MedicalResearch.com Interview with:
Carla M. Pugh, M.D., Ph.D. FACS
Associate Professor, Vice Chair, Education and Patient Safety
Clinical Director, UW Health Clinical Simulation Program
Section of Trauma, Acute Care Surgery, Burn and Surgical Critical Care Division of General Surgery University of Wisconsin, School of Medicine and Public Health, Madison, WI
Medical Research: What is the background for this study? What are the main findings?
Dr. Pugh: The clinical breast examination is routinely performed on millions of women each year. It is used for screening breast cancer and is also routinely performed on women presenting with symptomatic breast conditions.
In this study we assessed the performance of the clinical breast examination among a large sample of practicing physicians. There were two main goals to the study. The first goal was to identify current recommendations for performing the clinical breast examination and investigating how this relates to examination sensitivity or finding a mass. The second and more general goal was to develop a method for objective assessment of clinical skills.
Novel clinical breast examination simulators were used in this study; in addition to their ability to present different pathologies and multiple clinical scenarios, they were all integrated with advanced force sensors. These sensors include approximately 2000 discrete sensing elements, measuring force level and distribution thought the breast examination. These sensors provide information at a level of detail that is not possible with observation alone.
Four models were used in this study; two models presenting superficial soft masses and two models representing hard chest wall masses. The study was performed from 2013 to 2014 with 553 physicians performing the clinical breast examination on our models. The participants were recruited at three annual clinical meetings: 136 at the American Society of Breast Surgeons, 236 at the American Academy of Family Physicians, and 181 at the American College of Obstetricians and Gynecologists.
The study found a significant relationship between the force used during palpation and the accuracy of the assessment of the deep-tissue lesions. More specifically, the study found that some physicians don’t apply enough force during the examination putting them at high risk of missing deep-tissue lesions. Since force can’t be measured by human observation this underscores the added value of integrating sensors into clinical simulators.
Medical Research: What should clinicians and patients take away from your report?
Dr. Pugh: Clinicians and patients should be aware that while gentle patting of the breast might find superficial masses, more force is typically needed for finding deep-tissue lesions. The amount of force will depend on factors such as breast density and size and should be adjusted as such. This high risk practice of light patting was found at all levels of experience. Some physicians will need to change and improve the clinical breast examination techniques they have been using for many years.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Pugh: Assessment of clinical skill has been part of the medical licensing examination since 2004. Yet this assessment includes only patient actor based assessment with no objective measurements of hands-on performance. Adding sensor enabled simulators to this process can reveal and assess aspects of clinical skill performance that were not evaluated before. Furthermore, this approach provides a method for collecting data from a large sample of experts. This data can then be analyzed and can be used for finding risky behavior and for setting standards of clinical skill performance. Integrating sensors into simulators adds a level of information and detail that was not present before.
MedicalResearch.com Interview with: & Carla M. Pugh, M.D., Ph.D. FACS (2015). Clinical Breast Exams May Be Improved By Integrating Sensors