Optimizing the Total Body Skin Exam: An Observational Cohort Study

Publication date: Available online 15 February 2019

Source: Journal of the American Academy of Dermatology

Author(s): Matthew F. Helm, Katherine K. Hallock, Elizabeth Bisbee, Jeffrey J. Miller

Abstract

Background

Total body skin examinations (TBSE) are commonly performed in clinical practice. There is limited research on best practices for performing a TBSE.

Objective

To optimize the TBSE.

Methods

We performed an observational cohort study by video recording 5 dermatology faculty and 5 residents conducting their regular TBSE on both a male and female standardized subject. Exam time, physician movements, subject movements, sequence of body parts examined, and body parts missed were analyzed using an analytic hierarchy process (AHP) matrix. Differences were evaluated by a t-test of unequal variance. P-values <0.05 were deemed significant.

Results

We identified a optimal format for conducting a TBSE that is efficient and accurate

Limitations

This study was conducted with only healthy examiners and standardized subjects, rather than individuals with a variety of physical and mental disabilities. The structure of the study was not hypothesis driven and assumed that engineers observing physicians performing the total body skin examination would identify the most optimal TBSE.

Conclusion

Our results indicate that a standardized process of performing a TBSE minimizes the chance of missing a body area. This could also have implications on teaching a standardized TBSE to medical students, residents, and physicians.

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