Postgraduate medical education homogenizes follow-up strategies after primary therapy for rectal cancer patients

Abstract

14533 Background: The pedagogical literature suggests that continuing medical education (CME) is valuable, but objective evidence of its value has proved difficult to obtain. We investigated how self-reported surgeon age affects self-reported surveillance strategies utilized by expert surgeons following their own patients with rectal carcinoma after curative-intent treatment. We reasoned that, if there were no significant differences in strategies among surgeons of various ages, the homogenization would be ascribable to CME. Methods: We surveyed the 1,795 members of the American Society of Colon and Rectal Surgeons (ASCRS) using a questionnaire based on 4 succinct vignettes describing idealized patients treated with curative intent for TNM stages I-III rectal carcinoma. The surgeons were asked how often they use 14 specific surveillance modalities (office visit, 3 blood tests, 2 endoscopic procedures, 8 imaging studies) during years 1–5 after surgery. The motivation underlying their surveillance practices was analyzed using a menu of 12 possible factors and a Likert scale of 1 (lowest effect on motivation) to 10 (highest effect). We assessed the effect of surgeon age on follow-up intensity, controlling for TNM stage and year post- treatment, using repeated-measures ANOVA. One-way ANOVA was used to analyze the effect of surgeon age on motivation. Results: Of the 566 responses, 347 were considered evaluable. There were no significant differences among age strata (30–39, 40–49, 50–59, and = 60) in surveillance practices for any of the 4 vignettes. Only one motivating factor differed significantly among age strata: psychosocial support for the patient; surgeons = 60 were motivated more strongly (Likert score 6.9; p < .05) by this factor than younger surgeons (Likert score 5.8). Conclusions: CME contributes to homogenization of this important aspect of clinical management among ASCRS surgeons. No significant financial relationships to disclose.