Assessment of Fecal Occult Blood Testing in Acute Hospital Settings: Perspectives of Internal Medicine Residents in a Multicenter Study

Background Fecal occult blood testing (FOBT) is an outpatient screening tool for colorectal cancer. However, it is widely used in the hospital setting among hospitalized patients for a myriad of reasons. The aim of our study is to understand the knowledge and current utilization of FOBT among internal medicine (IM) residents across multiple training programs in the United States. Methods This was a multicenter survey conducted among 25 IM residency programs. A 15-item questionnaire survey on FOBT was emailed to IM residents in May 2022, at the end of the academic year, with two bi-weekly follow-up reminders. Logistic regression models and Stata statistical software version 14.2 (StataCorp, College Station, TX) were used for the analysis. Those included in the study were IM residents at any level of training. The exclusion criterion was other residents not enrolled in an IM program. Results A total of 227 (100%) IM residents responded to the survey (n=96 (42.2%) in post-graduate year (PGY)-1, n=67 (29.5%) in PGY-2, n=64 (28.2%) in PGY-3). Overall, 151 (66.5%) residents sometimes or always ordered FOBT during their respective training period and 153 (67.4%) ordered this test more often in inpatient than in outpatient settings. Approximately 136 (60%) residents had knowledge of dietary restrictions but only 73 (32%) residents questioned the patients before ordering it. The triggers for ordering FOBT were mostly anemia (174, 32%) followed by a change in stool color (102, 19%), weight loss (99, 18%) and bleeding per rectum (71, 13%). Majority (141, 62%) of the respondents felt influenced by their supervisors and 130 (57.2%) felt that FOBT results will change their management. Overall, as postgraduate year training increased, trainees were less likely to order FOBT for suspected GI bleeding. Conclusion Our survey results showed that residents were influenced by their supervisors and ordered FOBT largely in the inpatient setting. Although there was noted improvement in understanding of the futility of FOBT in suspected acute GI bleeding, more than half of final-year trainees would still order FOBT. There is a need for better education of IM trainees in the utilization of FOBT.