The Skin Cancer Objective Structured Clinical Examination (SCOSCE): A multi-institutional collaboration to develop and validate a clinical skills assessment for melanoma - 12/11/15

Doi : 10.1016/j.jaad.2015.08.014

Amit Garg, MD ^a,^⁎ , Katie Biello, MPH, PhD ^b, Joyce W. Hoot, MD ^d, Shalini B. Reddy, MD ^d, Lindsay Wilson, MD ^e, Paul George, MD, MHPE ^f, Leslie Robinson-Bostom, MD ^g, Leah Belazarian, MD ^h, Erik Domingues, MD ^h, Jennifer Powers, MD ^d, Reza Jacob, MD ^d, Michael Powers, BA ^d, Justin Besen, MD ^d, Alan C. Geller, RN, MPH ^c
Submitted on behalf of the
Integrated Skin Exam Consortium

^a Department of Dermatology, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York
^b Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
^c Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts
^d Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
^e Department of Dermatology, University of Utah School of Medicine, Salt Lake City, Utah
^f Department of Family Medicine, Brown Alpert Medical School, Providence, Rhode Island
^g Department of Dermatology, Brown Alpert Medical School, Providence, Rhode Island
^h Division of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts

^∗Reprint requests: Amit Garg, MD, Department of Dermatology, 1554 Northern Blvd, Suite 202, Manhasset, NY 11030.

Abstract

Background

Assessing medical students on core skills related to melanoma detection is challenging in the absence of a well-developed instrument.

Objective

We sought to develop an objective structured clinical examination for the detection and evaluation of melanoma among medical students.

Methods

This was a prospective cohort analysis of student and objective rater agreement on performance of clinical skills and assessment of differences in performance across 3 schools.

Results

Kappa coefficients indicated excellent agreement for 3 of 5 core skills including commenting on the presence of the moulage (k = 0.87, 95% confidence interval 0.77-0.96), obtaining a history for the moulage (k = 0.84, 95% confidence interval 0.74-0.94), and making a clinical impression (k = 0.80, 95% confidence interval 0.68-0.92). There were no differences in performance across schools with respect to 3 of 5 core skills: commenting on the presence of the moulage (P = .15), initiating a history (P = .53), and managing the suspicious lesion (P value range .07-.17). Overall, 54.2% and 44.7% of students commented on the presence of the moulage and achieved maximum performance of core skills, respectively, with no difference in performance across schools.

Limitations

Limitations include overall sample size of students and schools.

Conclusion

The Skin Cancer Objective Structured Clinical Examination represents a potentially important instrument to measure students' performance on the optimal step-by-step evaluation of a melanoma.

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Key words : cancer, curriculum, dermatology, education, examination, medical, Objective Structured Clinical Examination, skin, student, undergraduate

Abbreviations used : CI, OSCE, SCOSCE

Plan

Methods

Development of moulage

Development of the skin cancer OSCE

SCOSCE implementation

Statistical analysis

Results

Discussion

	Supported by Harry J. Lloyd Charitable Trust. The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.
	Conflicts of interest: None declared.