1. Provider comparison reveals no difference between training levels
Medical training does not adequately prepare physicians to manage chronic hepatitis B infection in the high-risk Asian and Pacific Islander patient population Bing Mei Wang1; Ellen Chang, ScD2; Samuel So, MD1; Stephanie Chao, MD1 1) Asian Liver Center at Stanford Univerisity, 2) Northern California Cancer Center
Abstract
Results
BACKGROUND: Asian and Pacific Islander (API) Americans bear a disproportionate burden of chronic infection with the hepatitis B virus (HBV); while API comprise 4.3% of the general US population, they represent over 50% of those infected. Left untreated, chronic HBV infection results in a high mortality rate (25%) due to liver disease and cancer. OBJECTIVE: Studies indicate that physicians sub-optimally diagnose and manage patients with chronic HBV infection. We suspect that medical residency does not provide adequate HBV training, especially with respect to the high prevalence API population. METHODS: We recruited physicians from a tertiary care center and the greater San Francisco Bay Area. We divided them into four cohorts: incoming interns (n=67), outgoing interns (n=62), outgoing residents (n=27), and attending physicians (n=72). We administered a survey to assess knowledge of diagnosis, management, and long-term follow up procedures. RESULTS: Preliminary results reveal that knowledge is poor overall. Only 22.8% of physicians could identify the correct serologic test to screen for hepatitis B; 12.09% of physicians knew the high prevalence rate amongst API, and 34.6% knew how to screen infected individuals for liver cancer. We used Wald chi-square analysis to determine the effect of education level on knowledge; in all cases except for knowledge of liver cancer screening (p=0.0032), knowledge did not significantly increase with further medical training. CONCLUSION: Medical training currently does not adequately train providers about chronic hepatitis B screening and management; new approaches to physician education are necessary.
Preliminary assessment of providers’ HBV knowledge demonstrates significant gaps
Provider comparison reveals no difference between training levels
An asterisk (*) denotes the percentage of respondents answering correctly who also answered correctly the control knowledge questions about breast and colorectal cancer screening.
Provider knowledge with respect to hepatitis B screening and long-term management is low overall. While providers have good understanding of the symptoms and complications of chronic hepatitis B infection, they are ill-prepared to manage patients with chronic hepatitis B infection.
Discussion
Disease prevention and cancer prevention through routine screening remains a challenge in the United States. Compounding this challenge is often a lack of awareness of certain health conditions that are particularly predominant among minority populations. Our study suggests that significant deficits in provider knowledge exist with respect to chronic hepatitis B infection and may contribute to the low rates of detection and treatment observed among the high-risk Asian and Pacific Islander population. This lack of knowledge is uniform among physicians at all levels of training. This may reflect inadequate education regarding minority health starting in medical school, persists throughout advanced medical training.
REWORK DISCUSSION AS FOLLOWS: These insufficiencies in provider knowledge with respect to chronic hepatitis B infection may contribute to the low rates of detection and treatment observed among the high-risk Asian and Pacific Islander population. Physician knowledge regarding hepatitis B screening and liver cancer prevention is lacking at all levels of training. This may reflect inadequate education regarding minority health starting in medical school which continues throughout medical training.
REWORK RECOMMENDATIONS AS FOLLOWS: Our medical education system must be reformed to better prepare current and future physicians in screening and prevention, particularly among minority populations. Preliminary data from our study suggests that internet-based curricula may be a favorable option among physicians.
Objectives
1) To determine whether physicians can adequately identify which populations are at highest risk for chronic hepatitis B infection and should undergo routine screening.
2) To articulate current deficits in physician knowledge with respect to chronic hepatitis B prevention and management
3) To stratify knowledge by training level and develop a strategy for improving physician knowledge
Methods
Participants:
Four Training Levels: Incoming interns (n=67), outgoing interns (n=52), outgoing residents (n=27), attending physicians (n=72)
Five Core Specialties: Internal medicine, family practice, pediatrics, obstetrics & gynecology, surgery
20-Question survey
Demographic information
Hepatitis B Knowledge
Data Analysis:
Wald chi-square analysis of cohort on knowledge
Generalized least squares method of regression for total knowledge score
Stratified by cohort level and sociodemographic information
Recommendations 
Our medical education system must be reformed to better prepare current and future physicians in screening and prevention, particularly among minority populations. Preliminary data from our study through surveys and interviews suggests that internet-based curricula may be a favorable option for physicians. The authors also suggest that minority health be a core requirement for physicians’ Continuing Medical Education credits.
Note: The data presented here has been updated since the submission of the abstract.