title: Curricular factors associated with medical students' practice of the skin cancer examination: an educational enhancement initiative by the integrated skin exam consortium.
abstract: OBJECTIVE
  As medical school curricula become progressively integrated, a need exists to optimize education related to the skin cancer examination (SCE) for melanoma, a relevant competency gap that influences secondary prevention efforts.
  
  
  OBJECTIVE
  To identify curricular factors associated with medical students' confidence, intent, and performance regarding the SCE.
  
  
  METHODS
  Survey-based cross-sectional study from the Integrated Skin Exam Consortium at accredited US medical schools among a volunteer sample of second-year students representing 8 geographically varied public and private institutions. Students were administered a questionnaire to assess characteristics, curricular exposures, and educational and practical experiences related to skin cancer, as well as knowledge of melanoma risk and a detection method.
  
  
  METHODS
  Primary outcomes were confidence in performing the SCE, intent to perform an integrated skin examination, and actual performance of the SCE.
  
  
  RESULTS
  Physical diagnosis session and clinical encounter were most predictive of confidence in performance of the SCE (odds ratios [ORs], 15.35 and 11.48, respectively). Other curricular factors associated with confidence included instruction time of at least 60 minutes on skin cancer (OR, 6.35), lecture on the SCE (OR, 7.54), knowledge of melanoma risk (OR, 3.71), and at least 1 opportunity to observe the SCE (OR, 2.70). Physical diagnosis session and at least 4 opportunities to observe the SCE were most predictive of intent to perform an integrated skin examination (ORs, 4.84 and 4.72, respectively). Other curricular factors associated with intent included knowledge of melanoma risk (OR, 1.83), clinical encounter (OR, 2.39), and at least 1 opportunity to observe the SCE (OR, 1.95). Clinical encounter, physical diagnosis session, and at least 1 opportunity to observe the SCE were most predictive of performance of the SCE (ORs, 21.67, 15.48, and 9.92, respectively). Other curricular factors associated with performance included instruction time of at least 60 minutes on skin cancer (OR, 2.42) and lecture on the SCE (OR, 5.04).
  
  
  CONCLUSIONS
  To augment the practice of the SCE among medical students, course directors may design an integrated curriculum that includes at least 60 minutes of instruction related to melanoma and the SCE, a description of the integrated skin examination as part of the physical diagnosis course, and education on high-risk demographic groups and anatomic sites specific to men and women and on the ABCDEs of melanoma, and at least 1 opportunity to observe the SCE.
authors.affiliation: Department of Dermatology, Hofstra North Shore Long Island Jewish School of Medicine, Hempstead, New York.
authors.forename: Amit
authors.initials: A
authors.lastname: Garg
authors.affiliation: Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Joyce
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Shalini B
authors.initials: SB
authors.lastname: Reddy
authors.affiliation: Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Powers
authors.affiliation: Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Reza
authors.initials: R
authors.lastname: Jacob
authors.affiliation: Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Michael
authors.initials: M
authors.lastname: Powers
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Katie
authors.initials: K
authors.lastname: Biello
authors.affiliation: Department of Dermatology, University of Texas Southwestern Medical School at Dallas.
authors.forename: Rachael
authors.initials: R
authors.lastname: Cayce
authors.affiliation: Department of Dermatology, University of Texas Southwestern Medical School at Dallas.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Savory
authors.affiliation: Division of Dermatology, University of Massachusetts Medical School, Worcester.
authors.forename: Leah
authors.initials: L
authors.lastname: Belazarian
authors.affiliation: Division of Dermatology, University of Massachusetts Medical School, Worcester.
authors.forename: Erik
authors.initials: E
authors.lastname: Domingues
authors.affiliation: Department of Dermatology, Stony Brook University School of Medicine, Stony Brook, New York.
authors.forename: Adam
authors.initials: A
authors.lastname: Korzenko
authors.affiliation: Department of Dermatology, University of Utah School of Medicine, Salt Lake City.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Wilson
authors.affiliation: Department of Dermatology, University of Connecticut School of Medicine, Farmington.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Grant-Kels
authors.affiliation: Department of Dermatology, Brown Alpert Medical School, Providence, Rhode Island.
authors.forename: Paul
authors.initials: P
authors.lastname: George
authors.affiliation: Department of Dermatology, Brown Alpert Medical School, Providence, Rhode Island.
authors.forename: Leslie
authors.initials: L
authors.lastname: Robinson-Bostom
authors.affiliation: Department of Dermatology, Ohio State University College of Medicine, Columbus.
authors.forename: Shannon C
authors.initials: SC
authors.lastname: Trotter
authors.affiliation: Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Alan C
authors.initials: AC
authors.lastname: Geller
mesh_terms: D003430:Cross-Sectional Studies; D003880:Dermatology / Q000193:education*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D033182:Intention; D008297:Male; D008545:Melanoma / Q000175:diagnosis*; D010808:Physical Examination; D012577:Schools, Medical; D020377:Self Efficacy; D012878:Skin Neoplasms / Q000175:diagnosis*; D013337:Students, Medical / Q000523:psychology*; D013647:Task Performance and Analysis; D013997:Time Factors; D014481:United States