A Randomized Trial on the Efficacy of Mastery Learning for Primary
Care Provider Melanoma Opportunistic Screening Skills
June K. Robinson, MD
, Namita Jain, MD, MPH
, Ashfaq A. Marghoob, MD
William McGaghie, PhD
, Michael MacLean, MS, PA-C
, Pedram Gerami, MD
Brittney Hultgren, PhD
, Rob Turrisi, PhD
, Kimberly Mallett, PhD
, and Gary J. Martin, MD
Department of Dermatology , Northwestern University Feinberg School of Medicine, Chicago, IL, USA;
Department of Dermatology, Memorial
Sloan-Kettering Cancer Center, Hauppauge, NY, USA;
Department of Medical Education, Northwestern University Feinberg School of Medicine,
Chicago, IL, USA;
Biobehavioral Health and Prevention Research Center, The Pennsylvania State University, University Park, PA, USA;
of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
BACKGROUND: Early detection of melanoma represents
an opportunity to reduce the burden of disease among
people at increased risk for melanoma.
OBJECTIVE: To develop and demonstrate the efficacy of
DESIGN: Randomized educational trial.
PARTICIPANTS: Primary care providers (PCPs).
INTERVENTION: Mastery learning course with visual
and dermoscopic assessment, diagnosis and manage-
ment, and deliberate practice with feedback to reach a
minimum passing standard.
MAIN MEASURES: Pre-test/post-test diagnostic accura-
cy. Referral of concerning lesions for 3 months before and
after the educational intervention.
KEY RESULTS: Among the 89 PCPs, 89.8% were internal
medicine physicians, and the remainder were physician
assistants embedded in internists’ practices. There were
no differences between control and intervention groups
regarding gender, age, race, or percentage of full-time
PCPs. The control group had more PCPs who reported less
than 5 years of practice (n = 18) than the intervention
group (n =6)(χ
[6, n =89]=14.34,p = 0.03). PCPs in the
intervention group answered more melanoma detection
questions correctly on the post-test (M = 10.05, SE = 1.24)
compared to control group PCPs (M = 7.11, SE = 0.24),
and had fewer false-positive and no false-negative mela-
noma diagnoses (intervention, M = 1.09, SE = 0. 20; con-
p < 0.001; η
= 0.26). PCPs who underwent training re-
ferred fewer benign lesions, including nevi, seborrheic
keratoses, and dermatofibromas, than control PCPs
(F[1,79] = 72.89, p < 0.001; η
= 0.489; F[1,79] = 25.82,
p <0.001; η
=0.246; F[1,79] = 34.25, p < 0.001; η
0.302; respectively). Those receiving training referred sig-
nificantly more melanomas than controls (F[1,79] =
24.38, p < 0.001; η
= 0.236). Referred melanomas (0.8
± 0.07 per month for intervention, 0.17 ± 0.06 for control)
were mostly located on the head and neck.
CONCLUSIONS: Mastery learning improved PCPs’ ability
to detect melanoma on a standardized post-test and may
improve referral of patients with suspected melanoma.
Further studies are needed to confirm this finding.
J Gen Intern Med 33(6):855–62
© Society of General Internal Medicine 2018
The incidence of melanoma in the United States is projected to
more than double by 2030.
Melanoma detection by health
care providers represents an opportunity to reduce the burden
of disease and is recommended for at-risk patients by the US
Preventive Services Task Force.
mas tend to be thinner (earlier stage) and more curable than
those found by untrained patients.
Training primary care
providers (PCPs) in the detection of melanoma during the
delivery of customary medical care for patients—i.e., oppor-
tunistic screening—may improve patient outcomes.
Previous studies in France, Germany, and the US have dem-
onstrated improvement in diagnostic skills with educational train-
ing focused on unaided visual inspection.
noninvasive in vivo technique commonly used by dermatologists,
provides greater discriminatory power than unaided visual inspec-
tion for the detection of melanoma.
However, this technique is
not included in PCP training.
Most PCPs consider melanoma
screening important, but lack confidence in their skills. Effective,
easily disseminated melanoma screening training is needed.
This report describes a mastery learning (ML) course to
educate PCPs in the early detection of melanoma by unaided
visual inspection (customary) and dermoscopy (in vivo 10×
magnification). Mastery learning
is an exacting variety of
in which learners acquire es-
sential knowledge and skills, measured rigorously against
Electronic supplementary material The online version of this article
(https://doi.org/10.1007/s11606-018-4311-3) contains supplementary
material, which is available to authorized users.
Received August 23, 2017
Revised December 19, 2017
Accepted January 4, 2018
Published online February 5, 2018