Resident Knowledge of Colorectal Cancer Screening Assessed by Web-Based Survey

Abstract

Purpose: While CRC screening rates have increased in the New York City area, numerous eligible patients remain unscreened. Many receive medical care from residents at teaching institutions' primary care clinics, and it is unknown whether residents are adequately trained to understand current screening modalities and guidelines in order to provide appropriate counseling. Our goal was to examine residents' understanding of guidelines and to define areas needing attention. Methods: An 11 question survey was designed utilizing current guidelines published by the ACG, USPSTF and the Multi Society Task Force. Multiple correct answers were solicited when appropriate. Program Directors from academic institutions in the greater NYC area were contacted by email to encourage their residents' participation. Results: 5 training programs participated, 676 surveys were sent, and 114 responses recorded. 93.9% correctly identified colonoscopy every 10 years as indicated for CRC detection, and 53.5% identified flexible sigmoidoscopy every 5 years. Fecal Occult Blood Test (FOBT) was identified by 35.1% as suitable if performed at home annually, while 27.2% stated it may be performed annually in the office. Other modalities (Fecal Immunochemical Test, Fecal DNA, barium enema, Virtual Colonoscopy) were listed as acceptable by fewer than 20% of responders. For CRC prevention, colonoscopy every 10 years was only identified by 50%, with 38.6% of responders identifying flexible sigmoidoscopy every 5 years. 41.2% of responders incorrectly identified FOBT as a cancer prevention test. Nearly all respondents correctly identified age 50 to begin average risk screening. For screening patients with a first-degree relative with CRC under age 60, only 65.8% of respondents identified age 40 or 10 years prior to the index age as correct. For patients with a first-degree relative with CRC over age 60, only 7.9% of responders considered age 40 suitable. Conclusion: While most residents seem knowledgeable regarding CRC screening with colonoscopy and the proper screening age for average risk individuals, many deficiencies remain. FOBT for screening purposes remains undervalued, and confusion about properly administering the test persists. The distinction between screening and prevention, addressed in the ACG and Multi Society Task Force guidelines, needs further reinforcement. For patients with high risk family history there appears to be a knowledge deficit, though the different guidelines' discrepancies may themselves contribute to confusion. Based on our results we conclude that the education of medical residents regarding CRC screening and prevention guidelines is deficient, and we have identified clear and vital target areas for further reinforcement.