The decision to suggest screening lower gastrointestinal endoscopy: the effect of training

Primary care residency directors in the Southeastern US were surveyed to obtain information on training in lower gastrointestinal endoscopy (LGIE). All residents in a sample of programs were asked to complete a similar questionnaire. Response was 77% for family practice residencies and 60% for internal medicine residencies. Significantly fewer (43%) internal medicine residents reported receiving training in either 35 cm or 60 cm LGIE than family practice residents (77%). When asked if they would suggest LGIE to screen an asymptomatic patient, 67% of family practice and 84% of internal medicine residents replied affirmatively. Those residents who had received training were significantly more likely to suggest screening LGIE. The screening decision was not influenced by the specialty of the physician who supervised the resident training. Out-of-pocket cost to the patient was expected to be a major consideration in the screening decision, but this was not supported statistically. Greater availability of residency training in LGIE will likely increase its use in screening.