Pre-precepting Residents on Matters of Importance for Today — The PROMPT Study

Abstract

Context: Achieving the goals proposed in national screening guidelines for colon cancer is difficult, especially in a primary care residency. The major vehicle for teaching outpatient medicine is the precepting process. Preceptors use their influence to teach guideline principles. Unfortunately, most precepting occurs after the visit and lost opportunities occur frequently.

Objective: To test whether having preceptors discuss screening guidelines with residents prior to patient encounters (pre-precepting) could improve adherence to colon cancer prevention guidelines.

Design: Intervention trial: An historical control group of 100 randomly chosen patient charts were studied to see if United States Preventative Services Task Force (USPSTF) guidelines for colon cancer screening were achieved. Faculty then pre-precepted 100 randomly chosen eligible patients with residents. Discussion with the patient and/or orders for screening tests were calculated from the residents’ notes. A survey of all participants was also done to gauge acceptance. Setting: A community health center for the medically underserved with approximately 13,000 patients. We limited our intervention to active patients over the age of 50. Intervention: Preceptors selected eligible patients from resident appointment lists. USPSTF colon cancer screening guidelines were discussed prior to resident-patient encounters.

Outcome Measures: A review of the pre-precepted charts determined the documented rate of discussion and /or screening. A satisfaction survey of residents and faculty was used to determine acceptance.

Results: A statistically significant improvement was noted in the pre-precepted group as compared to the historical controls (p˂0.05, X2 testing). Surveys of participants showed they accepted the new intervention.

Conclusions: Screening for colon cancer can be improved by pre-precepting. A pilot study for quality improvement via pre-precepting was well accepted by both faculty and residents. A multi-center blinded trial should be considered to further test this technique.