Traineesʼ Knowledge and Application of Guideline Recommendations for Colorectal Cancer Screening and Surveillance: A Gap That Needs to Be Bridged

Abstract

Introduction: Data demonstrates clinicians in practice do not follow CRC screening and surveillance guidelines. Knowledge of CRC screening or surveillance guidelines has not been assessed in trainees. Methods: An IRB approved 16-question web based survey assessing perceived confidence in recalling and accurate knowledge of published CRC screening and surveillance guidelines was created. To test knowledge, respondents were asked to identify factors incorporated into guidelines to determine CRC screening (age, family and personal history of CRC and polyps, IBD) and surveillance (polyp number, size, pathology and piecemeal resection) intervals. Vignettes for screening included: 40 y/o Caucasian with family history of CRC in a first degree relative at age of 65; 45 y/o African American with no CRC risk factors. Surveillance vignettes were: 63 y/o with 5 mm tubular adenoma and 8 mm tubulovillous adenoma with high grade dysplasia; 58 y/o with 7 mm sessile serrated polyp without dysplasia in the transverse colon. Directors of ACGME approved gastroenterology, internal medicine, family medicine, surgery, ob/gyn, urology and colorectal surgery training programs were requested to forward the survey to their trainees via email. Univariate analysis assessed whether respondents' confidence and knowledge (ascertained by accuracy of answers) varied by specialty. Pearson's chisquare tests were used. A p < 0.05 was considered statistically significant. A significance level of 0.008 was used for pairwise ad-hoc comparisons. Results: 586 responses were received: internal medicine (159), family medicine and primary care (147), gastroenterology (114), general surgery (51), ob/gyn (78), urology (13), colorectal surgery (13) and unspecified (11). 97% reported they followed guidelines however only 68% and 50% were confident in recalling screening and surveillance guidelines respectively. Overall 18% and 8% of respondents identifi ed all factors and correctly answered corresponding vignettes for screening and surveillance respectively. Significant differences existed between specialties. GI fellows had greatest overall accuracy in surveillance (39%) and were the worst (4%) in screening (Table 1).Table 1: Comparison of Perceived Confidence and Knowledge of CRC Screening and Surveillance Guidelines by Specialty in Trainees.Conclusion: A stunning gap exists in trainees' knowledge in recalling and applying CRC screening and surveillance guidelines. Tools are needed to ensure evidence based guidelines are adhered to and accurate patient recommendations are made as health care transitions to a value-based system.