Assessment of Occult Blood Testing in Acute Hospital Settings: A Multicenter GI Fellow Driven Study

Introduction: Fecal occult blood testing (FOBT) is an outpatient screening tool for colorectal cancer. It is widely misused in the hospital setting, without accounting for false positives or negatives resulting in unnecessary endoscopic procedures, increased costs and increased length of stay. The aim of our study is to understand the knowledge and current utilization of FOBT among internal medicine residents from multiple programs across the USA. Methods: This is a multicenter survey conducted by a GI fellow in about 25 Internal Medicine Residency programs in Washington-DC, Pennsylvania, New York, New Jersey, Florida, Indiana, Illinois, Georgia, and California. A 15-questionnaire survey on FOBT was emailed on May 18th, 2022, with follow-up reminders until June 3rd, 2022. We considered the end of the academic year as an ideal time to evaluate the understanding and clinical practice of internal medicine trainees. Results: A total of 227 residents responded to our survey {n=96 (42.2%) PGY-I, n=67 (29.5%) PGY-II & n=64 (28.2%) PGY-III}. Overall, 66.7% i.e., 2/3rd of residents sometimes or always ordered FOBT and 67.4% have ordered this test more often in inpatient than in outpatient settings. Approximately 60% of the residents had knowledge of dietary restrictions but only 32% of the residents were questioning the patients before ordering it. The triggers for ordering FOBT were mostly anemia (92.5%) followed by change in stool colour (61%), weight loss (60%) and bleeding per rectum (47.5%). 62% of respondents felt influenced by their supervisors but 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 (Table). 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 first. There is a need for better education of internal medicine trainees in the utilization of FOBT. Table 1. - Statistical analysis comparing the level of training with preference to FOBT vs. GI Consult for a suspected GI Bleed For a suspected GI Bleed, which of the following would you consider first Logistic regression analysis, comparing PGY-I with PGY-II & III Postgraduate Year GI Consult FOBT Odds Ratio Confidence Interval P-Value PGY – I 34 (35.4%) 62 (64.6%) Ref Ref Ref PGY – II 28 (41.8%) 39 (58.2%) 0.76 0.40 - 1.44 0.820 PGY – III 37 (43.6%) 27 (56.4%) 0.40 0.21 - 0.77 0.006