Improving Clinical Breast Exams for Military Women

There is a need to improve the quality of the clinical breast examination as part of the routine physical examination and a congressional mandated initiative to provide breast cancer training for all military primary care providers. The primary objective is to determine if individualized instruction with a standardized patient will increase significantly the quality of clinical breast examinations and breast cancer screening for women who serve in the US military. Standardized patients are lay-people trained, using standardized protocols and checklists to portray a patient encounter accurately and consistently for teaching or evaluation purposes. Building on preliminary work of the principal investigator and using a randomized control pre-test-post-test design, this two-year study will determine if, in relation to controls, health care providers taught individually by a standardized patient will exhibit significantly better performance of the clinical breast examination, greater use of recommended screening guidelines, greater risk factor and breast symptom assessment, and better communication and preparation for the examination, Approximately 80 health care providers (nurse practitioners and physicians) in seven military physical examination facilities within a USAR medical brigade will be randomly assigned to the control or experimental group. Providers in the experimental group will be taught individually improved techniques using the MammaCare method of breast examination. Military women trained by the investigator to serve as standardized patients will deliver the teaching using themselves as models. Unannounced standardized patients will use the Clinical Breast Exam Interview and Physical Exam Checklist to score each provider on outcome variables during the pre-test and post-test. Breast exam performance, observed screening practices and risk factors/symptoms assessment scores will be analyzed using analysis of covariance and preparation for the examination using the chi-square text. Demographic information and self-reported breast cancer screening practices will be collected by survey. The pre-test and post-test self-reported practices will be compared using the chi-square test. Effect sizes will be calculated using 80% power, p .05.