Improved Clinical Breast Examination Competencies via Intelligent Simulator Training

Objectives:

Clinical Breast Examination (CBE) is performed annually on millions of women but the common practice is antiquated and standards are missing resulting in more advanced cancers than necessary. To improve CBE competencies we created a new self-administered, computer controlled simulator technology that increases detection of small, palpable simulated breast lesions and measures examination skills.

Materials and Methods:

In operation, every palpation of the simulator's breast models is digitized by sensitive tactile transducers, received by digital signal processors, and analyzed in real time by software that allows the trainee-clinician to advance to the next level. Before and after simulator training we measured the breast examination skills of 10 clinical faculties and students from the University of Florida and 14 residents at the Mayo Clinic College of Medicine (Mayo) using a standardized series of breast models that contain small, simulated breast lesions.

Results:

After a short training interval averaging 90 minutes (range: 62 to 145 minutes), the Florida participants'mean true positive detections (sensitivity) doubled, (p<0.001). False positive detections reduced by half, (p=0.02) and exam thoroughness (area palpated), increased from 63% pretest to 96% posttest, (p<0.001). The Mayo residents'true positives increased from a mean of 68% to 90%, (p<0.001). False detections were negligible at pretest with little change on posttest. The area palpated increased from 68% to 79%, (p=0.001).

Summary:

Two independent trials suggest that the MammaCare CBE Simulator represents a new cost-effective technology that can significantly improve breast cancer screening.