Skin cancer examination teaching in US medical education

Objective: To determine physician preparation for performing the skin cancer examination ( SCE). Design: We evaluated medical students' observation, training, and practice of the SCE; hours spent in a dermatology clinic; and self-reported skill level for the SCE by a self-administered survey. Participants: Graduating students at 7 US medical schools during the 2002-2003 academic year. Main Outcome Measures: Percentages of students reporting SCE skill observation, training, and practice. Results: Of 934 students, 659 (70.6%) completed surveys. Twenty-three percent of students had never observed an SCE, 26.7% had never been trained to perform an SCE, and 43.4% had never examined a patient for skin cancer. Only 28.2% rated themselves as somewhat or very skilled in the SCE. This rate dropped to 19.7% among 553 students who had not completed a dermatology elective. Compared with students without training, students who had been trained at least once in the SCE were 7 times more likely to rate themselves as being somewhat or very skilled in the SCE. Sixty-nine percent of students agreed that insufficient emphasis in their medical training was placed on learning about the SCE. Conclusions: This survey documents the need for more consistent training of medical students in SCE. Even brief curricular additions would augment students' perceived skill levels and improve practice patterns and competencies of future physicians. More frequent and improved SCEs might result in earlier detection of melanoma and nonmelanoma skin cancers by nondermatologists, with significant public health benefits.