Detection and description of small breast masses by residents trained using a standardized clinical breast exam curriculum

Elizabeth Steiner; Donald F. Austin; Nancy C. Prouser

doi:10.1007/s11606-007-0444-5

Detection and description of small breast masses by residents trained using a standardized clinical breast exam curriculum

Elizabeth Steiner
, Donald F. Austin
, Nancy C. Prouser

Research output: Contribution to journal › Article › peer-review

17 Scopus citations

Abstract

OBJECTIVES: 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.

Original language	English (US)
Pages (from-to)	129-134
Number of pages	6
Journal	Journal of general internal medicine
Volume	23
Issue number	2
DOIs	https://doi.org/10.1007/s11606-007-0444-5
State	Published - Feb 2008

Funding

Acknowledgements: This work was funded in part by a grant from Northwest Health Foundation and supported by the OHSU Department of Family Medicine; Cancer Institute; and Department of Public Health & Preventive Medicine. Northwest Health Foundation had no role in any aspect of the study or the preparation of the manuscript. The Department of Family Medicine, Department of Public Health & Preventive Medicine, and the Cancer Institute did not require that they approve the manuscript. We are grateful for the assistance of Deanne Neth BA—OSCE observing, data entry, manuscript preparation; Scott Fields MD, Rebecca Rdesinski MSW, and the Working On Research Collabora- tively group in the Department of Family Medicine—editing; Sara Rogers BS—database design; and the program coordinators in the residency programs. Biostatistical support was provided by Solange Mongoue-Tchokote MS of the Biostatistics Shared Resource of the OHSU Cancer Institute (P30 CA69533).

Funders	Funder number
OHSU Knight Cancer Institute	P30 CA69533
OHSU, Department of Family Medicine
Solange Mongoue-Tchokote MS
National Institute of Health-National Cancer Institute	P30CA069533
Northwest Health Foundation

Keywords

Breast cancer
Clinical breast examination
Early detection
Medical education

ASJC Scopus subject areas

Internal Medicine

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10.1007/s11606-007-0444-5

Cite this

@article{4261168a63ae40b29d28072a9de0cc83,

title = "Detection and description of small breast masses by residents trained using a standardized clinical breast exam curriculum",

abstract = "OBJECTIVES: 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.",

keywords = "Breast cancer, Clinical breast examination, Early detection, Medical education",

author = "Elizabeth Steiner and Austin, \{Donald F.\} and Prouser, \{Nancy C.\}",

note = "Funding Information: Acknowledgements: This work was funded in part by a grant from Northwest Health Foundation and supported by the OHSU Department of Family Medicine; Cancer Institute; and Department of Public Health \& Preventive Medicine. Northwest Health Foundation had no role in any aspect of the study or the preparation of the manuscript. The Department of Family Medicine, Department of Public Health \& Preventive Medicine, and the Cancer Institute did not require that they approve the manuscript. We are grateful for the assistance of Deanne Neth BA{\textemdash}OSCE observing, data entry, manuscript preparation; Scott Fields MD, Rebecca Rdesinski MSW, and the Working On Research Collabora- tively group in the Department of Family Medicine{\textemdash}editing; Sara Rogers BS{\textemdash}database design; and the program coordinators in the residency programs. Biostatistical support was provided by Solange Mongoue-Tchokote MS of the Biostatistics Shared Resource of the OHSU Cancer Institute (P30 CA69533).",

year = "2008",

month = feb,

doi = "10.1007/s11606-007-0444-5",

language = "English (US)",

volume = "23",

pages = "129--134",

journal = "Journal of general internal medicine",

issn = "0884-8734",

publisher = "Springer",

number = "2",

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TY - JOUR

T1 - Detection and description of small breast masses by residents trained using a standardized clinical breast exam curriculum

AU - Steiner, Elizabeth

AU - Austin, Donald F.

AU - Prouser, Nancy C.

N1 - Funding Information: Acknowledgements: This work was funded in part by a grant from Northwest Health Foundation and supported by the OHSU Department of Family Medicine; Cancer Institute; and Department of Public Health & Preventive Medicine. Northwest Health Foundation had no role in any aspect of the study or the preparation of the manuscript. The Department of Family Medicine, Department of Public Health & Preventive Medicine, and the Cancer Institute did not require that they approve the manuscript. We are grateful for the assistance of Deanne Neth BA—OSCE observing, data entry, manuscript preparation; Scott Fields MD, Rebecca Rdesinski MSW, and the Working On Research Collabora- tively group in the Department of Family Medicine—editing; Sara Rogers BS—database design; and the program coordinators in the residency programs. Biostatistical support was provided by Solange Mongoue-Tchokote MS of the Biostatistics Shared Resource of the OHSU Cancer Institute (P30 CA69533).

PY - 2008/2

Y1 - 2008/2

N2 - OBJECTIVES: 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.

AB - OBJECTIVES: 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.

KW - Breast cancer

KW - Clinical breast examination

KW - Early detection

KW - Medical education

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ER -

Detection and description of small breast masses by residents trained using a standardized clinical breast exam curriculum

Abstract

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