TY - JOUR
T1 - Detection and description of small breast masses by residents trained using a standardized clinical breast exam curriculum
AU - Steiner, Elizabeth
AU - Austin, Donald F.
AU - Prouser, Nancy C.
N1 - Funding Information:
Acknowledgements: This work was funded in part by a grant from Northwest Health Foundation and supported by the OHSU Department of Family Medicine; Cancer Institute; and Department of Public Health & Preventive Medicine. Northwest Health Foundation had no role in any aspect of the study or the preparation of the manuscript. The Department of Family Medicine, Department of Public Health & Preventive Medicine, and the Cancer Institute did not require that they approve the manuscript. We are grateful for the assistance of Deanne Neth BA—OSCE observing, data entry, manuscript preparation; Scott Fields MD, Rebecca Rdesinski MSW, and the Working On Research Collabora- tively group in the Department of Family Medicine—editing; Sara Rogers BS—database design; and the program coordinators in the residency programs. Biostatistical support was provided by Solange Mongoue-Tchokote MS of the Biostatistics Shared Resource of the OHSU Cancer Institute (P30 CA69533).
PY - 2008/2
Y1 - 2008/2
N2 - OBJECTIVES: We evaluated the effect of standardized clinical breast examination (CBE) training on residents' ability to detect a 3-mm breast mass in a silicone breast model. METHODS: In this nonrandomized controlled trial, 75 first year residents (R1s) at 8 family medicine, internal medicine, and obstetrics and gynecology training programs received the intervention and second year residents (R2s) did not. Trained residency faculty taught R1s vertical strip, three-pressure method (VS3PM) CBE using a standardized curriculum, including a 1- to 2-hour online self-study with video and 2.5-hour practicum using silicone models and a trained patient surrogate. RESULTS: Solitary mass detection: 84% by R1s, 46% by R2s (RR=1.82, 95%CI=1.36, 2.43, P<0.0001). Of those finding a mass, 62% of R1s and 10% of R2s used at least 5 of 8 standardized descriptors (RR=6.19, 95%CI=2.06, 18.59, P=0.001). R1s false positive findings were not statistically different from R2s (P=0.54). Both the use of VS3PM and total time spent on CBE were independently highly predictive of finding the mass in either group. CONCLUSIONS: Most untrained primary care residents are not proficient in CBE. Standardized VS3PM CBE training improves the ability to detect and describe a small mass in a silicone breast model. Better CBE training for residents may improve the early detection of breast cancer.
AB - OBJECTIVES: We evaluated the effect of standardized clinical breast examination (CBE) training on residents' ability to detect a 3-mm breast mass in a silicone breast model. METHODS: In this nonrandomized controlled trial, 75 first year residents (R1s) at 8 family medicine, internal medicine, and obstetrics and gynecology training programs received the intervention and second year residents (R2s) did not. Trained residency faculty taught R1s vertical strip, three-pressure method (VS3PM) CBE using a standardized curriculum, including a 1- to 2-hour online self-study with video and 2.5-hour practicum using silicone models and a trained patient surrogate. RESULTS: Solitary mass detection: 84% by R1s, 46% by R2s (RR=1.82, 95%CI=1.36, 2.43, P<0.0001). Of those finding a mass, 62% of R1s and 10% of R2s used at least 5 of 8 standardized descriptors (RR=6.19, 95%CI=2.06, 18.59, P=0.001). R1s false positive findings were not statistically different from R2s (P=0.54). Both the use of VS3PM and total time spent on CBE were independently highly predictive of finding the mass in either group. CONCLUSIONS: Most untrained primary care residents are not proficient in CBE. Standardized VS3PM CBE training improves the ability to detect and describe a small mass in a silicone breast model. Better CBE training for residents may improve the early detection of breast cancer.
KW - Breast cancer
KW - Clinical breast examination
KW - Early detection
KW - Medical education
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U2 - 10.1007/s11606-007-0444-5
DO - 10.1007/s11606-007-0444-5
M3 - Article
C2 - 18058184
AN - SCOPUS:39149140091
VL - 23
SP - 129
EP - 134
JO - Journal of General Internal Medicine
JF - Journal of General Internal Medicine
SN - 0884-8734
IS - 2
ER -