Sensor Technology May Help Improve the Accuracy of Clinical Breast Exams
Sensor technology has the potential to significantly improve the teaching of proper technique for clinical breast exams, according to a new study by researchers at the University of Wisconsin School of Medicine and Public Health. The results of the study were published in a correspondence in The New England Journal of Medicine.
Carla M. Pugh, MD, PhD, Director of Patient Safety and Education at the University of Wisconsin Hospital and Clinics, and principal investigator of the study, said the use of sensors allows a level of critical analysis unavailable to clinicians until recently.
"Variations in palpable force used during a [clinical breast exam] cannot be reliably measured by human observation alone," said Dr. Pugh. "Our findings revealed that 15% of the physicians we tested were using a technique that put them at significant risk of missing deep tissue lesions near the chest wall. This research underscores the potential for sensor technology to be used not only to improve clinical performance, but also to allow for objective evidence-based training, assessment, and credentialing."
Assessment of Clinical Breast Exam Technique
Researchers asked 553 practicing physicians during the annual clinical meetings of the American Society of Breast Surgeons, American Academy of Family Physicians, and American College of Obstetricians to perform simulated clinical breast exams under conditions that mimic an office visit for a symptomatic patient. Participants completed a demographic survey, reviewed a clinical scenario, performed the clinical breast exam on a sensor-enabled breast model, and then documented their findings. The goal was to capture clinical breast exam technique while clinicians were purposefully seeking a mass.
Study Findings
The sensor data revealed that physicians who palpated fewer than 10 newtons were able to find two superficial masses on the breast model but missed two deeper ones. The physicians who increased the amount of palpation pressure improved the probability that they would identify the deeper lesions. The study suggested that the optimal palpable force for deeper lesions is between 12 and 17 newtons.
"I want to spark a serious conversation about the potential for high-end, mastery training in the health care profession," said Dr. Pugh. "Health care is at a critical juncture, where there are huge opportunities for major information exchanges that can empower physicians and patients. Both patients and physicians will benefit from clinical-skills performance data."
Dr. Pugh is the corresponding author of The New England Journal of Medicine correspondence.
The study was supported by the National Institutes of Health. For a full list of authors and disclosures, visit www.nejm.org.
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