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Detection and Description of Small Breast Masses by Residents Trained Using a Standardized Clinical Breast Exam Curriculum

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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.

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Notes

  1. The durometer is a measure of firmness; a durometer of 40 is hard.

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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 Collaboratively 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).

Conflict of Interest

None disclosed.

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Authors and Affiliations

  1. OHSU Cancer Institute Breast Health Education Program, Oregon Health & Science University, Portland, OR, USA

    Elizabeth Steiner MD, Donald F. Austin MD, MPH & Nancy C. Prouser MS

Authors
  1. Elizabeth Steiner MD
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  2. Donald F. Austin MD, MPH
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  3. Nancy C. Prouser MS
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Corresponding author

Correspondence to Elizabeth Steiner MD.

Additional information

The work described in this project was originally presented at the Annual Meeting of the North American Primary Care Research Group, Quebec City, Quebec, Canada, in October 2005.

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Steiner, E., Austin, D.F. & Prouser, N.C. Detection and Description of Small Breast Masses by Residents Trained Using a Standardized Clinical Breast Exam Curriculum. J GEN INTERN MED 23, 129–134 (2008). https://doi.org/10.1007/s11606-007-0444-5

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  • DOI: https://doi.org/10.1007/s11606-007-0444-5

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