Objective risk, subjective risk, and colorectal cancer screening among a clinic sample.

Among cancers, colorectal (CRC) is the third most incident and the second most lethal. Although screening for the disease has been shown to be effective in reducing morbidity and mortality, screening rates remain low. Risk of disease has been shown to increase screening uptake, but different types of risk may influence intent to screen, screening in a timely manner, or participating in screening at all. A cross-sectional design was used to select a diverse sample of CRC asymptomatic patients 50 or more years of age (N=104) visiting one of three Midwestern medical clinics. Results showed a positive relationship between receipt of CRC screening and planning to screen for CRC in the future. Objective risk factors (personal/family history and having a primary care physician) were associated with CRC screening uptake and screening within the time intervals recommended by professional screening guidelines, but subjective risk did not obtain significance for screening participation. Both objective (primary care physician) and subjective risk (long-term comparative risk, knowledge) were associated with future plans to screen. Findings suggest that CRC screening behaviors may be differentially influenced by type of risk.

Colorectal cancer screening behavior and health insurance status (United States).

OBJECTIVE: The purpose of this study was to examine the association between health insurance status and CRC screening behavior among a diverse sample of ambulatory patients. METHODS: Cross-sectional, retrospective study. Quota sampling techniques were used to recruit 52 insured/uninsured patients > or =age 50 from three Midwestern medical clinics (N=104). Data were collected by interviewer-administered CRC screening questionnaires. RESULTS: Thirty-nine percent of the sample was in compliance with CRC testing guidelines. Insured compared to uninsured participants were significantly more likely to have ever completed any testing (77% versus 33%), and were more likely to have undertaken testing according to current US guidelines (62% versus 17%), all ps < 0.001. Insured participants also were significantly more likely than the uninsured to know about, receive physician recommendation to screen, and profess future intent to screen, ps < 0.001. Fewer uninsured participants were tested for routine reasons compared to insured participants. Significant group differences did not emerge on future preference for a particular screening methodology, if testing costs were equal. CONCLUSIONS: Results suggest that CRC screening depends, in part, on health insurance status. Increasing insurance coverage or resources for low-cost, accurate tests may facilitate future screening.

The adult screening physical examination: what physicians do.

BACKGROUND: Patients expect a thorough physical examination. However, there is debate on the utility of the physical examination, and students are deficient in many common maneuvers. PURPOSES: (1) To estimate physician perceived utility of physical examination maneuvers in a routine adult screening examination. (2) To promote teaching of core physical examination competencies in student and resident education. METHODS: Primary care physicians at 2 academic medical centers were surveyed. Using a 5-category frequency scale, physicians estimated how often they perform and document 90 common physical examination maneuvers in a routine adult screening examination. RESULTS: Survey response rate was 56%. Physicians reported significant variation in frequency of use for individual physical examination maneuvers. Both common (blood pressure) and rarely performed (visual acuity) maneuvers were identified. CONCLUSION: This study helps define the adult screening physical examination by estimating which individual physical examination maneuvers physicians typically utilize. Educational resources and clinical research should focus on identifying an evidence-based approach to the physical examination.

The Art of Medicine through the Humanities: an overview of a one-month humanities elective for fourth year students.

BACKGROUND: The purpose of incorporating humanities teaching into medical education is to encourage students to develop into more sensitive and caring doctors who communicate well with their patients and colleagues. CONTENT: A unique 4th year student elective at the Medical College of Wisconsin incorporates reflective and writing activities. Small group sessions are facilitated by faculty with specific interest and expertise in the humanities. EVALUATION: Students keep a journal in which they record their reflections on personal issues, career planning and reactions to classroom discussions. Each student writes a poem and an essay or short story. The course is well received and oversubscribed. CONCLUSIONS: Students increase their understanding of the humanities through readings, small group discussions, journal keeping and formal writing. By incorporating humanism into their professional lives, medical students can learn to care for their patients in a more humane and thoughtful manner.

A new program to reward and retain volunteer clinical faculty at the Medical College of Wisconsin.

UNLABELLED: BACKGROUND AND PROBLEM: Volunteer clinical faculty (VCF) are vital to the educational mission of medical schools. At the Medical College of Wisconsin (MCW), VCF are increasingly relied upon to meet clinical training needs in medical student and resident education. However, many VCF receive little or no preparation to excel in their teaching roles, and they are under increasing time demands that limit their availability to teach. METHODS: Beginning in 2001, the primary care departments at MCW began a series of initiatives called "ExCEED" to promote VCF teaching excellence and efficiency through two main program components: Advisory Councils, made up of VCF leaders, and Support Services, such as web-based resources and teaching workshops. RESULTS: Preliminary ExCEED findings show that VCF have acquired important knowledge, skills, and tools that have better prepared them for their teaching roles. CONCLUSION: ExCEED is a systematic, multi-method approach to engage VCF that is positively influencing the clinical education of MCW students and residents.

Colorectal cancer screening: physician attitudes and practices.

PURPOSE: The American Cancer Society (ACS) set a nationwide goal to increase to 75% by 2015 the proportion of people aged 50 and older who have colorectal cancer (CRC) screening consistent with ACS guidelines. Little is known about current physician screening practices and attitudes. The purpose of this study was to document current physician attitudes and practices regarding CRC screening, and to formulate appropriate interventions to meet the ACS screening goal. METHODS: Questionnaires were sent to a random sample of 600 primary care physicians in Wisconsin. The survey measured 1) screening preferences; 2) estimates of patients screened by each method; 3) agreement to statements regarding screening guidelines and practices, patient compliance, effectiveness in reducing mortality, factors regarding colonoscopy as a screening tool; 4) use of reminder systems; 5) demographics. RESULTS: Physicians prefer combining fecal occult blood testing (FOBT) with flexible sigmoidoscopy for CRC screening, while they believe patients prefer FOBT alone. Only 1.5% view colonoscopy as their preferred method of screening. There is discrepancy between physicians' beliefs that patients should be screened and estimated numbers they screen. Only 38.2% of respondents would screen a moderate-risk patient at the ACS recommended age. Physicians perceive screening compliance to be low. Cost, availability, risks, and lack of proof of effectiveness influence physician decisions. Fewer than half have any reminder system for CRC screening. CONCLUSIONS: CRC screening rates are currently lower than the 2015 ACS goal. Influential factors include physician attitudes and beliefs about effectiveness, familiarity with guidelines, perception of patient preferences and compliance, and lack of adequate reminder systems. Targeting interventions to these factors may increase the rate of CRC screening. Despite increased consensus from professional societies on colonoscopy as the best choice for screening, few primary care physicians would choose this option.

A pathway to advancing end-of-life education.

OBJECTIVE: This paper identifies key features associated with high-quality educational materials for end-of-life curriculum. METHODS: The End of Life Physician Education Resource Center (EPERC), located on the Internet at provides a clearinghouse for end-of-life materials. All materials posted on EPERC are peer reviewed by content and education experts for quality. An analysis of reviewers' ratings, from the EPERC rating form and their narrative comments, revealed common strengths and weaknesses of submitted materials. Examples of exemplar materials from the EPERC website are presented to highlight key strengths. DISCUSSION: Articulating the best qualities of submitted materials provides clear standards for those seeking to develop or adopt high quality end-of-life educational materials.