Training pattern recognition of skin lesion morphology, configuration, and distribution

J Am Acad Dermatol. 2015 Mar;72(3):489-95. doi: 10.1016/j.jaad.2014.11.016. Epub 2015 Jan 13.


Background: The ability to reliably recognize and classify a range of skin signs and symptoms remains a necessary skill across most clinical disciplines but one that is traditionally mastered via nonsystematic experience over long periods.

Objective: We investigated whether online Perceptual and Adaptive Learning Modules (PALMs) could efficiently train preclerkship medical students to identify and discriminate primary skin lesion morphologies, configurations, and anatomic distributions.

Methods: Medical students completed an online skin lesion morphology PALM voluntarily in year 1 and by requirement, along with configuration and anatomic distribution PALMs, in year 2. In controlled before-and-after studies, multiple-choice pretests and posttests using previously unused images, assessed PALM-induced learning. In prospective cohort studies, differences in year-2 performance between students who had and had not completed the morphology PALM in year 1 were also assessed.

Results: Multiple-choice tests, used to evaluate PALM effectiveness, demonstrated large (effect sizes of 1.1 [±0.1 SE] to 2.2 [±0.1 SE]) and statistically significant (P < .0001) improvements after PALM training, with learning retention when tested after 1 year.

Limitations: Results are from self-selected groups and a single class at 1 institution.

Conclusion: PALMs are a useful tool for efficient development of the core clinical skills of pattern recognition and classification of skin lesion characteristics.

Keywords: adaptive learning; dermatology; diagnosis; experiential learning; lesion configuration; lesion distribution; lesion morphology; pattern recognition; perceptual learning; skin lesions.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Clinical Competence*
  • Dermatology / education*
  • Education, Medical / methods
  • Humans
  • Job Satisfaction
  • Skin Diseases / pathology*