Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2015; 21(22): 6914-6923
Published online Jun 14, 2015. doi: 10.3748/wjg.v21.i22.6914
Medical training fails to prepare providers to care for patients with chronic hepatitis B infection
Stephanie D Chao, Bing-Mei Wang, Ellen T Chang, Li Ma, Samuel K So
Stephanie D Chao, Department of Surgery, Stanford University School of Medicine, Asian Liver Center at Stanford University, School of Medicine, Palo Alto, CA 94304, United States
Stephanie D Chao, Bing-Mei Wang, Ellen T Chang, Li Ma, Samuel K So, Asian Liver Center at Stanford University, Stanford University School of Medicine, Asian Liver Center at Stanford University School of Medicine, Palo Alto, CA 94304, United States
Ellen T Chang, Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA 94305, United States
Author contributions: Chao SD and So SK designed the research; Chao SD and Wang BM performed the research; Chao SD, Wang BM and Chang ET analyzed the data; Chao SD, Wang BM and Ma L wrote the paper; all authors have read and approved the final version to be published.
Ethics approval: Stanford University Institutional Review Board Approved.
Informed consent: Informed consent obtained in writing using Institutional Review Board approved consent forms.
Conflict-of-interest: None declared.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Stephanie D Chao, MD, Assistant Professor, Department of Surgery, Stanford University School of Medicine, Asian Liver Center at Stanford University, School of Medicine, 780 Welch Road, CJ 130, Palo Alto, CA 94304, United States. stephanie.chao@stanford.edu
Telephone: +1-650-5668861 Fax: +1-650-5668863
Received: April 9, 2015
Peer-review started: April 9, 2015
First decision: April 23, 2015
Revised: May 5, 2015
Accepted: May 27, 2015
Article in press: May 27, 2015
Published online: June 14, 2015
Processing time: 70 Days and 8 Hours
Abstract

AIM: To investigate physicians’ knowledge including chronic hepatitis B (CHB) diagnosis, screening, and management in various stages of their training.

METHODS: A voluntary 20-question survey was administered in Santa Clara County, CA where Asian and Pacific Islanders (API) account for a third of the population. Among the 219 physician participants, there were 63 interns, 60 second-year residents, 26 chief residents and 70 attending physicians. The survey asked questions regarding respondents’ demographics, general hepatitis B virus knowledge questions (i.e., transmission, prevalence, diagnostic testing, prevention, and treatment options), as well as, self-reported practice behavior and confidence in knowledge.

RESULTS: Knowledge about screening and managing patients with CHB was poor: only 24% identified the correct tests to screen for CHB, 13% knew the next steps for patients testing positive for CHB, 18% knew the high prevalence rate among API, and 31% knew how to screen for liver cancer. Wald chi-square analysis determined the effect of training level on knowledge; in all cases except for knowledge of liver cancer screening (P = 0.0032), knowledge did not significantly increase with length in residency training or completion of residency.

CONCLUSION: Even in a high-risk region, both medical school and residency training have not adequately prepared physicians in the screening and management of CHB.

Keywords: Liver cancer; Hepatitis B; Asian Pacific Islander; Liver disease; Health disparity

Core tip: Chronic hepatitis B (CHB) affects 1.25 million Americans and CHB disproportionately impacting the Asian population. The Centers for Disease Control and Prevention recommends routine preventive screening for high-risk populations. However, our study demonstrates that our system of medical training may not adequately train providers how to screen high-risk patients, who to screen for CHB, or how to manage patients who test positive for CHB. Physician knowledge is poor overall and does not improve during medical training. Prompt attention is needed to reduce the burden of chronic liver disease and liver cancer in the high prevalence Asian and Pacific Islander Population.