1.4 (1.2–1.7) 77.3 1.3 (1.1–1.6) Referred (n = 15) 86.6 82.8 0.7 (0.5–0.9) 85.1 0.8 (0.6–1.1) Reassured (n = 10) 52.3 71.9 2.8 (2.2–3.6) 65.7 2.1 (1.5–2.8) ↵* All 54 participants took the pretest and immediate posttest; 48 (89%) took the 6-month posttest.
↵† Odd ratio (OR) is an estimate of relative risk and is an indication of how much better the posttest scores of participants are compared to the pretest score. See the Analysis section.
↵‡ Includes both diagnosis and management.
CI, confidence interval.
- Table 3. Mean Overall Scores in the Pretest and Immediate Posttest According to Participant Characteristics
Participant Characteristics Pretest Mean Score (%) Immediate Posttest Mean Score (%) OR* 95% CI Age (years) 30–39 37.3 48.8 1.7 1.3–2.2 40–49 40.4 54.9 1.9 1.4–2.6 50–59 33.8 43.8 1.6 1.3–2.0 60–69 33.0 38.0 1.3 0.9–1.9 Sex Female 38.4 46.5 1.4 1.2–1.7 Male 33.4 46.9 1.9 1.5–2.3 Race Asian 35.8 43.1 1.4 1.2–1.7 Black 30.0 54.0 3.2 1.5–6.9 White 36.6 49.7 1.8 1.4–2.2 Ethnicity Hispanic 36.0 48.0 1.6 0.6–4.4 Non-Hispanic 35.9 46.2 1.6 1.4–1.9 Provider degree DO 42.0 44.0 1.1 0.5–2.4 MD 36.0 46.8 1.6 1.4–1.9 NP 28.0 44.0 2.0 0.8–5.4 School location Domestic 38.1 50.0 1.7 1.4–2.1 Foreign 34.1 43.0 1.5 1.2–1.9 Clinical specialty Family medicine 39.1 45.3 1.3 0.9–1.9 Internal medicine 35.3 47.0 1.7 1.5–2.0 Other 40.0 44.0 — — Years in practice <5 32.0 46.0 1.9 1.2–2.9 5–9 43.4 50.5 1.3 0.9–2.0 10–19 39.1 53.6 2.0 1.5–2.5 20–29 33.9 41.3 1.4 1.0–1.9 ≥30 30.4 38.0 1.4 1.0–2.0 Total previous skin cancer training courses (n) 0 33.3 50.7 2.3 1.4–3.6 1 35.1 46.7 1.7 1.4–2.1 2 36.7 44.7 1.4 1.1–1.8 3 44.0 53.3 1.5 0.9–2.5 Prior skin cancer training Medical/nursing school None 34.6 47.2 1.8 1.4–2.2 Yes 37.0 46.3 1.5 1.3–1.9 Residency None 34.1 46.7 1.8 1.4–2.2 Yes 37.3 46.6 1.5 1.3–1.8 Live CME None 36.0 47.5 1.7 1.4–2.0 Yes 36.3 42.0 1.2 0.8–1.8 Web-based course None 36.0 46.2 1.6 1.4–1.9 Yes 37.0 52.0 1.9 1.2–3.0 Type of INFORMED course presentation Traditional course 36.6 41.7 1.2 0.9–1.7 Case-based learning 35.9 48.4 1.8 1.5–2.1 ↵* Odd ratio (OR) is an estimate of relative risk and is an indication of how much better the immediate posttest scores of participants are compared to the pretest score.
CME, continuing medical education; INFORMED, Internet Course for Melanoma Early Detection; DO, doctor of osteopathy; MD, medical doctor; NP, nurse practitioner; CI, confidence interval.
- Table 4. Participants' Confidence and Attitudes About Skin Cancer Identification on a 5-Point Likert Scale in the Pretest, Immediate Posttest, and 6-Month Posttest*
Confidence/Attitude Categories Pretest Immediate Posttest 6-Month Posttest Diagnosing skin cancer 2.9 (0.6) 3.1 (0.7) 3.2 (0.8) Distinguishing benign from malignant lesions 3.0 (0.8) 3.2 (0.8) 3.3 (0.7) Distinguishing benign pigmented lesions from melanoma 2.8 (0.8) 3.1 (0.8) 3.1 (0.8) Providing appropriate initial management of skin lesions 3.2 (0.9) 3.6 (0.8) 3.8 (0.9) Identifying patients at high risk for skin cancer 3.4 (0.8) 4.1 (0.8) 4.0 (0.9) Performing a skilled, complete skin examination 3.6 (1.1) 4.3 (0.7) 4.2 (1.0) Data are mean scores ± standard deviations.
↵* All 54 participants took the pretest and immediate posttest; 48 (89%) took the 6-month posttest.
