title: Skin cancer education for primary care physicians: a systematic review of published evaluated interventions.
abstract: BACKGROUND
  Early detection of melanoma may provide an opportunity to positively impact melanoma mortality. Numerous skin cancer educational interventions have been developed for primary care physicians (PCPs) to improve diagnostic accuracy. Standardized training is also a prerequisite for formal testing of melanoma screening in the primary care setting.
  
  
  OBJECTIVE
  We conducted a systematic review to determine the extent of evaluated interventions designed to educate PCPs about skin cancer, including melanoma.
  
  
  METHODS
  Relevant studies in the English language were identified through systemic searches performed in MEDLINE, EMBASE, BIOSIS, and Cochrane through December 2010. Supplementary information was obtained from corresponding authors of the included studies when necessary.
  
  
  METHODS
  Studies eligible for inclusion formally evaluated skin cancer education interventions and were designed primarily for PCPs. Excluded studies lacked a specified training intervention, used decision-making software, focused solely on risk factor identification, or did not directly educate or assess participants. Twenty studies met the selection criteria. Data were extracted according to intervention content and delivery format, and study outcomes.
  
  
  RESULTS
  All interventions included instructions about skin cancer diagnosis, but otherwise varied in content. Curricula utilized six distinct educational techniques, usually incorporating more than one. Intervention duration varied from 12 min to over 6 h. Eight of the 20 studies were randomized trials. Most studies (18/20, 90%) found a significant improvement in at least one of the following five outcome categories: knowledge, competence, confidence, diagnostic performance, or systems outcomes. Competence was most commonly measured; no study evaluated all categories. Variability in study design, interventions, and outcome measures prevented correlation of outcomes with intervention characteristics.
  
  
  CONCLUSIONS
  Despite the development of many isolated educational interventions, few have been tested rigorously or evaluated under sufficient standardized conditions to allow for quantitative comparison. Improved and rigorously tested skin cancer educational interventions for PCPs with outcome measures focusing on changes in performance are needed.
authors.affiliation: Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, NY 07920, USA.
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: Goulart
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Quigley
authors.forename: Stephen
authors.initials: S
authors.lastname: Dusza
authors.forename: Sarah T
authors.initials: ST
authors.lastname: Jewell
authors.forename: Gwen
authors.initials: G
authors.lastname: Alexander
authors.forename: Maryam M
authors.initials: MM
authors.lastname: Asgari
authors.forename: Melody J
authors.initials: MJ
authors.lastname: Eide
authors.forename: Suzanne W
authors.initials: SW
authors.lastname: Fletcher
authors.forename: Alan C
authors.initials: AC
authors.lastname: Geller
authors.forename: Ashfaq A
authors.initials: AA
authors.lastname: Marghoob
authors.forename: Martin A
authors.initials: MA
authors.lastname: Weinstock
authors.forename: Allan C
authors.initials: AC
authors.lastname: Halpern
mesh_terms: D042241:Early Diagnosis; D006801:Humans; D008545:Melanoma / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy; D058007:Physicians, Primary Care / Q000193:education*; D011320:Primary Health Care / Q000379:methods* / Q000592:standards; D016032:Randomized Controlled Trials as Topic / Q000379:methods / Q000592:standards; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000517:prevention & control / Q000628:therapy*