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Visual perception training: a prospective cohort trial of a novel, technology-based method to teach melanoma recognition
  1. Andrew Wonho Choi1,2,
  2. Rebecca S Xu3,
  3. Saya Jacob4,
  4. Brittany O Dulmage3,
  5. Maria L Colavincenzo3,
  6. June K Robinson3,
  7. Shuai Xu3
  1. 1 Internal Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
  2. 2 Dermatology, University of California San Diego Health System, San Diego, California, USA
  3. 3 Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
  4. 4 Internal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
  1. Correspondence to Dr Shuai Xu, Department of Dermatology, Northwestern University, Feinberg School of Medicine, 676 N St Clair St, Suite 1600, Chicago, IL, United States; stevexu{at}

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Melanoma is one of the most treatable types of cancers if detected early, a task that often depends on non-dermatologist providers. However, only 54%–56% of family practitioners and internists reported skill and comfort in performing total body skin exams and fewer than 50% of referrals to dermatologists include the correct diagnosis.1 2 The asymmetry, border, colour, diameter and evolution (ABCDE) system is traditionally taught for detecting melanoma but uses exclusively rule-based criteria, whereas melanoma and its mimickers belong to ‘fuzzy’ categories in which visual features overlap on a spectrum.3 Perceptual expertise, the ability to identify objects rapidly and accurately at specific levels of categorisation, contributes to discriminating between fuzzy categories.4 Novices may develop perceptual expertise through experience or through targeted visual perception training (VPT). Previous work demonstrated that VPT successfully improved the ability of undergraduates to diagnose melanoma, although follow-up was limited to 1 week.5 This prospective cohort trial of preclinical medical students was performed to evaluate the effectiveness of a novel, technology-based VPT system for melanoma detection with retention assessed at 4 weeks.


All participants were preclinical medical students at an urban, private medical school in the USA. All participants (both control and intervention) were presented with a web-based instructional handout describing the ABCDEs of identifying suspicious skin lesions. The ABCDEs remains a mainstay of education for both dermatologists and non-dermatologists in the detection of melanoma.6 We assigned 20 medical students to the VPT training group and 10 to …

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  • AWC and RSX contributed equally.

  • Contributors AWC and SX had full access to all the data used in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: AWC, RSX and SX. Acquisition, analysis or interpretation of data: AWC, RSX, SJ, BOD, MC, JR and SX. Drafting of the manuscript: AWC, RSX and SX. Critical revision of the manuscript for important intellectual content: AWC, RSX, SJ, BOD, MC, JR and SX. Statistical analysis: RSX. Administrative, technical or material support: AWC, SJ, BOD, MC, JR and SX. Study supervision: SX.

  • Funding This research has received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was deemed exempt from approval by the Institutional Review Board as an evaluation study of an educational intervention.

  • Provenance and peer review Not commissioned; externally peer reviewed.