Celiac Disease and Internal Medicine Housestaff

Abstract

Purpose: Previous investigations determined that both generalists and gastroenterologists demonstrate significant knowledge deficits regarding the diagnosis and management of patients with celiac disease. No studies have examined knowledge of celiac disease among resident physicians. We aimed to determine exposure to and knowledge of celiac disease in a cohort of internal medicine residents at a tertiary care center. Methods: A sixteen-item survey was mailed to all current internal medicine housestaff at our medical center. The survey evaluated exposure to and basic knowledge of celiac disease. Knowledge questions were based on a recent widely circulated review on celiac disease. Results: 63 surveys were mailed and 61 were returned for a response rate of 96.8%. 45.9% of respondents were first-year residents, 27.9% were in their second year, and the remainder were in their third year. 42.6% recalled receiving a lecture mentioning celiac disease in medical school, 68.8% had ordered a blood test to diagnose celiac disease, 37.7% had cared for a patient with celiac disease, and 9.8% had diagnosed a patient with celiac disease. Less than one quarter of respondents knew the prevalence of celiac disease in North America or that the most common presenting symptom of the disease in adults is iron deficiency anemia. Most respondents did not know that the tissue transgluatminase test can be falsely negative in IgA-deficient individuals (45.9%) or that tissue transglutaminase can be followed serially to monitor dietary compliance (26.2%). Most respondents (59.1%) knew that celiac disease is associated with other autoimmune diseases. The average score on the knowledge component was 50.7%, although more time in residency was significantly associated with higher scores. Resident physicians who had cared for a patient with (66.3% vs. 51.6%, p = 0.047) and made the diagnosis of (77.6% vs. 55.3%, p < 0.01) celiac disease scored better on the knowledge exam. There was no statistically significant difference in scores between those who had received a medical school lecture and those who had not (59.6% vs. 55.4%, p = 0.11). Conclusions: Resident physicians' knowledge pertaining to the diagnosis and management of celiac disease is often deficient. Exposure to patients with celiac disease improves general knowledge. More efforts are needed to educate resident physicians about this common disease.