The current study delves into the landscape of resident physician knowledge and practices concerning colorectal cancer screening guidelines, providing valuable insights. The primary focus of our investigation was to assess awareness of the recently updated USPSTF screening guidelines for colorectal cancer. While a majority of responders appropriately identified the recommended age to commence screening in average risk individuals (age 45), approximately 30% still inaccurately identified the age, revealing persistent knowledge deficits across trainees. Delayed screening could lead to worse outcomes, including higher healthcare costs related to more aggressive treatment in the setting of more advanced disease and increased mortality. A study by Abdelsattar et al. demonstrated that patients diagnosed with CRC before the age of 50 presented with more advanced disease than those diagnosed after the age of 50 [11].

The persistent knowledge deficit demonstrated in the current study reiterates broader issues within healthcare systems where screening guideline adherence remains problematic. The current findings echo previous reports that despite a foundational understanding of CRC screening modalities among residents, gaps persist in areas including risk factors, appropriate screening initiation ages, and the distinction between screening and prevention [7]. The current study similarly identifies continued knowledge gaps, which may potentiate suboptimal screening practices and decreasing early detection opportunities.

Studies on residents’ knowledge and adherence to CRC screening and surveillance guidelines indicated that, while knowledge improves as trainees advance through their years, senior residents did not consistently perform better than junior residents [3, 5,6,7,8]. This is also echoed in our study where post graduate year was not associated with improved knowledge of screening guidelines and modalities. Another study evaluating obstetrics and gynecology residents found that while most respondents were aware of CRC guidelines, significant gaps remained in applying them in clinical practices [12]. Taken together, these studies emphasize the variability in CRC screening knowledge and practices across physician trainees and the importance of focused education on improving practice, regardless of post graduate year.

Appropriate follow-up intervals for non-invasive screening modalities are also a key area for potential education. With the ease of at home testing like FOBT/FIT, physicians must understand the availability of this type of testing and appropriate follow-up. As demonstrated in our study, only 30 of the 82 residents who regularly recommend colorectal cancer screening utilized non-invasive testing. A thorough understanding of the limitations of non-invasive modalities is key to understanding the best opportunities to implement their use.

This study has some limitations. Given that the survey was provided at a single academic center, it has poor generalizability. The study can be expanded to include other academic centers as well as community centers to increase generalizability. While sample size for this study was reasonable, response rate was only 34.5%. A stronger study would include higher response rate and larger sample size for a more accurate representation. Also, surveys inherently create an environment for response bias. This survey attempted to limit response bias and subjective responses by providing multiple choice answers.

Education interventions geared toward improving resident knowledge and screening guidelines will be important to improving awareness among trainees. Khan et al. highlighted the potential for knowledge enhancement through a smartphone application [13]. The application was created as a simple tool for residents to access when they had questions about CRC guidelines, providing information about each screening tool, when it should be implemented, and follow up recommendations associated with individual tools [13].

Furthermore, a study on internal medicine residents’ practices in screening high-risk populations, specifically African American patients, for CRC highlighted a concerning trend: residents were inconsistent in performing and recommending screenings exams, which could be attributed to knowledge gaps and limited resources. This study assessed the effectiveness of educational intervention of a formal lecture focused on racial disparities in CRC and found statistically significant improvement in resident performance on endoscopic exams post intervention, although there were no significant changes in rectal exams or fecal occult blood testing [14]. This suggests that targeted education may enhance the performance of endoscopic procedures, though further efforts are needed to continue to improve adherence to CRC screening guidelines.

Another study completed at a university center implemented a low-cost educational health maintenance card, created by medical residents, to improve adherence to cancer screening guidelines. After implementation, adherence to appropriate screening significantly increased for cervical (40.8%), breast (33.2%), and colorectal cancer (20.5%) among average-risk patients. Inappropriate screening also notably decreased for cervical (26.8%) and breast cancer (32.8%), with minimal change for colorectal cancer. The intervention led to an estimated annual savings of nearly $1 million by reducing unnecessary testing. Additionally, resident knowledge of screening guidelines improved significantly and remained elevated 2 years post-intervention. The findings support that a simple, low-cost tool can enhance guideline adherence, reduce unnecessary screening, and generate meaningful cost savings [15].

Additionally, while artificial intelligence (AI) tools like ChatGPT show potential in assisting with CRC screening guidelines and surveillance, their performance in providing accurate, guideline-based recommendations remains limited. This study evaluated ChatGPT-3.5’s ability to provide accurate colorectal cancer screening and surveillance recommendations using 10 clinical vignettes, comparing its performance to that of expert physicians with and without a CRC mobile application. ChatGPT’s average accuracy was 45%, significantly lower than physicians without the application (56%) and those using the application (77%) it also demonstrated inconsistencies across sessions. The authors concluded that while AI tools like ChatGPT could have future potential, current versions lack the accuracy and consistency and are not recommended for guideline recommendations [16].

Our institution remains committed to enhancing guideline-specific colorectal cancer screening and surveillance recommendations. However, this continues to be a challenge due to the need for consistent education across multiple specialties at the institutional level. With the advancement of mobile applications, future artificial intelligence, and improved resident educational lectures, we hope to utilize these tools to support consistent, evidence-based practices across departments.