C0181 - Enhancing Resident Education on Colorectal Cancer Screening and Surveillance: A Pilot Project

Monday, October 24, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Rishabh Khatri, MD

Temple University Hospital
Philadelphia, PA

Rishabh Khatri, MD¹, Jun Song, MD¹, Frank Friedenberg, MD, MS², Adam C. Ehrlich, MD, MPH²
¹Temple University Hospital, Philadelphia, PA; ²Lewis Katz School of Medicine at Temple University, Philadelphia, PA

Introduction: The U.S. Preventive Services Task Force issued new guidelines for colorectal cancer (CRC) screening in 2021. Adoption of these new recommendations by Internal Medicine (IM) residents has not been well studied. Clinical practice paradigms are updated frequently but practices are ingrained in physicians during residency. We investigated the knowledge of current CRC screening guidelines of IM residents at a large, metropolitan training hospital.

Methods: A 13-question survey was designed to record demographics (5 questions) and test knowledge of CRC screening guidelines (8 questions) among IM residents. The survey tested both understanding of CRC screening initiation for average-risk and high-risk patients and identifying an appropriate screening test with its respective associated intervals. An educational pamphlet detailing these CRC screening guidelines was created and distributed to all IM residents. No other intervention was performed. Two months after distribution, a post-intervention survey was used to assess changes in resident knowledge and practice. IM residents were stratified into post-graduate year (PGY) level for analysis.

Results: IM residents (n=120) completed the pre-intervention survey, and 112 residents completed the post-intervention survey after distribution of the CRC guideline pamphlet. The average questions correct across PGY levels were significantly improved after educational intervention (8 is perfect score, mean 4.46 pre-survey vs mean 5.74 post-survey, p< 0.05) [Figure 1]. Residents overall showed improvement in identifying CRC screening initiation age across all PGY levels, however this was not uniform with every PGY level after educational intervention. Residents overall showed improvement in identifying CRC screening tests with its respective intervals among all tests, however there were differences between PGY level after educational intervention [Table 1].

Discussion: Overall, residents across all PGY levels showed improvement in knowledge after a very simple educational intervention. Growth in knowledge was not uniform between every training year. While residents in training are knowledgeable regarding CRC screening with colonoscopy in average-risk patients, there are deficiencies in areas of high-risk patients. Targeted educational interventions specific to training level may optimize resident understanding of management for high-risk patients, alternative screening modalities, and dynamic CRC screening guidelines.

Figure: Figure 1: Pre- (Blue) and Post-Educational (Orange) Intervention Mean Scores across PGY-level

		PGY-1			PGY-2			PGY-3			Overall
		Pre-Intervention (% Correct) (n=56)	Post-Intervention (% Correct) (n=49)	Relative % Change	Pre-Intervention (% Correct) (n=34)	Post-Intervention (% Correct) (n=35)	Relative % Change	Pre-Intervention (% Correct) (n=30)	Post-Intervention (% Correct) (n=28)mu	Relative % Change	Pre-Intervention (% Correct) (n=120)	Post-Intervention (% Correct) (n=112)	Relative % Change
Assessment of Appropriate CRC Screening Initiation	For the average risk American, CRC Screening should begin at what age?	57.1	87.8	54%	47.1	94.3	100%	46.7	78.6	68%	55.3	87.5	58%
	For the average risk African American, routine CRC screening should begin at what age?	46.4	73.5	58%	64.7	80	24%	70.6	76.6	8%	59.1	77.6	31%
	For patients with first degree relative diagnosed with CRC at 55 yo, routine screening should begin earliest at what age?	39.3	18.4	-53%	5.9	45.7	675%	26.7	25	-6%	26.6	28.6	7.5%
Assessment of Methods of CRC Detection and Their Associated Intervals	Colonoscopy (q 10 years)	92.9	100	8%	100	100	0%	100	100	0%	96.7	100	3.4%
	FIT (q 1 years)	46.4	65.3	41%	47.1	94.3	100%	46.7	60.7	30%	46.7	73.2	57%
	Flexible Sigmoidoscopy (q 5 years)	42.9	81.6	90%	76.5	91.4	19%	63.3	60.7	-4%	57.5	79.4	38%
	FOBT (q 1 years)	42.9	55.1	28%	41.2	37.1	-10%	53.3	78.6	47%	45	51.7	15%
	Cologuard (q 3 years)	25	57.1	128%	47.1	82.9	76%	73.3	82.1	12%	43.3	66.7	54%

Table: Table 1: Pre- and Post-Educational Intervention Results for Resident Knowledge across PGY-level (FIT: Fecal Immunochemical Test; FOBT: Fecal Occult Blood Test)

Disclosures:

Rishabh Khatri indicated no relevant financial relationships.

Jun Song indicated no relevant financial relationships.

Frank Friedenberg indicated no relevant financial relationships.

Adam Ehrlich: Bristol Meyers Scquibb – Advisory Committee/Board Member. Pfizer – Advisory Committee/Board Member.

Rishabh Khatri, MD¹, Jun Song, MD¹, Frank Friedenberg, MD, MS², Adam C. Ehrlich, MD, MPH². C0181 - Enhancing Resident Education on Colorectal Cancer Screening and Surveillance: A Pilot Project, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.