Shared Care and Teaching: A Longitudinal Study of Combined Family Medicine and Surgery Skin Clinic

BACKGROUND: Procedural competency in skin cancer management remains an essential yet inconsistently achieved skill within Family Medicine training. This gap is magnified by increasing skin cancer incidence and lengthening wait times for tertiary-level cancer care. STUDY AIMS: This study aimed to develop, implement, and evaluate an interdisciplinary educational intervention to enhance procedural skills and self-efficacy among second-year Family Medicine residents, to examine system-level outcomes in skin cancer care. METHODS: A novel curriculum integrating a structured workshop and hands-on clinical sessions was designed using Kern’s Six-Step Curriculum Development model and deliberate practice principles. Residents performed skin biopsies and excisions under dual supervision from Surgery and Family Medicine faculty, receiving real-time feedback. Quantitative evaluation employed validated measures of knowledge, self-efficacy, and practice attitudes, administered pre-, post-, and longitudinally at 8–10 years post-training. Outcomes were assessed using Kirkpatrick’s four-level evaluation model. Complementary descriptive qualitative analysis of semi-structured interviews with current Family Physicians with a designated focused practice in dermatology explored experiential and career-shaping factors. RESULTS: Participants demonstrated significant improvements in diagnostic and procedural knowledge, practice attitudes, and self-efficacy. Thematic analysis of qualitative data identified six career-shaping factors: variability in training exposure, self-directed learning, mentorship, delayed procedural confidence, experiential motivation, and opportunities for curriculum renewal. The program’s impact was assessed across Kirkpatrick Levels 1–4, incorporating measures of satisfaction, knowledge acquisition, self-efficacy, clinical behavior change, and system-level outcomes. DISCUSSION: This study found sustained gains in knowledge and self-efficacy in skin cancer management with integration of skin procedures into independent practice. Over half of the program’s graduates continued to practice regionally, performing biopsies and excisions within community settings (Kirkpatrick Level 3 Behavior). System-level analysis of a longitudinal study showed stabilization of tertiary skin cancer referrals, despite rising oncology volumes, and notable improvements in timely access to consultations (Kirkpatrick Level 4). Findings demonstrate that an interdisciplinary, feedback-rich educational model can translate into sustained behavioral change, improved referral volumes, and enhanced service capacity. CONCLUSIONS: Aligning educational innovation with system needs can achieve measurable impacts. The shared-care clinic model represents a scalable approach to advance procedural training and strengthen primary care’s role in dermatologic care.

Author dc:creator

• Kathryn E. Roth (23291659)

• Interdisciplinary Communication;
• Self Efficacy;
• Surgical Procedures, Minor;
• Program Evaluation;
• Health Systems Plans/organization & administration;
• Longitudinal Studies;
• Practice Patterns
• Family Practice/education;
• Internship and Residency/education;
• Skin Neoplasms/diagnosis;
• Curriculum;

Statement dc:rights

• In Copyright

DOI dc:identifier

https://doi.org/10.25417/uic.31451428.v1

OAI identifier oai:identifier

oai:figshare.com:article/31451428