Assessing Resident Physician Melanoma Detection Across Ethnic Groups

描述(申请人提供)：非西班牙裔白人(简称白人)的黑色素瘤发病率高于黑人。然而，最近人们认识到，目前患有更晚期疾病的少数族裔1-4在有色人种皮肤中呈现黑色素瘤的低水平怀疑和培训可能会导致对少数族裔进行皮肤检查的偏见或对恶性病变的误诊，延误医疗保健。5我们小组有相当丰富的经验来评估医学生中的黑色素瘤检测，使用标准化患者(SP)佩戴模拟黑色素瘤的印记(真实纹身)。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内内科(IM)住院医生，通过对住院门诊连续性诊所进行未经宣布的(秘密)SP访问，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在相同解剖位置穿着相同的黑色素瘤印记的黑色素瘤的检出率。每一次未经宣布的SP与医生的会面都将被录音。我们的第二个目标是使用Gale和Marsden临床决策模型中的诊断思维过程(DTP)清单来审查记录和分析内容，以确定诊断错误的常见来源。在完成首次探视后，居民将被随机分为教育干预组或控制组，不需要额外的教育。使用SPS和模拟练习的干预将帮助住院医生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方面的错误。我们的第三个目标是确定黑色素瘤的发现率是否提高并可持续，未宣布的SP(包括白色和黑色)将再次插入居民连续性诊所。如果医生未能在黑人中发现黑色素瘤，这可能会导致诊断延误和对患者的伤害。记录这些不足之处对改进医学教育课程将是无价的。

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.