Sigmoidoscopic screening for colorectal neoplasia: A comparison of residents in obstetrics and gynecology to those in internal medicine in a military medical center

Abstract

Objective: To determine the effectiveness of a flexible sigmoidoscopy training program integrated into an Obstetrics and Gynecology (OBG) residency program. Methods: All patients undergoing screening flexible sigmoidoscopies performed by either OBG or Internal Medicine (IM) residents between July 1997 and March 1998 were evaluated. All patients were asymptomatic, of average risk for colorectal cancer, and referred for screening flexible sigmoidoscopy by their primary care physician. The primary outcome measured was a comparison between IM and OBG residents in number of precancerous adenomas diagnosed and confirmed by biopsy. Secondary outcome measures included completeness of exam, and secondary diagnoses in each group. Results: There were 425 patients evaluated (210 by OBG residents, 215 by IM residents). The number of precancerous adenomas confirmed by biopsy were 43 (20.5%) by the OBG residents and 25 (11.6%) by the IM residents (p=0.01). There was a significant difference in frequency of adenomas identified in male patients by the OBG group compared to the male patients in the IM group, 35.3% vs. 14.6% respectively, p<0.001; however the results in female patients were similar, 7.6% OBG vs. 7.6% IM group. The IM residents had more non-precancerous hyperplasia confirmed on biopsy than the OBG residents 28.8% vs. 18.1%, p=0.012. The IM residents diagnosed more rectal polyps, diverticulosis, and hemorrhoids than the OBG residents. Incomplete exams were equal in both groups. Conclusion: Our study demonstrates that a flexible sigmoidoscopy training program for residents in OBG is not only feasible but effective. Abnormality detection rates are similar to those in an IM teaching program.