title: Use of simulators to explore specialty recommendation for a palpable breast mass.
abstract: BACKGROUND
  The aim of this study was to evaluate recommendation patterns of different specialties for the work-up of a palpable breast mass using simulated scenarios and clinical breast examination models.
  
  
  METHODS
  Study participants were a convenience sample of physicians (n = 318) attending annual surgical, family practice, and obstetrics and gynecology (OB/GYN) conferences. Two different silicone-based breast models (superficial mass vs chest wall mass) were used to test clinical breast examination skills and recommendation patterns (imaging, tissue sampling, and follow-up).
  
  
  RESULTS
  Participants were more likely to recommend mammography (P < .001) and core biopsy (P < .0001) and less likely to recommend needle aspiration (P < .043) and 1-month follow-up (P < .001) for the chest wall mass compared with the superficial mass. Family practitioners were less likely to recommend ultrasound (P < .001) and obstetrics and gynecologists were less likely to recommend mammogram (P < .006) across models. Surgeons were more likely to recommend core biopsy and less likely to recommend needle aspiration across models (P < .001).
  
  
  CONCLUSIONS
  Recommendation patterns differed across the 2 models in line with existing practice guidelines. Additionally, differences in practice patterns between primary care and specialty providers may represent varying clinician capabilities, healthcare resources, and individual preferences. Our work shows that simulation may be used to track adherence to practice guidelines for breast masses.
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Electrical and Computer Engineering, University of Wisconsin College of Engineering, Madison, WI, USA. Electronic address: Slaufer2@wisc.edu.
authors.forename: Shlomi
authors.initials: S
authors.lastname: Laufer
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Rebecca D
authors.initials: RD
authors.lastname: Ray
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Anne-Lise D
authors.initials: AL
authors.lastname: D'Angelo
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Grace F
authors.initials: GF
authors.lastname: Jones
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Carla M
authors.initials: CM
authors.lastname: Pugh
mesh_terms: D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000175:diagnosis*; D002983:Clinical Competence; D000066491:Clinical Decision-Making; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D008327:Mammography; D008953:Models, Anatomic; D008954:Models, Biological; D010173:Palpation; D012017:Referral and Consultation; D000066908:Simulation Training; D013043:Specialties, Surgical; D016217:Ultrasonography, Mammary; D057832:Watchful Waiting
keywords: Assessment; Breast cancer; Clinical breast examination; Palpable breast mass; Sensors; Simulation; Validity