Dr. Jeffrey Miller, chair of the Department of Dermatology at Penn State College of Medicine, can pinpoint the moment he realized a routine procedure he performs daily is prone to error.
"I missed a melanoma," Miller said. And that got him thinking about what he could do to try and prevent that from happening again.
In a new research study published in the Journal of the American Academy of Dermatology, Miller and dermatology residents at Penn State Health Milton S. Hershey Medical Center used engineering principles to improve the accuracy and efficiency of an evaluation that dermatologists frequently use to check patients for skin cancers.
The evaluation, called a total body skin exam, is a full visual assessment of the entirety of a patient's skin surfaces for cancers.
The standard practice at the Milton S. Hershey Medical Center is to perform the evaluation at almost every dermatology visit, whether the patient has a history of skin cancer or not.
We have found cancers on people who are not coming in with a concern."
Dermatology resident Dr. Matthew Helm
According to the researchers, there is no standardized method for performing a total body skin exam. Dermatologists may develop their own approach, which can potentially result in missed areas and lost time. The research team knew that bioengineering principles had helped Olympic athletes make the most of each motion, and started to wonder whether the same principles could be applied in medicine.
"Efficiency and accuracy are important because we do a lot of total body skin exams every day," Helm said. "If it takes us 20 minutes each time, we will never get through our day. However, we do not want to sacrifice accuracy for efficiency."
To find the sweet spot between efficiency and accuracy, the research team sought assistance from Penn State engineering students.
"Part of our students' capstone program is to work on a real-world problem and deliver results to their sponsor," said Charles Purdum, assistant teaching professor and director of industry relations in the Harold and Inge Marcus Department of Industrial and Manufacturing Engineering. "This project was attractive to me because it was a unique application of engineering principles in the health care field."
A mix of biomedical and industrial engineering students formed the team that consulted with Miller on the project. They met on a weekly basis and gave proposals, timelines, updates and a final report.
"We treat it like an engineer's first project out of college," Purdum said. "It's a great model to show students what industry is like."
The engineering students watched video recordings of five dermatology faculty and five residents conducting total body skin exams on both a male and female patient. They assessed the exam time, physician and subject movements, sequence of body parts evaluated and whether any body parts were missed.
Using statistics, the students calculated the variability between the evaluations performed by each provider. The engineering students observed that the underside of the neck and armpits were frequently missed areas, and considered that when designing the optimal order of the procedure.
After watching the videos a second time, the students proposed a more efficient and accurate technique to Miller and the dermatology residents.
"The proposed method was different from how I had been doing the exam," said Helm. "Now I use the optimized way, and I feel like it has helped me to be a better clinician."
Miller hopes to help prevent errors by teaching faculty, residents and medical students the new technique. The next phase of the research will measure if that educational objective is successful.
"If we can save one life from skin cancer because we are doing the exam consistently well, then we've succeeded," said Miller.
Dr. Katherine Hallock, dermatology resident, Hershey Medical Center, and Dr. Elizabeth Bisbee, University of Florida Department of Dermatology, were also involved with this research.
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