IMPROVEMENT OF INTERNAL MEDICINE RESIDENT PHYSICIANSʼ COLORECTAL CANCER SCREENING IN AFRICAN-AMERICANS CAN OCCUR WITH FOCUSED EDUCATIONAL EFFORTS

Abstract

Purpose: Colorectal cancer screening causes significant morbidity and mortality in the United States. African-Americans are disproportionately affected by this malignancy. There is evidence to suggest that physicians inconsistently screen for colorectal cancer in African-Americans. This study evaluated internal medicine resident physicians' colorectal cancer screening practices in African-Americans prior to and following a focused educational intervention. Methods: A medical record review of internal medicine resident physicians' adherence to colorectal cancer screening recommendations was conducted. Consecutive African-American patients ≥50 years of age of average risk for colorectal cancer who presented for a health maintenance evaluation were included. Physicians' performance of rectal exams, fecal occult blood testing (FOBT), flexible sigmoidoscopy/colonoscopy were evaluated for 6 months prior to and 6 months following an educational intervention that focused upon issues related to racial disparities in colorectal cancer. Statistical significance was assessed using Fischer's exact test. Results: There were 116 patients included in the pre-intervention assessment. Forty-eight (41.4%) had rectal exams, 46 (37.7%) had FOBT and 31 (26.7%) had endoscopic exams. There were 132 patients included in the post-intervention assessment. Fifty-one (38.6%) had rectal exams, 50 (37.9%) had FOBT and 78 (59.1%) had endoscopic exams. There was no statistically significant difference in the rate at which rectal exams (p = 0.6605) and FOBT (p = 0.7748) were performed prior to and following the educational initiative. However, there was a statistically significant difference in the rate at which endoscopic assessments (p <0.0001) were performed. Conclusions: Physicians inconsistently adhered to colorectal cancer screening guidelines in African-Americans. Educational interventions focused upon racial disparity in colorectal cancer may improve physicians' performance of endoscopic exams in African-Americans. However, continued efforts to enhance resident physicians' colorectal cancer screening practices in African-Americans is important.