A Brief Evidence-Based Curriculum Can Improve Internal Medicine Residents’ Ability to Successfully Manage Irritable Bowel Syndrome and Reduce Unnecessary Diagnostic Testing

Abstract

Introduction: Gastroenterologists are often tasked with educating internal medicine (IM) residents about irritable bowel syndrome (IBS). However, many residents completing training are not comfortable managing IBS in the primary care setting and this may result in unnecessary diagnostic testing. The purpose of this study was to measure baseline knowledge of IBS in IM residents, and to objectively measure changes in knowledge and confidence in caring for IBS patients after completing an IBS curriculum based on the Rome III criteria. Methods: Twenty-eight IM resident volunteers were randomized to participate in the IBS curriculum (intervention group) or no specific IBS training (control group). The intervention group participated in 4 weekly lectures given by 2 gastroenterologists and a clinical psychologist. Educational materials for the sessions was obtained from the Rome Foundation and GastroSlides (online resource). Both intervention and control groups completed the same pretest, posttest and survey. Data analysis was performed using student’s T-test. The primary outcome measure was performance on questions about IBS diagnosis and management. Secondary outcome measures included confidence in diagnosis and management of IBS, and ordering of diagnostic tests when appropriate. Results: Baseline characteristics of residents in the control and intervention groups were similar. The average performance of the intervention group on the pretest was 66.4%, which significantly improved to 78.1% on the posttest (p=0.001) after participating in the IBS curriculum. Both groups had similar performance on the pretest (66.4% vs. 65.7%; p=0.87), while the intervention group posttest score was higher than that of controls (78.1% vs. 70.4%; p=0.021). Before participating in the IBS curriculum, the majority of trainees in the intervention group erroneously believed that IBS was a diagnosis of exclusion (64.3%) compared to 0% at the end of the curriculum (p=0.0006). More residents in the intervention group were “quite confident” in their ability to diagnose IBS based on symptoms after completing the curriculum compared to controls (64.3% vs. 14.3%, p=0.018). Also, more residents in the intervention group reported that they will likely order less diagnostic tests prior to making the diagnosis of IBS after completing the curriculum compared to controls (85.7% vs. 42.9%; p=0.046). Conclusion: A brief evidence-based IBS curriculum for IM residents significantly improved their understanding of the diagnosis and management of IBS. In addition, the trainees who completed the curriculum felt more confident diagnosing IBS and needed less diagnostic testing prior to making the diagnosis. The curriculum changed the misconception that IBS is a diagnosis of exclusion.