# Development and piloting of an online course to improve knowledge, confidence and attitudes towards triaging images of skin lesions submitted online in primary care

## TL;DR

An online course improved primary care practitioners' confidence and knowledge in triaging skin lesion images, potentially reducing unnecessary specialist referrals.

## Contribution

The study developed and piloted a targeted online course for triaging skin lesions in primary care, showing effectiveness in improving confidence and knowledge.

## Key findings

- The online course significantly improved PCPs' confidence and attitudes towards triaging skin lesions (p < 0.001).
- Non-GP PCPs showed improved knowledge after completing the course (p = 0.01).
- Participants found the course design and difficulty level appropriate and useful for practice.

## Abstract

Melanoma is the 5th commonest cancer in the UK and survivors require frequent and thorough skin checks. During the Achieving Self-directed Integrated Cancer Aftercare (ASICA) trial, melanoma survivors used an app to submit images of concerning lesions for assessment by a dermatology nurse. In the past, online courses have been used to train non-specialist primary care practitioners (PCPs) in this skill.

This study aimed to determine whether an online course could increase knowledge, confidence, and attitudes towards skin image triage in PCPs in the Grampian area.

Preliminary discussions were held with PCPs to determine the need for an online course. The course was designed at the University of Aberdeen and included an introduction to the skin, case studies and quizzes on a variety of skin conditions based on melanoma survivors’ submissions via the ASICA app. Two pre- and post-course questionnaires were administered to all participants to (1) assess knowledge gained and (2) assess any improvements in confidence and attitudes towards triaging skin lesions that could be indicative of skin cancer. All PCPs in the Grampian area were invited to participate with almost 70 medical practices contacted. Results were analysed using a paired sample T-test.

The course was advertised to all GP practices in the Grampian area and 38 PCPs completed all its stages. Undertaking the course improved all PCPs’ confidence and attitudes towards triaging (p < 0.001). It also improved knowledge in all non-GP PCPs (p = 0.01). Most participants found the course useful; thought it was at the right level of difficulty, right format and thought the design was good.

Our online course in triaging skin lesions submitted digitally to PCPs was able to improve knowledge, confidence, and attitudes towards triaging. The course was acceptable in its design and was deemed useful and applicable to practice. Further research should investigate the effect the course has on secondary care referral numbers.

Skin problems can make up to 15% of Primary Care appointments and patients with benign or low risk skin problems are often inappropriately referred to specialists causing delay in secondary care.

Based on the findings of the ASICA trial it was suggested that low risk concerns can be effectively triaged by non-specialist primary care practitioners (PCPs).

Previous studies showed that online courses can improve knowledge, confidence, and attitudes towards triaging images of skin lesions.

The content of this online course was designed based on the most commonly submitted lesions in the ASICA trial and allowed PCPs (including GPs, GP trainees, ANPs, practice nurses and physician associates) to complete it in their own time.

The study showed that completing the online course increased PCP confidence and attitudes towards triaging skin lesions, regardless of their prior knowledge and experience.

The course also increased knowledge of all non-GP PCPs as well as PCPs with up to 2 years in their current post.