1 INTRODUCTION

The visible nature of cutaneous melanoma (CM) provides an opportunity to detect and treat suspicious lesions early, thereby potentially reducing mortality. However, one study of 216 patients with melanoma found that only 20% had an established dermatologist whereas 63% received primary care provider (PCP) evaluation within a year prior to diagnosis (Geller et al., 1992). Another study using photographs of lesions found diagnostic accuracy and management of pigmented lesions to be greater by dermatologists than PCPs (Chen et al., 2006). PCPs report that skin cancer early detection is important, but they often lack the appropriate training or time to implement effective skin screenings in their busy practices (Goulart et al., 2011).

Given greater patient access to PCPs than dermatologists, training PCPs to detect and triage concerning pigmented lesions may provide crucial support to the early detection of melanoma. Through Oregon's War on Melanoma public health campaign, we created the “Melanoma Toolkit for Early Detection” (MTED) training curriculum and resource repository for medical providers outside of dermatology. Collaborative efforts from other primary care trainings and an assessment of community needs informed the creation of MTED (Jiang et al., 2017). A novel aspect of MTED is the “Toolkit” design that allows PCPs to choose all or part of a curriculum of evidence-based training, resources, and patient educational materials. This model supports the adaptability of the MTED intervention, as PCPs can select the materials most meaningful for their practice and capability. During the training development, PCP stakeholders vocalized that they supported this learner-centered approach as they valued freedom to engage only with the material most relevant to their practice. Educational theory informed both the intervention presentation and the instrument content creation: Mayer's cognitive theory of multimedia learning suggests learning involves actively integrating, attending to, and filtering information (Mayer, 2010). We hypothesized that execution of this learning theory (which involved reducing extraneous processing of irrelevant material, aligning content with learning objectives, and providing goal-directed practice with feedback) would lead to increased knowledge and confidence in identifying benign and malignant lesions.

中文翻译：

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用于初级保健提供者早期检测的黑色素瘤工具包：一项试点研究

1 简介

皮肤黑色素瘤 (CM) 的可见性质为早期发现和治疗可疑病变提供了机会，从而有可能降低死亡率。然而，一项对 216 名黑色素瘤患者的研究发现，只有 20% 的患者有皮肤科医生，而 63% 的患者在诊断前一年内接受了初级保健提供者 (PCP) 的评估（Geller 等，  1992）。另一项使用病变照片的研究发现，皮肤科医生对色素性病变的诊断准确性和管理比 PCP 更高（Chen 等人，  2006 年）。PCP 报告说皮肤癌的早期检测很重要，但他们通常缺乏适当的培训或时间来在忙碌的实践中实施有效的皮肤筛查（Goulart 等人，  2011 年）。

鉴于患者比皮肤科医生更容易接触到 PCP，培训 PCP 检测和分类有关色素性病变可能为黑色素瘤的早期检测提供重要支持。通过俄勒冈州的黑色素瘤战争公共卫生运动，我们为皮肤科以外的医疗提供者创建了“黑色素瘤早期检测工具包”(MTED) 培训课程和资源库。其他初级保健培训的合作努力和对社区需求的评估为 MTED 的创建提供了信息（Jiang et al.,  2017）。MTED 的一个新颖方面是“工具包”设计，它允许 PCP 选择全部或部分循证培训课程、资源和患者教育材料。该模型支持 MTED 干预的适应性，因为 PCP 可以选择对他们的实践和能力最有意义的材料。在培训开发过程中，PCP 利益相关者表示他们支持这种以学习者为中心的方法，因为他们重视只参与与他们的实践最相关的材料的自由。教育理论为干预演示和工具内容创建提供了信息：Mayer 的多媒体学习认知理论表明学习涉及积极整合、关注和过滤信息（Mayer，  2010）。我们假设这种学习理论的执行（包括减少对无关材料的无关处理，使内容与学习目标保持一致，并提供目标导向的实践和反馈）将增加识别良性和恶性病变的知识和信心。