Skin Biopsies and Diagnostic Outcomes at a Multisite Family Medicine Residency Network.

IF 1 4区医学 Q3 MEDICINE, GENERAL & INTERNAL Southern Medical Journal Pub Date : 2024-10-01 DOI:10.14423/SMJ.0000000000001739

Alice J Lin, Laura K Ferris, John Maier, Robin Maier

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Abstract

Objectives: Physicians other than dermatologists evaluate nearly 60% of all skin diseases, and 22% of these physicians are family physicians. Dermatology education is therefore an important aspect of Family Medicine training. Dermatologic procedural training in Family Medicine residency is not standardized, however, so family physicians graduate with highly variable skills. This study describes the scope and diagnostic outcomes of skin biopsies performed by residents at a multisite Family Medicine residency network in comparison with those performed by attendings at a Family Medicine faculty community practice.

Methods: We performed a retrospective chart review of patients evaluated at eight Family Medicine residency training sites and one Family Medicine faculty community practice within a regional academic health system between January 2020 and October 2022. Patients with a skin finding who underwent at least one skin biopsy during their visit were included in the study.

Results: Among all of the skin findings, the incidence of skin biopsy was 3.6% (258/7104) for residents and 1.8% (175/9917) for attendings (P < 0.001). Family Medicine residents performed fewer shave biopsies (57.8% vs 77.7%, P < 0.001) and more punch biopsies (25.6% vs 11.4%, P < 0.001) compared with attendings. Most biopsies performed by residents and attendings were benign, although residents biopsied significantly more benign (79.1% vs 64.6%, P < 0.001) and malignant lesions (11.2% vs 5.7%, P = 0.049). Attendings biopsied significantly more low-to-moderate-grade dysplastic (22.3% vs 5.0%, P < 0.001) and high-grade atypical lesions (4.0% vs 0.8%, P = 0.034).

Conclusions: Family Medicine residents at this residency network receive training in a variety of skin biopsy types. Distinct skin biopsy practices and outcomes between residents and attendings may reflect differences in patient populations, clinical expertise, and dermatology referral patterns.

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多地点全科医学住院医师网络的皮肤活检和诊断结果。

目标：近 60% 的皮肤病是由皮肤科医生以外的其他医生诊断的，其中 22% 是家庭医生。因此，皮肤病学教育是全科医学培训的一个重要方面。然而，全科住院医师培训中的皮肤科程序培训并不标准化，因此家庭医生毕业时的技能差异很大。本研究描述了多地点全科医学住院医师培训网络的住院医师与全科医学系社区诊所的主治医师进行皮肤活检的范围和诊断结果比较：我们对2020年1月至2022年10月期间在一个地区学术医疗系统的8个全科住院医师培训基地和1个全科教师社区诊所接受评估的患者进行了回顾性病历审查。研究纳入了在就诊期间有皮肤发现且至少接受过一次皮肤活检的患者：在所有皮肤检查结果中，住院医师的皮肤活检发生率为 3.6%（258/7104），主治医师为 1.8%（175/9917）（P < 0.001）。与主治医师相比，全科住院医师进行的刮片活检较少（57.8% 对 77.7%，P < 0.001），而打孔活检较多（25.6% 对 11.4%，P < 0.001）。住院医师和主治医师进行的大多数活检都是良性的，但住院医师活检的良性病变（79.1% vs 64.6%，P < 0.001）和恶性病变（11.2% vs 5.7%，P = 0.049）明显多于主治医师。主治医师活检的低中度发育不良病变（22.3% vs 5.0%，P < 0.001）和高级别非典型病变（4.0% vs 0.8%，P = 0.034）明显增多：该住院医师培训网络的全科住院医师接受了各种类型皮肤活检的培训。住院医师和主治医师之间不同的皮肤活检方法和结果可能反映了患者群体、临床专业知识和皮肤科转诊模式的差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Southern Medical Journal 医学-医学：内科

CiteScore

1.40

自引率

9.10%

发文量

222

审稿时长

4-8 weeks

期刊介绍： As the official journal of the Birmingham, Alabama-based Southern Medical Association (SMA), the Southern Medical Journal (SMJ) has for more than 100 years provided the latest clinical information in areas that affect patients'' daily lives. Now delivered to individuals exclusively online, the SMJ has a multidisciplinary focus that covers a broad range of topics relevant to physicians and other healthcare specialists in all relevant aspects of the profession, including medicine and medical specialties, surgery and surgery specialties; child and maternal health; mental health; emergency and disaster medicine; public health and environmental medicine; bioethics and medical education; and quality health care, patient safety, and best practices. Each month, articles span the spectrum of medical topics, providing timely, up-to-the-minute information for both primary care physicians and specialists. Contributors include leaders in the healthcare field from across the country and around the world. The SMJ enables physicians to provide the best possible care to patients in this age of rapidly changing modern medicine.