Assessing Resident Physician Melanoma Detection Across Ethnic Groups

描述（由申请方提供）：非西班牙裔白人（称为白人）中黑色素瘤的发病率高于黑人。然而，在这方面，最近已经认识到少数民族呈现出更晚期的疾病。1 -4对有色皮肤中黑色素瘤表现的怀疑和培训水平低可能导致对少数民族进行皮肤检查的偏见或对恶性病变的误诊延误医疗护理。5我们的小组在使用佩戴印模的标准化患者（SP）评估医学生中黑色素瘤检测方面有相当多的经验（逼真的纹身）模仿黑色素瘤。基于我们的专业知识，我们建议将我们的黑色素瘤检测研究扩展到三年级内科（IM）居民，使用未经宣布的（隐形）SP访问居民门诊连续性诊所，使我们能够观察实际的患者护理实践。我们的第一个具体目标是确定放置在居民连续性诊所的白色和黑色SP在相同的解剖位置佩戴相同的黑色素瘤印模的黑色素瘤检出率。每次未经通知的SP医生会面都将被录音。我们的第二个目标是使用Gale和Marsden模型的诊断思维过程清单（DTP）审查记录并分析内容，以确定诊断错误的常见来源。在完成初始访视后，住院医师将被随机分配至教育干预组或对照组，不进行额外教育。利用SP和模拟练习的干预将帮助居民识别和纠正黑色素瘤医学知识，检查技能，临床数据解释或沟通中的错误。我们的第三个目标是确定黑色素瘤检出率是否提高，是否可持续，未宣布的SP（白色和黑色）将再次插入居民连续性诊所。 如果医生未能在黑人中检测到黑色素瘤，这可能会导致诊断延迟和患者伤害。记录这些不足之处将是非常宝贵的，以改善医学教育课程。

DESCRIPTION (provided by applicant): The incidence of melanoma is greater in non-Hispanic Whites (referred to as Whites) than in Blacks. However, it has recently been recognized that minorities present with more advanced stage disease.1-4 Low levels of suspicion and training in melanoma presentations in skin of color may lead to a bias against performing skin examination in minorities or misdiagnoses of malignant lesions delaying medical care.5 Our group has considerable experience assessing melanoma detection in medical students using standardized patients (SPs) wearing a moulage (realistic tattoo) simulating a melanoma. Building on our expertise, we propose to extend our melanoma detection studies to third-year internal medicine (IM) residents using unannounced (stealth) SP visits to resident ambulatory continuity clinics allowing us to observe actual patient care practices. Our first specific aim is to determine melanoma detection rates for White and Black SPs placed into resident continuity clinics wearing identical melanoma moulages in the same anatomic location. Each unannounced SP-physician encounter will be audio-recorded. Our second aim is to review recordings and analyze content using the Inventory of Diagnostic Thinking Processes (DTP) from the Gale and Marsden model for clinical decision-making to determine common sources of diagnostic error. Following completion of initial visits, residents will then be randomized to eithr an educational intervention or control arm with no additional education. The intervention utilized SPs and simulation exercises will help residents identify and correct errors in melanoma medical knowledge, examination skills, clinical data interpretation, or communication. Our third aim is to determine if the melanoma detection rate improved and is sustainable, unannounced SPs (both White and Black) will once again be inserted into resident continuity clinics. If physicians fail to detect melanoma in Blacks this could result in diagnostic delays and patient harm. Documenting these deficiencies would be invaluable to improving medical education curriculums.