Detection and description of small breast masses by residents trained using a standardized clinical breast exam curriculum.
OBJECTIVE
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.
OHSU Cancer Institute Breast Health Education Program, Oregon Health & Science University, Portland, OR 97239, USA. steinere@ohsu.edu
Elizabeth
E
Steiner
Donald F
DF
Austin
Nancy C
NC
Prouser
D001941:Breast Diseases / Q000175:diagnosis*; D016022:Case-Control Studies; D002983:Clinical Competence; D003479:Curriculum; D042241:Early Diagnosis; D005188:False Negative Reactions; D005189:False Positive Reactions; D006801:Humans; D007396:Internship and Residency; D008348:Manikins; D010808:Physical Examination / Q000379:methods*