Survey of internal medicine residents' use of the fecal occult blood test and their understanding of colorectal cancer screening and surveillance

OBJECTIVE: Primary care physicians have imperfect understanding of current colorectal cancer screening guidelines and recommendations. Furthermore, co mpliance with colorectal cancer screening by internal medicine residents ha s been demonstrated to be poor. We sought to identify whether current train ees in internal medicine had adequate understanding of colorectal cancer sc reening and surveillance and test utilization. METHODS: We applied a structured questionnaire about colorectal cancer scre ening and the use of fecal occult blood tests to 168 internal medicine resi dents at four accredited programs in the U.S. They were also asked for reco mmendations about six hypothetical patients who may have been candidates fo r screening or surveillance. RESULTS: Seventy-one percent identified 50 yr as the currently recommended age to commence screening in an average-risk individual; 64.3% would begin screening with fecal occult blood testing and flexible sigmoidoscopy and 4. 8% with colonoscopy. Most perform fecal occult blood testing on stool obtai ned at digital rectal exam and without prior dietary restrictions. Many use fecal occult blood testing for indications other than colorectal cancer sc reening. Only 29% recommended colonoscopy to evaluate a positive fecal occu lt blood test. Most residents plan to be screened for colorectal neoplasia at the appropriate age; significantly more opted for colonoscopy than recom mended it for their patients. CONCLUSIONS: Internal medicine residents have many misperceptions regarding colorectal cancer screening and the utility of the Fecal occult blood test . Educational efforts should be directed at internal medicine residents, ma ny of whom plan careers in primary care, where most colorectal cancer scree ning is currently performed. (C) 2000 by Am. Cell. of Gastroenterology.