Background: Family physicians have an important clinical role in assessment and management of suspicious skin lesions. As a result of a previous needs assessment study, an educational intervention based on audit and feedback with opportunity for reflection on practice was introduced to 46 family physicians randomly allocated to either an intervention (23) or control group (23). As an educational tool, audit allows doctors to systematically review their practice and establish the quality of care they provide. When combined with feedback and comparison of clinical performance with peers or standards, it has been shown to increase learning and change behavior.
Methods: Data based on their own patients, on the correlation between clinical and histologic diagnosis, and excisions of skin lesions were collated and reported to the intervention group.
Results: Despite randomization of the doctors, the patient population of doctors in the intervention and control groups were significantly different in key characteristics, including the types of skin lesions treated. The intervention group of doctors showed improved performance in providing clinical information on pathology requests and in adequate surgical excision of skin lesions. Diagnostic performance did not improve significantly, but physicians' certainty of diagnosis did.
Implications: This study design has highlighted the difficulty in balancing the use of evidence-based educational strategies in an equivalent setting to normal practice with evaluation of performance using measures that include characteristics of practitioners' patients that cannot be controlled.