Winning Abstracts from the 2006 Medical Student Abstract Competition: Improving Senior Medical Students’ Knowledge of Appropriate Screening Strategies for Older Patients Using a Probabalistic Approach to Decision-Making
.Author: Veronica Sikka, Virginia Commonwealth University, 2007
Introduction:
Medical students are taught epidemiology early in medical school with inconsistent reinforcement in later years. As part of our Donald W. Reynolds educational initiative, we sought to assess senior medical students’ knowledge one month before graduation regarding cancer screening in the elderly and evaluate an educational intervention.
Methods:
In April 2004, prior to a new 40-minute lecture on cancer screening in the elderly, 80 senior medical students were shown 6 case scenarios that reflected increasing age and co-morbidity. In each scenario, students indicated whether they would screen for cancer of the colon, breast, cervix, lung, ovary, and prostate. Their responses were collected. The lecturer presented population-level data on life expectancy stratified by age and health status, plus data on operating characteristics, benefits and burdens of common screening tests. He did not discuss the cases. After the lecture, students again scored the same 6 cases.
Results:
Before the lecture, students tended to screen aggressively even when the patient’s age, diagnosis, or general condition suggested a high burden-benefit ratio. After the lecture, screening declined significantly in many low-yield or high-burden scenarios, while aggressive screening persisted in cases with greatest chance of benefit. Several informative patterns evident in pre and post lecture choices will be discussed.
Conclusion:
In 2004, graduating students at Virginia Commonwealth University School of Medicine were insufficiently prepared for cancer screening decisions in elderly patients. Decision-making improved after the intervention for most but not all situations. The evaluation method provided interesting insights.
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