title: Are university-based residency training programs lacking in resident education of proper diagnosis and treatment for common skin and breast lesions?
abstract: BACKGROUND
  Skin and breast cancers are the 2 most common malignancies in US women. Early detection with appropriate therapy is essential in improving survival rates. The aim of this study was to evaluate and compare general surgery (GS) and family medicine (FM) residents in their ability to identify and appropriately treat common skin and breast lesions.
  
  
  METHODS
  Thirty-three-question, institutional review board-approved, Web-based surveys (1 breast and 1 skin survey) were each sent to 244 GS and 452 FM training programs (both university-based and community-based programs) uniformly distributed across the United States. Each survey included demographics and 20 multiple-choice questions (10 lesion identification questions and 10 corresponding treatment questions).
  
  
  RESULTS
  A total of 374 completed resident surveys were collected (242 FM, 132 GS). Respondents were uniformly distributed geographically (55.9% women, 44.1% men; 54.2% community based, 45.8% university based). GS residents correctly identified 82.7% of lesions compared with 83.3% for FM residents (P = .89) and correctly treated 76.8% of lesions compared with 75.4% for FM residents (P = .81). No significant identification or treatment differences were noted by postgraduate year (PGY), but both GS and FM residents had lower accuracy of correct treatment identification compared with lesion identification, which was significant for GS PGY 2 residents (P = .02), FM PGY 2 residents (P = .03), and FM PGY 2 residents (P = .03). University-based GS residents had a more significant disparity between correct identification and correct treatment (83.6% vs 74.6%, P = .03) compared with community-based GS residents (80.4% vs 74.6%, P = .11). Both university-based and community-based FM residents had significant disparities in this comparison (university-based FM residents with 82.4% vs 69.8%, P = .02, vs community-based FM residents with 86.7% vs 74.5%, P = .04).
  
  
  CONCLUSIONS
  Both GS and FM residents incorrectly treated more lesions than they diagnosed. This diagnosis-treatment disparity was more pronounced among university-based residents. Validation of this observation may better identify potential training deficiencies in breast and skin oncology to enhance GS resident education.
authors.affiliation: Department of Surgery, University of Kansas School of Medicine, Kansas City, KS, USA.
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Cohen
authors.forename: Bobbi G
authors.initials: BG
authors.lastname: Fishinghawk
authors.forename: Dakota M
authors.initials: DM
authors.lastname: Urban
authors.forename: Kurt P
authors.initials: KP
authors.lastname: Schropp
authors.forename: Erica
authors.initials: E
authors.lastname: Person
authors.forename: Joshua M V
authors.initials: JM
authors.lastname: Mammen
authors.forename: Daniel
authors.initials: D
authors.lastname: Aires
authors.forename: Mark S
authors.initials: MS
authors.lastname: Cohen
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis / Q000628:therapy; D002983:Clinical Competence / Q000706:statistics & numerical data*; D005194:Family Practice / Q000193:education*; D005260:Female; D013502:General Surgery / Q000193:education*; D006764:Hospitals, Community; D006785:Hospitals, University; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D008297:Male; D015397:Program Evaluation; D012878:Skin Neoplasms / Q000175:diagnosis / Q000628:therapy; D011795:Surveys and Questionnaires; D014481:United States