Colorectal cancer screening compliance by medicine residents: Perceived and actual

OBJECTIVE: Implementation of colorectal cancer (CRC) screening with widely available techniques can result in a significant reduction in CRC-related m ortality. Clinical practice paradigms are often ingrained in physicians dur ing residency. We, therefore, investigated both compliance and perceived ob stacles to CRC screening in the practices of physicians-in-training. METHODS: We conducted a retrospective analysis of medical records of patien ts who were receiving their primary care in the internal medicine resident clinics at the University of Nebraska Medical Center and were at average ri sk for CRC. In addition to demographics, data on the use of screening mammo graphy, Pap smear, cholesterol, fecal occult blood testing (FOBT), and flex ible sigmoidoscopy (FS) were collected. A questionnaire was also distribute d to all internal medicine residents to assess their CRC screening knowledg e and perceived screening compliance. RESULTS: One hundred ei-ht patient charts were reviewed. The percentage of patients appropriately screened for each test was as follows: mammography 6 6%, Pap smear 65%, cholesterol 53%, FOBT 13%, and FS 16%. Residents dramati cally overestimated their perceived FS and FOBT screening, rates, 78% and 8 8%, respectively. Most residents identified barriers to FS screening. Altho ugh rudimentary CRC screening knowledge appeared adequate, a number of know ledge-based deficiencies were identified. CONCLUSIONS: Internal medicine residents at our institution demonstrate poo r CRC screening compliance especially when compared with other health care maintenance interventions. This cannot be entirely accounted for by inadequ ate knowledge; discrepancy between the perceived and actual implementation of CRC screening may be important. Efforts to improve screening compliance should include a focus on physicians-in-training. (Am J Gastroenterol 2001; 96:3004-3008. (C) 2001 by Am. Coll. of Gastroenterology).