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Improving the competency of medical students in clinical breast examination through a standardized simulation and multimedia-based curriculum

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Clinical breast examination (CBE) is an important step in the assessment of patients with breast-related complaints. We developed a standardized simulation and multimedia-based (SSMBI) curriculum using current evidenced-based recommendations. This study aimed to determine if SSMBI training resulted in better performance (examination scores and detection of abnormal findings) than the traditional teaching method.

Methods

Novice fourth-year medical students were exposed to the SSMBI curriculum (n = 68) or traditional (n = 52) training. The traditional group was taught by a lecture and attending weekly clinics where they had hands-on experience. The SSMBI group underwent a structured lecture followed by an instructional video and dedicated simulated teaching. Both groups were assessed through a written knowledge exam and an objective structured clinical examination (OSCE). Student’s t test and χ2 tests were used to assess differences in CBE technique and knoweldge.

Results

Students who underwent SSMBI training had significantly higher numbers of correct answers describing the different steps and justifications of CBE. OSCE performance was significantly higher in the SSMBI group. SSMBI-trained students were more likely to complete all the necessary CBE steps compared to traditionally-trained students (88.2% vs. 28.2%, p < 0.00001). The SSMBI group was also more systematic and more likely to perform adequate inspection, palpation, examination of the nipple-areolar complex, and identify and characterize a palpable lesion (p < 0.05).

Conclusions

Formal SSMBI training is an important asset when teaching medical students how to perform a CBE. Real clinical experience is still necessary to refine this skill and the physician–patient interaction.

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Abbreviations

CBE:

Clinical breast examination

OSCE:

Objective structured clinical examinations

SSMBI:

Standardized simulation and multimedia-based

References

  1. Klein S (2005) Evaluation of palpable breast masses. Breast 100:28–33

    Google Scholar 

  2. McDonald S, Saslow D, Alciati MH (2004) Performance and reporting of clinical breast examination: a review of the literature. CA Cancer J Clin 54(6):345–361

    Article  PubMed  Google Scholar 

  3. Barton MB, Harris R, Fletcher SW (1999) Does this patient have breast cancer? The screening clinical breast examination: should it be done? How?. Jama 282(13):1270–1280

    Article  PubMed  CAS  Google Scholar 

  4. Goodson WH III, Grissom NA, Moore DH, Dirbas FM (2005) Streamlining clinical breast examination. J Natl Cancer Inst 97(19):1476–1477

    Article  PubMed  Google Scholar 

  5. Barlow WE, Lehman CD, Zheng Y, Ballard-Barbash R, Yankaskas BC, Cutter GR, Carney PA, Geller BM, Rosenberg R, Kerlikowske K (2002) Performance of diagnostic mammography for women with signs or symptoms of breast cancer. J Natl Cancer Inst 94(15):1151–1159

    Article  PubMed  Google Scholar 

  6. Bobo JK, Lee NC, Thames SF (2000) Findings from 752 081 clinical breast examinations reported to a national screening program from 1995 through 1998. J Natl Cancer Inst 92(12):971–976

    Article  PubMed  CAS  Google Scholar 

  7. Khatcheressian JL, Hurley P, Bantug E, Esserman LJ, Grunfeld E, Halberg F, Hantel A, Henry NL, Muss HB, Smith TJ (2012) Breast cancer follow-up and management after primary treatment: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. https://doi.org/10.1200/JCO.2012.45.9859

    Article  PubMed  Google Scholar 

  8. Wiecha J, Gann P (1993) Provider confidence in breast examination. Fam Pract Res J 13(1):37–41

    PubMed  CAS  Google Scholar 

  9. Fletcher SW, O’malley MS, Pilgrim CA, Gonzalez JJ (1989) How do women compare with internal medicine residents in breast lump detection? J Gen Intern Med 4(4):277–283

    Article  PubMed  CAS  Google Scholar 

  10. Campbell HS, Fletcher SW, Lin S, Pilgrim CA, Morgan TM (1991) Improving physicians’ and nurses’ clinical breast examination: a randomized controlled trial. Am J Prev Med 7(1):1–8

    Article  PubMed  CAS  Google Scholar 

  11. Smith RL, Hanchak NA, Leibreid D (1996) The effectiveness of postgraduate education on the clinical breast examination skills of primary care physicians. Am J Man Care 2:989–995

    Google Scholar 

  12. Iannotti RJ, Finney LJ, Sander AA, De Leon JM (2002) Effect of clinical breast examination training on practitioner’s perceived competence. Cancer Detect Prev 26(2):146–148

    Article  Google Scholar 

  13. Pilgrim C, Lannon C, Harris RP, Cogburn W, Fletcher SW (1993) Improving clinical breast examination training in a medical school. J Gen Intern Med 8(12):685–688

    Article  PubMed  CAS  Google Scholar 

  14. Madan AK, Aliabadi-Wahle S, Babbo AM, Posner M, Beech DJ (2002) Education of medical students in clinical breast examination during surgical clerkship. Am J Surg 184(6):637–640

    Article  PubMed  Google Scholar 

  15. Costanza ME, Luckmann R, Quirk ME, Clemow L, White MJ, Stoddard AM (1999) The effectiveness of using standardized patients to improve community physician skills in mammography counseling and clinical breast exam. Prev Med 29(4):241–248

    Article  PubMed  CAS  Google Scholar 

  16. Merrick HW, Nowacek GA, Boyer J, Padgett B, Francis P, Gohara SF, Staren ED (2002) Ability of the objective structured clinical examination to differentiate surgical residents, medical students, and physician assistant students. J Surg Res 106(2):319–322

    Article  PubMed  Google Scholar 

  17. Steiner E, Austin DF, Prouser NC (2008) Detection and description of small breast masses by residents trained using a standardized clinical breast exam curriculum. J Gen Intern Med 23(2):129–134

    Article  PubMed  Google Scholar 

  18. Cook TD, Campbell DT, Shadish W (2002) Experimental and quasi-experimental designs for generalized causal inference. Houghton Mifflin, Boston

    Google Scholar 

  19. Angarita FA, Acuna SA, Torregrosa L, Tawil M (2008) Examen clínico de mama  (instruction video). Asociación Colombiana de Cirugía. https://www.ascolcirugia.org/component/k2/item/36-examen-clinico-de-la-mama.html. Accessed 1 Oct 2017

  20. Saslow D, Hannan J, Osuch J, Alciati MH, Baines C, Barton M, Bobo JK, Coleman C, Dolan M, Gaumer G (2004) Clinical breast examination: practical recommendations for optimizing performance and reporting. CA Cancer J Clin 54(6):327–344

    Article  PubMed  Google Scholar 

  21. Sachdeva AK, Wolfson PJ, Blair PG, Gillum DR, Gracely EJ, Friedman M (1997) Impact of a standardized patient intervention to teach breast and abdominal examination skills to third-year medical students at two institutions. Am J Surg 173(4):320–325

    Article  PubMed  CAS  Google Scholar 

  22. Nathwani JN, Garren A, Laufer S, Kwan C, Pugh CM (2018) Improving diagnosis in healthcare: local versus national adoption of recommended guidelines for the clinical breast examination. Am J Surg 215(6):995–999

    Article  PubMed  Google Scholar 

  23. Ault GT, Sullivan M, Chalabian J, Skinner KA (2002) A focused breast skills workshop improves the clinical skills of medical students. J Surg Res 106(2):303–307

    Article  PubMed  Google Scholar 

  24. Goodson WH, Moore DH (2002) Causes of physician delay in the diagnosis of breast cancer. Arch Intern Med 162(12):1343–1348

    Article  PubMed  Google Scholar 

  25. Papadakis MA (2004) The step 2 clinical-skills examination. N Engl J Med 350(17):1703–1705

    Article  PubMed  CAS  Google Scholar 

  26. Lee M, Vermillion M (2018) Comparative values of medical school assessments in the prediction of internship performance. Med Teach 1:1–6

    Google Scholar 

  27. Gilliland WR, Rochelle JL, Hawkins R, Dillon GF, Mechaber AJ, Dyrbye L, Papp KK, Durning SJ (2008) Changes in clinical skills education resulting from the introduction of the USMLE™ step 2 clinical skills (CS) examination. Med Teach 30(3):325–327

    Article  PubMed  Google Scholar 

  28. Michaelson JS, Silverstein M, Wyatt J, Weber G, Moore R, Halpern E, Kopans DB, Hughes K (2002) Predicting the survival of patients with breast carcinoma using tumor size. Cancer 95(4):713–723

    Article  PubMed  Google Scholar 

  29. Miller AB, To T, Baines CJ, Wall C (2000) Canadian National breast screening study-2: 13-year results of a randomized trial in women aged 50–59 years. J Natl Cancer Inst 92(18):1490–1499

    Article  PubMed  CAS  Google Scholar 

  30. National Comprehensive Cancer Network (2016) Breast cancer screening and diagnosis. Version 1

  31. American College of Obstetricians and Gynecologists (2017) Breast cancer risk assessment and screening in average-risk women. ACOG Pract Bull 170:1–16

    Google Scholar 

  32. Nelson HD, Pappas M, Cantor A, Griffin J, Daeges M, Humphrey L (2016) Harms of breast cancer screening: systematic review to update the 2009 U.S. Preventive Services Task Force Recommendation. Ann Intern Med 164(4):256–267

    Article  PubMed  Google Scholar 

  33. Oeffinger KC, Fontham ET, Etzioni R, Herzig A, Michaelson JS, Shih YC, Walter LC, Church TR, Flowers CR, LaMonte SJ, Wolf AM, DeSantis C, Lortet-Tieulent J, Andrews K, Manassaram-Baptiste D, Saslow D, Smith RA, Brawley OW, Wender R, American Cancer Society (2015) Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society. JAMA 314(15):1599–1614

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  34. Kolb TM, Lichy J, Newhouse JH (2002) Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations. Radiology 225(1):165–175

    Article  PubMed  Google Scholar 

  35. Kim SJ, Moon WK, Cho N, Chang JM (2011) The detection of recurrent breast cancer in patients with a history of breast cancer surgery: comparison of clinical breast examination, mammography and ultrasonography. Acta Radiol Stockh Swed 52(1):15–20

    Google Scholar 

  36. Corbex M, Burton R, Sancho-Garnier H (2012) Breast cancer early detection methods for low and middle income countries, a review of the evidence. Breast 21(4):428–434

    Article  PubMed  Google Scholar 

  37. Okonkwo QL, Draisma G, der Kinderen A, Brown ML, de Koning HJ (2008) Breast cancer screening policies in developing countries: a cost-effectiveness analysis for India. JNCI 100(18):1290–1300

    Article  PubMed  Google Scholar 

  38. Berg WA, Gutierrez L, NessAiver MS, Carter WB, Bhargavan M, Lewis RS, Ioffe OB (2004) Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology 233(3):830–849

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada

    Fernando A. Angarita & Matthew Castelo

  2. Melbourne Medical School, The University of Melbourne, Melbourne, Australia

    Benjamin Price

  3. Department of Surgery, Pontificia Universidad Javeriana, Bogota, Colombia

    Mauricio Tawil, Juan Carlos Ayala & Lilian Torregrossa

  4. Department of Surgery, Hospital Universitario San Ignacio, Carrera 7 Nº 40 - 62, Oficina 718, Bogotá, Colombia

    Mauricio Tawil & Lilian Torregrossa

Authors
  1. Fernando A. Angarita
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  2. Benjamin Price
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  3. Matthew Castelo
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  4. Mauricio Tawil
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  5. Juan Carlos Ayala
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  6. Lilian Torregrossa
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Correspondence to Lilian Torregrossa.

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All authors declare that they have no conflicts of interest.

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Ethics approval was obtained by the review board from the Pontificia Universidad Javeriana School of Medicine in Bogota, Colombia.

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Angarita, F.A., Price, B., Castelo, M. et al. Improving the competency of medical students in clinical breast examination through a standardized simulation and multimedia-based curriculum. Breast Cancer Res Treat 173, 439–445 (2019). https://doi.org/10.1007/s10549-018-4993-6

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  • DOI: https://doi.org/10.1007/s10549-018-4993-6

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