The goal of this project is to create an educational model for use in medical school using breast models and simulated patients to increase proficiency in the performance of clinical breast examination. We believe that education of physicians coupled with administrative changes can influence physician practice behavior and help facilitate the incorporation of cancer prevention and early detection techniques into practice patterns. Clinical Breast Examination (CBE), although still surrounded by some controversy, is an accepted means of screening for early signs of breast cancer. Additionally, physicians who are skilled in CBE are important referral sources for mammography screening and for reinforcing women's breast self examination techniques. Conversely, when a physician has not had adequate training in CBE, there may be missed clinical opportunities for referral to mammography. Contributing to inadequate CBE skills is the lack of practical experience in medical school. It remains that the strongest facilitator to mammography is the presence of a physician recommendation or referral. This proposal develops a model for instructing medical students enrolled in the problem-based Parallel curriculum at Bowman Gray School of Medicine in CBE techniques. A combination of classroom instruction and practice with trained simulated patients will be presented during the first year of medical school, followed by a case study and a clinical performance examination (CPX) that would require students to perform CBE and receive feedback from trained simulated patients. Following incorporation into the Parallel curriculum, which is more flexible, we will attempt to assimilate the breast examination component into the traditional curriculum. Developed as a pilot concept, this curriculum piece on breast cancer screening can subsequently be exported to the community for use by community advocates, primary care physicians, physician assistants, nurse practitioners, and other health care providers. We believe that the education of health care providers remains a major opportunity for influencing the prevention and early detection of breast cancer.
