North American Primary Care Research Group (NAPCRG)

SEATTLE – Third-year medical students often have negative experiences related to the specialty they are interested in when they rotate through clerkships in other specialties, according to a survey presented at the annual meeting of the North American Primary Care Research Group.

In the survey of 603 students, students reported negative experiences during their clinical clerkships whether they were interested in primary care (family medicine, internal medicine, or pediatrics) or in a subspecialty (for example, otolaryngology or orthopedics).

These negative experiences included being discouraged from pursuing their specialty interest, being called offensive names because of it, or receiving poorer grades as a result.

"This study ... confirmed that there is a lot of bashing about student career choices," said investigator Dr. Shou Ling Leong, who is associate vice chair for education, and professor of family and community medicine, at Pennsylvania State University, Hershey. But the widespread nature of the problem was surprising.

"This behavior is worrisome. If we are truly putting down each other’s specialty, what does that say about professionalism?" she commented in an interview. "As physicians, we are held to a high level of professional standards, and if we mistreat each other, we are not serving as good role models for our students."

The findings are especially worrisome when it comes to primary care, given the severe shortage of these physicians nationally and the fact that negative experiences during training likely discourage some students from pursuing careers in the field, according to Dr. Leong.

"Now, this is not the only reason that students may not go into the field. Lifestyles and the amount of debt they owe and a multitude of factors may contribute to career selection," she acknowledged. But "if their supervisors – their professors and their residents – are telling them, ‘Don’t do it, this is not a good field,’ that’s going to have an impact on whether they are going to continue to pursue primary care."

Interspecialty friction can also undermine the medical home approach to care, which is built on collaboration among a team of physicians and other health care professionals, she further noted. "Negativity is going to erode the efficiency and the effectiveness of a team."

For the survey, conducted between 2004 and 2009, Dr. Leong distributed questionnaires to medical students at her college on the last day of their third-year clerkships.

They were asked to rate how frequent and how bothersome various negative experiences were on Likert scales. To determine whether experiences differed by specialty interest, Dr. Leong split the students into groups based on their reported specialty interest at the beginning and end of the year.

All of these groups reported at least some negative experiences related to their specialty interest during each of their clerkships in other specialties, according to results presented in a poster session.

"No matter what field you are going into, if you are on a rotation of a specialty that is different from what you are interested in, someone will tell you that it’s the wrong field," Dr. Leong commented.

The study was not designed to determine whether the negative experiences actually discouraged any students from pursuing primary care, according to Dr. Leong. But given that the students found these events troubling, they may have been a contributing or deciding factor for some.

Comments made in focus groups suggested there may be two subsets of students in this regard. "Those who truly believe in primary care will still go into primary care," she explained. "But those who are still sort of on the fence – ‘I like this, but I’m not completely passionate about it’ – I think that’s the vulnerable group that it probably had an effect on."

Discussing the study’s results, Dr. Leong said that "somehow we need to fix this problem so that, first, our students who are truly interested in primary care should be supported and feel comfortable pursuing the field, and second, if we truly are going to work together, we need to be more respectful of each other."

She noted that sharing the study’s results with faculty, residents, and others involved in medical students’ training could go a long way toward eliminating specialty-related negative experiences during clerkships.

"When people are conscious of what they are doing, perhaps they will then correct their behavior," she said. "By calling awareness to these issues, hopefully we can create a nurturing and respectful learning environment."

Dr. Leong reported that she had no conflicts of interest related to the study.

SEATTLE – Third-year medical students often have negative experiences related to the specialty they are interested in when they rotate through clerkships in other specialties, according to a survey presented at the annual meeting of the North American Primary Care Research Group.

In the survey of 603 students, students reported negative experiences during their clinical clerkships whether they were interested in primary care (family medicine, internal medicine, or pediatrics) or in a subspecialty (for example, otolaryngology or orthopedics).

These negative experiences included being discouraged from pursuing their specialty interest, being called offensive names because of it, or receiving poorer grades as a result.

"This study ... confirmed that there is a lot of bashing about student career choices," said investigator Dr. Shou Ling Leong, who is associate vice chair for education, and professor of family and community medicine, at Pennsylvania State University, Hershey. But the widespread nature of the problem was surprising.

"This behavior is worrisome. If we are truly putting down each other’s specialty, what does that say about professionalism?" she commented in an interview. "As physicians, we are held to a high level of professional standards, and if we mistreat each other, we are not serving as good role models for our students."

The findings are especially worrisome when it comes to primary care, given the severe shortage of these physicians nationally and the fact that negative experiences during training likely discourage some students from pursuing careers in the field, according to Dr. Leong.

"Now, this is not the only reason that students may not go into the field. Lifestyles and the amount of debt they owe and a multitude of factors may contribute to career selection," she acknowledged. But "if their supervisors – their professors and their residents – are telling them, ‘Don’t do it, this is not a good field,’ that’s going to have an impact on whether they are going to continue to pursue primary care."

Interspecialty friction can also undermine the medical home approach to care, which is built on collaboration among a team of physicians and other health care professionals, she further noted. "Negativity is going to erode the efficiency and the effectiveness of a team."

For the survey, conducted between 2004 and 2009, Dr. Leong distributed questionnaires to medical students at her college on the last day of their third-year clerkships.

They were asked to rate how frequent and how bothersome various negative experiences were on Likert scales. To determine whether experiences differed by specialty interest, Dr. Leong split the students into groups based on their reported specialty interest at the beginning and end of the year.

All of these groups reported at least some negative experiences related to their specialty interest during each of their clerkships in other specialties, according to results presented in a poster session.

"No matter what field you are going into, if you are on a rotation of a specialty that is different from what you are interested in, someone will tell you that it’s the wrong field," Dr. Leong commented.

The study was not designed to determine whether the negative experiences actually discouraged any students from pursuing primary care, according to Dr. Leong. But given that the students found these events troubling, they may have been a contributing or deciding factor for some.

Comments made in focus groups suggested there may be two subsets of students in this regard. "Those who truly believe in primary care will still go into primary care," she explained. "But those who are still sort of on the fence – ‘I like this, but I’m not completely passionate about it’ – I think that’s the vulnerable group that it probably had an effect on."

Discussing the study’s results, Dr. Leong said that "somehow we need to fix this problem so that, first, our students who are truly interested in primary care should be supported and feel comfortable pursuing the field, and second, if we truly are going to work together, we need to be more respectful of each other."

She noted that sharing the study’s results with faculty, residents, and others involved in medical students’ training could go a long way toward eliminating specialty-related negative experiences during clerkships.

"When people are conscious of what they are doing, perhaps they will then correct their behavior," she said. "By calling awareness to these issues, hopefully we can create a nurturing and respectful learning environment."

Dr. Leong reported that she had no conflicts of interest related to the study.

SEATTLE – Third-year medical students often have negative experiences related to the specialty they are interested in when they rotate through clerkships in other specialties, according to a survey presented at the annual meeting of the North American Primary Care Research Group.

In the survey of 603 students, students reported negative experiences during their clinical clerkships whether they were interested in primary care (family medicine, internal medicine, or pediatrics) or in a subspecialty (for example, otolaryngology or orthopedics).

These negative experiences included being discouraged from pursuing their specialty interest, being called offensive names because of it, or receiving poorer grades as a result.

"This study ... confirmed that there is a lot of bashing about student career choices," said investigator Dr. Shou Ling Leong, who is associate vice chair for education, and professor of family and community medicine, at Pennsylvania State University, Hershey. But the widespread nature of the problem was surprising.

"This behavior is worrisome. If we are truly putting down each other’s specialty, what does that say about professionalism?" she commented in an interview. "As physicians, we are held to a high level of professional standards, and if we mistreat each other, we are not serving as good role models for our students."

The findings are especially worrisome when it comes to primary care, given the severe shortage of these physicians nationally and the fact that negative experiences during training likely discourage some students from pursuing careers in the field, according to Dr. Leong.

"Now, this is not the only reason that students may not go into the field. Lifestyles and the amount of debt they owe and a multitude of factors may contribute to career selection," she acknowledged. But "if their supervisors – their professors and their residents – are telling them, ‘Don’t do it, this is not a good field,’ that’s going to have an impact on whether they are going to continue to pursue primary care."

Interspecialty friction can also undermine the medical home approach to care, which is built on collaboration among a team of physicians and other health care professionals, she further noted. "Negativity is going to erode the efficiency and the effectiveness of a team."

For the survey, conducted between 2004 and 2009, Dr. Leong distributed questionnaires to medical students at her college on the last day of their third-year clerkships.

They were asked to rate how frequent and how bothersome various negative experiences were on Likert scales. To determine whether experiences differed by specialty interest, Dr. Leong split the students into groups based on their reported specialty interest at the beginning and end of the year.

All of these groups reported at least some negative experiences related to their specialty interest during each of their clerkships in other specialties, according to results presented in a poster session.

"No matter what field you are going into, if you are on a rotation of a specialty that is different from what you are interested in, someone will tell you that it’s the wrong field," Dr. Leong commented.

The study was not designed to determine whether the negative experiences actually discouraged any students from pursuing primary care, according to Dr. Leong. But given that the students found these events troubling, they may have been a contributing or deciding factor for some.

Comments made in focus groups suggested there may be two subsets of students in this regard. "Those who truly believe in primary care will still go into primary care," she explained. "But those who are still sort of on the fence – ‘I like this, but I’m not completely passionate about it’ – I think that’s the vulnerable group that it probably had an effect on."

Discussing the study’s results, Dr. Leong said that "somehow we need to fix this problem so that, first, our students who are truly interested in primary care should be supported and feel comfortable pursuing the field, and second, if we truly are going to work together, we need to be more respectful of each other."

She noted that sharing the study’s results with faculty, residents, and others involved in medical students’ training could go a long way toward eliminating specialty-related negative experiences during clerkships.

"When people are conscious of what they are doing, perhaps they will then correct their behavior," she said. "By calling awareness to these issues, hopefully we can create a nurturing and respectful learning environment."

Dr. Leong reported that she had no conflicts of interest related to the study.

SEATTLE – Third-year medical students often have negative experiences related to the specialty they are interested in when they rotate through clerkships in other specialties, according to a survey presented at the annual meeting of the North American Primary Care Research Group.

In the survey of 603 students, students reported negative experiences during their clinical clerkships whether they were interested in primary care (family medicine, internal medicine, or pediatrics) or in a subspecialty (for example, otolaryngology or orthopedics).

These negative experiences included being discouraged from pursuing their specialty interest, being called offensive names because of it, or receiving poorer grades as a result.

"This study ... confirmed that there is a lot of bashing about student career choices," said investigator Dr. Shou Ling Leong, who is associate vice chair for education, and professor of family and community medicine, at Pennsylvania State University, Hershey. But the widespread nature of the problem was surprising.

"This behavior is worrisome. If we are truly putting down each other’s specialty, what does that say about professionalism?" she commented in an interview. "As physicians, we are held to a high level of professional standards, and if we mistreat each other, we are not serving as good role models for our students."

The findings are especially worrisome when it comes to primary care, given the severe shortage of these physicians nationally and the fact that negative experiences during training likely discourage some students from pursuing careers in the field, according to Dr. Leong.

"Now, this is not the only reason that students may not go into the field. Lifestyles and the amount of debt they owe and a multitude of factors may contribute to career selection," she acknowledged. But "if their supervisors – their professors and their residents – are telling them, ‘Don’t do it, this is not a good field,’ that’s going to have an impact on whether they are going to continue to pursue primary care."

Interspecialty friction can also undermine the medical home approach to care, which is built on collaboration among a team of physicians and other health care professionals, she further noted. "Negativity is going to erode the efficiency and the effectiveness of a team."

For the survey, conducted between 2004 and 2009, Dr. Leong distributed questionnaires to medical students at her college on the last day of their third-year clerkships.

They were asked to rate how frequent and how bothersome various negative experiences were on Likert scales. To determine whether experiences differed by specialty interest, Dr. Leong split the students into groups based on their reported specialty interest at the beginning and end of the year.

All of these groups reported at least some negative experiences related to their specialty interest during each of their clerkships in other specialties, according to results presented in a poster session.

"No matter what field you are going into, if you are on a rotation of a specialty that is different from what you are interested in, someone will tell you that it’s the wrong field," Dr. Leong commented.

The study was not designed to determine whether the negative experiences actually discouraged any students from pursuing primary care, according to Dr. Leong. But given that the students found these events troubling, they may have been a contributing or deciding factor for some.

Comments made in focus groups suggested there may be two subsets of students in this regard. "Those who truly believe in primary care will still go into primary care," she explained. "But those who are still sort of on the fence – ‘I like this, but I’m not completely passionate about it’ – I think that’s the vulnerable group that it probably had an effect on."

Discussing the study’s results, Dr. Leong said that "somehow we need to fix this problem so that, first, our students who are truly interested in primary care should be supported and feel comfortable pursuing the field, and second, if we truly are going to work together, we need to be more respectful of each other."

She noted that sharing the study’s results with faculty, residents, and others involved in medical students’ training could go a long way toward eliminating specialty-related negative experiences during clerkships.

"When people are conscious of what they are doing, perhaps they will then correct their behavior," she said. "By calling awareness to these issues, hopefully we can create a nurturing and respectful learning environment."

Dr. Leong reported that she had no conflicts of interest related to the study.

SEATTLE – Third-year medical students often have negative experiences related to the specialty they are interested in when they rotate through clerkships in other specialties, according to a survey presented at the annual meeting of the North American Primary Care Research Group.

In the survey of 603 students, students reported negative experiences during their clinical clerkships whether they were interested in primary care (family medicine, internal medicine, or pediatrics) or in a subspecialty (for example, otolaryngology or orthopedics).

These negative experiences included being discouraged from pursuing their specialty interest, being called offensive names because of it, or receiving poorer grades as a result.

"This study ... confirmed that there is a lot of bashing about student career choices," said investigator Dr. Shou Ling Leong, who is associate vice chair for education, and professor of family and community medicine, at Pennsylvania State University, Hershey. But the widespread nature of the problem was surprising.

"This behavior is worrisome. If we are truly putting down each other’s specialty, what does that say about professionalism?" she commented in an interview. "As physicians, we are held to a high level of professional standards, and if we mistreat each other, we are not serving as good role models for our students."

The findings are especially worrisome when it comes to primary care, given the severe shortage of these physicians nationally and the fact that negative experiences during training likely discourage some students from pursuing careers in the field, according to Dr. Leong.

"Now, this is not the only reason that students may not go into the field. Lifestyles and the amount of debt they owe and a multitude of factors may contribute to career selection," she acknowledged. But "if their supervisors – their professors and their residents – are telling them, ‘Don’t do it, this is not a good field,’ that’s going to have an impact on whether they are going to continue to pursue primary care."

Interspecialty friction can also undermine the medical home approach to care, which is built on collaboration among a team of physicians and other health care professionals, she further noted. "Negativity is going to erode the efficiency and the effectiveness of a team."

For the survey, conducted between 2004 and 2009, Dr. Leong distributed questionnaires to medical students at her college on the last day of their third-year clerkships.

They were asked to rate how frequent and how bothersome various negative experiences were on Likert scales. To determine whether experiences differed by specialty interest, Dr. Leong split the students into groups based on their reported specialty interest at the beginning and end of the year.

All of these groups reported at least some negative experiences related to their specialty interest during each of their clerkships in other specialties, according to results presented in a poster session.

"No matter what field you are going into, if you are on a rotation of a specialty that is different from what you are interested in, someone will tell you that it’s the wrong field," Dr. Leong commented.

The study was not designed to determine whether the negative experiences actually discouraged any students from pursuing primary care, according to Dr. Leong. But given that the students found these events troubling, they may have been a contributing or deciding factor for some.

Comments made in focus groups suggested there may be two subsets of students in this regard. "Those who truly believe in primary care will still go into primary care," she explained. "But those who are still sort of on the fence – ‘I like this, but I’m not completely passionate about it’ – I think that’s the vulnerable group that it probably had an effect on."

Discussing the study’s results, Dr. Leong said that "somehow we need to fix this problem so that, first, our students who are truly interested in primary care should be supported and feel comfortable pursuing the field, and second, if we truly are going to work together, we need to be more respectful of each other."

She noted that sharing the study’s results with faculty, residents, and others involved in medical students’ training could go a long way toward eliminating specialty-related negative experiences during clerkships.

"When people are conscious of what they are doing, perhaps they will then correct their behavior," she said. "By calling awareness to these issues, hopefully we can create a nurturing and respectful learning environment."

Dr. Leong reported that she had no conflicts of interest related to the study.

SEATTLE – Third-year medical students often have negative experiences related to the specialty they are interested in when they rotate through clerkships in other specialties, according to a survey presented at the annual meeting of the North American Primary Care Research Group.

In the survey of 603 students, students reported negative experiences during their clinical clerkships whether they were interested in primary care (family medicine, internal medicine, or pediatrics) or in a subspecialty (for example, otolaryngology or orthopedics).

These negative experiences included being discouraged from pursuing their specialty interest, being called offensive names because of it, or receiving poorer grades as a result.

"This study ... confirmed that there is a lot of bashing about student career choices," said investigator Dr. Shou Ling Leong, who is associate vice chair for education, and professor of family and community medicine, at Pennsylvania State University, Hershey. But the widespread nature of the problem was surprising.

"This behavior is worrisome. If we are truly putting down each other’s specialty, what does that say about professionalism?" she commented in an interview. "As physicians, we are held to a high level of professional standards, and if we mistreat each other, we are not serving as good role models for our students."

The findings are especially worrisome when it comes to primary care, given the severe shortage of these physicians nationally and the fact that negative experiences during training likely discourage some students from pursuing careers in the field, according to Dr. Leong.

"Now, this is not the only reason that students may not go into the field. Lifestyles and the amount of debt they owe and a multitude of factors may contribute to career selection," she acknowledged. But "if their supervisors – their professors and their residents – are telling them, ‘Don’t do it, this is not a good field,’ that’s going to have an impact on whether they are going to continue to pursue primary care."

Interspecialty friction can also undermine the medical home approach to care, which is built on collaboration among a team of physicians and other health care professionals, she further noted. "Negativity is going to erode the efficiency and the effectiveness of a team."

For the survey, conducted between 2004 and 2009, Dr. Leong distributed questionnaires to medical students at her college on the last day of their third-year clerkships.

They were asked to rate how frequent and how bothersome various negative experiences were on Likert scales. To determine whether experiences differed by specialty interest, Dr. Leong split the students into groups based on their reported specialty interest at the beginning and end of the year.

All of these groups reported at least some negative experiences related to their specialty interest during each of their clerkships in other specialties, according to results presented in a poster session.

"No matter what field you are going into, if you are on a rotation of a specialty that is different from what you are interested in, someone will tell you that it’s the wrong field," Dr. Leong commented.

The study was not designed to determine whether the negative experiences actually discouraged any students from pursuing primary care, according to Dr. Leong. But given that the students found these events troubling, they may have been a contributing or deciding factor for some.

Comments made in focus groups suggested there may be two subsets of students in this regard. "Those who truly believe in primary care will still go into primary care," she explained. "But those who are still sort of on the fence – ‘I like this, but I’m not completely passionate about it’ – I think that’s the vulnerable group that it probably had an effect on."

Discussing the study’s results, Dr. Leong said that "somehow we need to fix this problem so that, first, our students who are truly interested in primary care should be supported and feel comfortable pursuing the field, and second, if we truly are going to work together, we need to be more respectful of each other."

She noted that sharing the study’s results with faculty, residents, and others involved in medical students’ training could go a long way toward eliminating specialty-related negative experiences during clerkships.

"When people are conscious of what they are doing, perhaps they will then correct their behavior," she said. "By calling awareness to these issues, hopefully we can create a nurturing and respectful learning environment."

Dr. Leong reported that she had no conflicts of interest related to the study.

SEATTLE – Women at average risk are often screened for ovarian cancer, even though national guidelines recommend against this practice, based on a study reported at the annual meeting of the North American Primary Care Research Group.

In a cross-sectional survey of 1,088 primary care physicians presented with examples cases, 72% said they would almost never offer low-risk women transvaginal ultrasound or the cancer antigen (CA)-125 blood test, and 35% said they would almost never do so for medium-risk women.

Of concern, 30% of physicians overall said they would almost always offer or order the tests for such women.

"Screening is actually not recommended for either of these groups, suggesting that physicians are either not accurately assessing the risk or that they are choosing to offer or order the test despite recommendations to the contrary," commented lead investigator Dr. Laura-Mae Baldwin.

Besides risk assessment, a mistaken belief that the tests are effective for screening in average-risk women – endorsed by a third of the physicians – was the next strongest predictor of nonadherence to guidelines.

In fact, transvaginal ultrasound and the CA-125 test have high false-positive rates and low positive predictive values when used for ovarian cancer screening, according to Dr. Baldwin, who is a professor of family medicine and director of the Family Medicine Research Section at the University of Washington, Seattle.

"There is no professional organization or government agency that currently recommends routine ovarian cancer screening," she noted. "The U.S. Preventive Services Task Force (USPSTF) actually gives it a D grade, meaning that the harms exceed the benefits, and they recommend against the test."

"But as we know, physicians have demonstrated enthusiasm for some cancer screening tests that don’t have clear proven benefit, and we thought it might be possible that women may be exposed to the potential harms of ovarian cancer screening despite these recommendations," she said.

The investigators sent vignette-based surveys to a cross-sectional sample of U.S. primary care physicians selected from American Medical Association Physician Masterfiles.

The vignettes portrayed women at low, medium, and high risk for ovarian cancer. Respondents were asked, for the patient described, how often they would offer or order each of a list of tests for cancer screening, and were given response options of almost always, sometimes, and almost never.

"We excluded the physicians who had vignettes of women at high risk for ovarian cancer because there are some recommendations that suggest that it may be appropriate to screen in those women, so we wanted really to look at a group that had a more average risk of ovarian cancer," Dr. Baldwin explained.

Results were based on 1,088 respondents who represented a weighted sample of 106,001 physicians nationally. Some 42% were general internists, 41% were family physicians, and 17% were obstetrician-gynecologists.

Nearly three-fourths of the physicians worked in group practices. When asked about their sources of information on cancer screening, the most common were the American Cancer Society (66% listed it among their top three), the USPSTF (53%), the National Institutes of Health and National Cancer Institute (33%), and the American College of Obstetricians and Gynecologists (31%).

In a finding that Dr. Baldwin described as highly surprising, 33% of physicians believed that transvaginal ultrasound, the CA-125 test, or both were effective for ovarian cancer screening in average-risk women.

For low-risk patients, 72% of physicians were adherent to screening recommendations (defined as almost never offering or ordering either screening test); for medium-risk patients, 35% were adherent.

On the flip side, 6% of physicians said they would almost always offer or order a screening test for a low-risk patient, and 24% said they would almost always do so for a medium-risk patient.

In multivariate analyses, physicians were less likely to be adherent to recommendations against screening if the patient was at medium risk or requested testing, or they had been in practice for at least 10 years, Dr. Baldwin reported.

On the other hand, physicians were more likely to be adherent if they high-listed USPSTF as an information source, did not have any personal or family experience with cancer, were involved with clinical teaching, or were in a group practice.

However, when belief about the effectiveness of the screening tests was added to the other physician factors, physicians believing them to be effective were less likely to adhere to recommendations than their peers believing them to be ineffective.

Also, three of the other factors – years in practice, high-listing the USPSTF, and group practice – were no longer significantly related to adherence. "So basically, those associations were mediated by the degree to which those groups believed in the effectiveness of these tests," she explained.

"We don’t really understand why a third of physicians believe that these are effective ovarian cancer screening tests," Dr. Baldwin commented. "But use of the USPSTF recommendations, and practice in settings that promote interactions between physicians, like group practices, may help dispel misconceptions about the effectiveness of the ovarian cancer screening tests."

"Further research is definitely needed to try to understand what’s going on with these misconceptions and the contribution of potential risk assessment errors to this screening," she concluded.

Dr. Baldwin reported that she had no relevant financial conflicts of interest.

SEATTLE – Women at average risk are often screened for ovarian cancer, even though national guidelines recommend against this practice, based on a study reported at the annual meeting of the North American Primary Care Research Group.

In a cross-sectional survey of 1,088 primary care physicians presented with examples cases, 72% said they would almost never offer low-risk women transvaginal ultrasound or the cancer antigen (CA)-125 blood test, and 35% said they would almost never do so for medium-risk women.

Of concern, 30% of physicians overall said they would almost always offer or order the tests for such women.

"Screening is actually not recommended for either of these groups, suggesting that physicians are either not accurately assessing the risk or that they are choosing to offer or order the test despite recommendations to the contrary," commented lead investigator Dr. Laura-Mae Baldwin.

Besides risk assessment, a mistaken belief that the tests are effective for screening in average-risk women – endorsed by a third of the physicians – was the next strongest predictor of nonadherence to guidelines.

In fact, transvaginal ultrasound and the CA-125 test have high false-positive rates and low positive predictive values when used for ovarian cancer screening, according to Dr. Baldwin, who is a professor of family medicine and director of the Family Medicine Research Section at the University of Washington, Seattle.

"There is no professional organization or government agency that currently recommends routine ovarian cancer screening," she noted. "The U.S. Preventive Services Task Force (USPSTF) actually gives it a D grade, meaning that the harms exceed the benefits, and they recommend against the test."

"But as we know, physicians have demonstrated enthusiasm for some cancer screening tests that don’t have clear proven benefit, and we thought it might be possible that women may be exposed to the potential harms of ovarian cancer screening despite these recommendations," she said.

The investigators sent vignette-based surveys to a cross-sectional sample of U.S. primary care physicians selected from American Medical Association Physician Masterfiles.

The vignettes portrayed women at low, medium, and high risk for ovarian cancer. Respondents were asked, for the patient described, how often they would offer or order each of a list of tests for cancer screening, and were given response options of almost always, sometimes, and almost never.

"We excluded the physicians who had vignettes of women at high risk for ovarian cancer because there are some recommendations that suggest that it may be appropriate to screen in those women, so we wanted really to look at a group that had a more average risk of ovarian cancer," Dr. Baldwin explained.

Results were based on 1,088 respondents who represented a weighted sample of 106,001 physicians nationally. Some 42% were general internists, 41% were family physicians, and 17% were obstetrician-gynecologists.

Nearly three-fourths of the physicians worked in group practices. When asked about their sources of information on cancer screening, the most common were the American Cancer Society (66% listed it among their top three), the USPSTF (53%), the National Institutes of Health and National Cancer Institute (33%), and the American College of Obstetricians and Gynecologists (31%).

In a finding that Dr. Baldwin described as highly surprising, 33% of physicians believed that transvaginal ultrasound, the CA-125 test, or both were effective for ovarian cancer screening in average-risk women.

For low-risk patients, 72% of physicians were adherent to screening recommendations (defined as almost never offering or ordering either screening test); for medium-risk patients, 35% were adherent.

On the flip side, 6% of physicians said they would almost always offer or order a screening test for a low-risk patient, and 24% said they would almost always do so for a medium-risk patient.

In multivariate analyses, physicians were less likely to be adherent to recommendations against screening if the patient was at medium risk or requested testing, or they had been in practice for at least 10 years, Dr. Baldwin reported.

On the other hand, physicians were more likely to be adherent if they high-listed USPSTF as an information source, did not have any personal or family experience with cancer, were involved with clinical teaching, or were in a group practice.

However, when belief about the effectiveness of the screening tests was added to the other physician factors, physicians believing them to be effective were less likely to adhere to recommendations than their peers believing them to be ineffective.

Also, three of the other factors – years in practice, high-listing the USPSTF, and group practice – were no longer significantly related to adherence. "So basically, those associations were mediated by the degree to which those groups believed in the effectiveness of these tests," she explained.

"We don’t really understand why a third of physicians believe that these are effective ovarian cancer screening tests," Dr. Baldwin commented. "But use of the USPSTF recommendations, and practice in settings that promote interactions between physicians, like group practices, may help dispel misconceptions about the effectiveness of the ovarian cancer screening tests."

"Further research is definitely needed to try to understand what’s going on with these misconceptions and the contribution of potential risk assessment errors to this screening," she concluded.

Dr. Baldwin reported that she had no relevant financial conflicts of interest.

SEATTLE – Women at average risk are often screened for ovarian cancer, even though national guidelines recommend against this practice, based on a study reported at the annual meeting of the North American Primary Care Research Group.

In a cross-sectional survey of 1,088 primary care physicians presented with examples cases, 72% said they would almost never offer low-risk women transvaginal ultrasound or the cancer antigen (CA)-125 blood test, and 35% said they would almost never do so for medium-risk women.

Of concern, 30% of physicians overall said they would almost always offer or order the tests for such women.

"Screening is actually not recommended for either of these groups, suggesting that physicians are either not accurately assessing the risk or that they are choosing to offer or order the test despite recommendations to the contrary," commented lead investigator Dr. Laura-Mae Baldwin.

Besides risk assessment, a mistaken belief that the tests are effective for screening in average-risk women – endorsed by a third of the physicians – was the next strongest predictor of nonadherence to guidelines.

In fact, transvaginal ultrasound and the CA-125 test have high false-positive rates and low positive predictive values when used for ovarian cancer screening, according to Dr. Baldwin, who is a professor of family medicine and director of the Family Medicine Research Section at the University of Washington, Seattle.

"There is no professional organization or government agency that currently recommends routine ovarian cancer screening," she noted. "The U.S. Preventive Services Task Force (USPSTF) actually gives it a D grade, meaning that the harms exceed the benefits, and they recommend against the test."

"But as we know, physicians have demonstrated enthusiasm for some cancer screening tests that don’t have clear proven benefit, and we thought it might be possible that women may be exposed to the potential harms of ovarian cancer screening despite these recommendations," she said.

The investigators sent vignette-based surveys to a cross-sectional sample of U.S. primary care physicians selected from American Medical Association Physician Masterfiles.

The vignettes portrayed women at low, medium, and high risk for ovarian cancer. Respondents were asked, for the patient described, how often they would offer or order each of a list of tests for cancer screening, and were given response options of almost always, sometimes, and almost never.

"We excluded the physicians who had vignettes of women at high risk for ovarian cancer because there are some recommendations that suggest that it may be appropriate to screen in those women, so we wanted really to look at a group that had a more average risk of ovarian cancer," Dr. Baldwin explained.

Results were based on 1,088 respondents who represented a weighted sample of 106,001 physicians nationally. Some 42% were general internists, 41% were family physicians, and 17% were obstetrician-gynecologists.

Nearly three-fourths of the physicians worked in group practices. When asked about their sources of information on cancer screening, the most common were the American Cancer Society (66% listed it among their top three), the USPSTF (53%), the National Institutes of Health and National Cancer Institute (33%), and the American College of Obstetricians and Gynecologists (31%).

In a finding that Dr. Baldwin described as highly surprising, 33% of physicians believed that transvaginal ultrasound, the CA-125 test, or both were effective for ovarian cancer screening in average-risk women.

For low-risk patients, 72% of physicians were adherent to screening recommendations (defined as almost never offering or ordering either screening test); for medium-risk patients, 35% were adherent.

On the flip side, 6% of physicians said they would almost always offer or order a screening test for a low-risk patient, and 24% said they would almost always do so for a medium-risk patient.

In multivariate analyses, physicians were less likely to be adherent to recommendations against screening if the patient was at medium risk or requested testing, or they had been in practice for at least 10 years, Dr. Baldwin reported.

On the other hand, physicians were more likely to be adherent if they high-listed USPSTF as an information source, did not have any personal or family experience with cancer, were involved with clinical teaching, or were in a group practice.

However, when belief about the effectiveness of the screening tests was added to the other physician factors, physicians believing them to be effective were less likely to adhere to recommendations than their peers believing them to be ineffective.

Also, three of the other factors – years in practice, high-listing the USPSTF, and group practice – were no longer significantly related to adherence. "So basically, those associations were mediated by the degree to which those groups believed in the effectiveness of these tests," she explained.

"We don’t really understand why a third of physicians believe that these are effective ovarian cancer screening tests," Dr. Baldwin commented. "But use of the USPSTF recommendations, and practice in settings that promote interactions between physicians, like group practices, may help dispel misconceptions about the effectiveness of the ovarian cancer screening tests."

"Further research is definitely needed to try to understand what’s going on with these misconceptions and the contribution of potential risk assessment errors to this screening," she concluded.

Dr. Baldwin reported that she had no relevant financial conflicts of interest.

SEATTLE – Women at average risk are often screened for ovarian cancer, even though national guidelines recommend against this practice, based on a study reported at the annual meeting of the North American Primary Care Research Group.

In a cross-sectional survey of 1,088 primary care physicians presented with examples cases, 72% said they would almost never offer low-risk women transvaginal ultrasound or the cancer antigen (CA)-125 blood test, and 35% said they would almost never do so for medium-risk women.

Of concern, 30% of physicians overall said they would almost always offer or order the tests for such women.

"Screening is actually not recommended for either of these groups, suggesting that physicians are either not accurately assessing the risk or that they are choosing to offer or order the test despite recommendations to the contrary," commented lead investigator Dr. Laura-Mae Baldwin.

Besides risk assessment, a mistaken belief that the tests are effective for screening in average-risk women – endorsed by a third of the physicians – was the next strongest predictor of nonadherence to guidelines.

In fact, transvaginal ultrasound and the CA-125 test have high false-positive rates and low positive predictive values when used for ovarian cancer screening, according to Dr. Baldwin, who is a professor of family medicine and director of the Family Medicine Research Section at the University of Washington, Seattle.

"There is no professional organization or government agency that currently recommends routine ovarian cancer screening," she noted. "The U.S. Preventive Services Task Force (USPSTF) actually gives it a D grade, meaning that the harms exceed the benefits, and they recommend against the test."

"But as we know, physicians have demonstrated enthusiasm for some cancer screening tests that don’t have clear proven benefit, and we thought it might be possible that women may be exposed to the potential harms of ovarian cancer screening despite these recommendations," she said.

The investigators sent vignette-based surveys to a cross-sectional sample of U.S. primary care physicians selected from American Medical Association Physician Masterfiles.

The vignettes portrayed women at low, medium, and high risk for ovarian cancer. Respondents were asked, for the patient described, how often they would offer or order each of a list of tests for cancer screening, and were given response options of almost always, sometimes, and almost never.

"We excluded the physicians who had vignettes of women at high risk for ovarian cancer because there are some recommendations that suggest that it may be appropriate to screen in those women, so we wanted really to look at a group that had a more average risk of ovarian cancer," Dr. Baldwin explained.

Results were based on 1,088 respondents who represented a weighted sample of 106,001 physicians nationally. Some 42% were general internists, 41% were family physicians, and 17% were obstetrician-gynecologists.

Nearly three-fourths of the physicians worked in group practices. When asked about their sources of information on cancer screening, the most common were the American Cancer Society (66% listed it among their top three), the USPSTF (53%), the National Institutes of Health and National Cancer Institute (33%), and the American College of Obstetricians and Gynecologists (31%).

In a finding that Dr. Baldwin described as highly surprising, 33% of physicians believed that transvaginal ultrasound, the CA-125 test, or both were effective for ovarian cancer screening in average-risk women.

For low-risk patients, 72% of physicians were adherent to screening recommendations (defined as almost never offering or ordering either screening test); for medium-risk patients, 35% were adherent.

On the flip side, 6% of physicians said they would almost always offer or order a screening test for a low-risk patient, and 24% said they would almost always do so for a medium-risk patient.

In multivariate analyses, physicians were less likely to be adherent to recommendations against screening if the patient was at medium risk or requested testing, or they had been in practice for at least 10 years, Dr. Baldwin reported.

On the other hand, physicians were more likely to be adherent if they high-listed USPSTF as an information source, did not have any personal or family experience with cancer, were involved with clinical teaching, or were in a group practice.

However, when belief about the effectiveness of the screening tests was added to the other physician factors, physicians believing them to be effective were less likely to adhere to recommendations than their peers believing them to be ineffective.

Also, three of the other factors – years in practice, high-listing the USPSTF, and group practice – were no longer significantly related to adherence. "So basically, those associations were mediated by the degree to which those groups believed in the effectiveness of these tests," she explained.

"We don’t really understand why a third of physicians believe that these are effective ovarian cancer screening tests," Dr. Baldwin commented. "But use of the USPSTF recommendations, and practice in settings that promote interactions between physicians, like group practices, may help dispel misconceptions about the effectiveness of the ovarian cancer screening tests."

"Further research is definitely needed to try to understand what’s going on with these misconceptions and the contribution of potential risk assessment errors to this screening," she concluded.

Dr. Baldwin reported that she had no relevant financial conflicts of interest.

SEATTLE – Women at average risk are often screened for ovarian cancer, even though national guidelines recommend against this practice, based on a study reported at the annual meeting of the North American Primary Care Research Group.

In a cross-sectional survey of 1,088 primary care physicians presented with examples cases, 72% said they would almost never offer low-risk women transvaginal ultrasound or the cancer antigen (CA)-125 blood test, and 35% said they would almost never do so for medium-risk women.

Of concern, 30% of physicians overall said they would almost always offer or order the tests for such women.

"Screening is actually not recommended for either of these groups, suggesting that physicians are either not accurately assessing the risk or that they are choosing to offer or order the test despite recommendations to the contrary," commented lead investigator Dr. Laura-Mae Baldwin.

Besides risk assessment, a mistaken belief that the tests are effective for screening in average-risk women – endorsed by a third of the physicians – was the next strongest predictor of nonadherence to guidelines.

In fact, transvaginal ultrasound and the CA-125 test have high false-positive rates and low positive predictive values when used for ovarian cancer screening, according to Dr. Baldwin, who is a professor of family medicine and director of the Family Medicine Research Section at the University of Washington, Seattle.

"There is no professional organization or government agency that currently recommends routine ovarian cancer screening," she noted. "The U.S. Preventive Services Task Force (USPSTF) actually gives it a D grade, meaning that the harms exceed the benefits, and they recommend against the test."

"But as we know, physicians have demonstrated enthusiasm for some cancer screening tests that don’t have clear proven benefit, and we thought it might be possible that women may be exposed to the potential harms of ovarian cancer screening despite these recommendations," she said.

The investigators sent vignette-based surveys to a cross-sectional sample of U.S. primary care physicians selected from American Medical Association Physician Masterfiles.

The vignettes portrayed women at low, medium, and high risk for ovarian cancer. Respondents were asked, for the patient described, how often they would offer or order each of a list of tests for cancer screening, and were given response options of almost always, sometimes, and almost never.

"We excluded the physicians who had vignettes of women at high risk for ovarian cancer because there are some recommendations that suggest that it may be appropriate to screen in those women, so we wanted really to look at a group that had a more average risk of ovarian cancer," Dr. Baldwin explained.

Results were based on 1,088 respondents who represented a weighted sample of 106,001 physicians nationally. Some 42% were general internists, 41% were family physicians, and 17% were obstetrician-gynecologists.

Nearly three-fourths of the physicians worked in group practices. When asked about their sources of information on cancer screening, the most common were the American Cancer Society (66% listed it among their top three), the USPSTF (53%), the National Institutes of Health and National Cancer Institute (33%), and the American College of Obstetricians and Gynecologists (31%).

In a finding that Dr. Baldwin described as highly surprising, 33% of physicians believed that transvaginal ultrasound, the CA-125 test, or both were effective for ovarian cancer screening in average-risk women.

For low-risk patients, 72% of physicians were adherent to screening recommendations (defined as almost never offering or ordering either screening test); for medium-risk patients, 35% were adherent.

On the flip side, 6% of physicians said they would almost always offer or order a screening test for a low-risk patient, and 24% said they would almost always do so for a medium-risk patient.

In multivariate analyses, physicians were less likely to be adherent to recommendations against screening if the patient was at medium risk or requested testing, or they had been in practice for at least 10 years, Dr. Baldwin reported.

On the other hand, physicians were more likely to be adherent if they high-listed USPSTF as an information source, did not have any personal or family experience with cancer, were involved with clinical teaching, or were in a group practice.

However, when belief about the effectiveness of the screening tests was added to the other physician factors, physicians believing them to be effective were less likely to adhere to recommendations than their peers believing them to be ineffective.

Also, three of the other factors – years in practice, high-listing the USPSTF, and group practice – were no longer significantly related to adherence. "So basically, those associations were mediated by the degree to which those groups believed in the effectiveness of these tests," she explained.

"We don’t really understand why a third of physicians believe that these are effective ovarian cancer screening tests," Dr. Baldwin commented. "But use of the USPSTF recommendations, and practice in settings that promote interactions between physicians, like group practices, may help dispel misconceptions about the effectiveness of the ovarian cancer screening tests."

"Further research is definitely needed to try to understand what’s going on with these misconceptions and the contribution of potential risk assessment errors to this screening," she concluded.

Dr. Baldwin reported that she had no relevant financial conflicts of interest.

SEATTLE – Women at average risk are often screened for ovarian cancer, even though national guidelines recommend against this practice, based on a study reported at the annual meeting of the North American Primary Care Research Group.

In a cross-sectional survey of 1,088 primary care physicians presented with examples cases, 72% said they would almost never offer low-risk women transvaginal ultrasound or the cancer antigen (CA)-125 blood test, and 35% said they would almost never do so for medium-risk women.

Of concern, 30% of physicians overall said they would almost always offer or order the tests for such women.

"Screening is actually not recommended for either of these groups, suggesting that physicians are either not accurately assessing the risk or that they are choosing to offer or order the test despite recommendations to the contrary," commented lead investigator Dr. Laura-Mae Baldwin.

Besides risk assessment, a mistaken belief that the tests are effective for screening in average-risk women – endorsed by a third of the physicians – was the next strongest predictor of nonadherence to guidelines.

In fact, transvaginal ultrasound and the CA-125 test have high false-positive rates and low positive predictive values when used for ovarian cancer screening, according to Dr. Baldwin, who is a professor of family medicine and director of the Family Medicine Research Section at the University of Washington, Seattle.

"There is no professional organization or government agency that currently recommends routine ovarian cancer screening," she noted. "The U.S. Preventive Services Task Force (USPSTF) actually gives it a D grade, meaning that the harms exceed the benefits, and they recommend against the test."

"But as we know, physicians have demonstrated enthusiasm for some cancer screening tests that don’t have clear proven benefit, and we thought it might be possible that women may be exposed to the potential harms of ovarian cancer screening despite these recommendations," she said.

The investigators sent vignette-based surveys to a cross-sectional sample of U.S. primary care physicians selected from American Medical Association Physician Masterfiles.

The vignettes portrayed women at low, medium, and high risk for ovarian cancer. Respondents were asked, for the patient described, how often they would offer or order each of a list of tests for cancer screening, and were given response options of almost always, sometimes, and almost never.

"We excluded the physicians who had vignettes of women at high risk for ovarian cancer because there are some recommendations that suggest that it may be appropriate to screen in those women, so we wanted really to look at a group that had a more average risk of ovarian cancer," Dr. Baldwin explained.

Results were based on 1,088 respondents who represented a weighted sample of 106,001 physicians nationally. Some 42% were general internists, 41% were family physicians, and 17% were obstetrician-gynecologists.

Nearly three-fourths of the physicians worked in group practices. When asked about their sources of information on cancer screening, the most common were the American Cancer Society (66% listed it among their top three), the USPSTF (53%), the National Institutes of Health and National Cancer Institute (33%), and the American College of Obstetricians and Gynecologists (31%).

In a finding that Dr. Baldwin described as highly surprising, 33% of physicians believed that transvaginal ultrasound, the CA-125 test, or both were effective for ovarian cancer screening in average-risk women.

For low-risk patients, 72% of physicians were adherent to screening recommendations (defined as almost never offering or ordering either screening test); for medium-risk patients, 35% were adherent.

On the flip side, 6% of physicians said they would almost always offer or order a screening test for a low-risk patient, and 24% said they would almost always do so for a medium-risk patient.

In multivariate analyses, physicians were less likely to be adherent to recommendations against screening if the patient was at medium risk or requested testing, or they had been in practice for at least 10 years, Dr. Baldwin reported.

On the other hand, physicians were more likely to be adherent if they high-listed USPSTF as an information source, did not have any personal or family experience with cancer, were involved with clinical teaching, or were in a group practice.

However, when belief about the effectiveness of the screening tests was added to the other physician factors, physicians believing them to be effective were less likely to adhere to recommendations than their peers believing them to be ineffective.

Also, three of the other factors – years in practice, high-listing the USPSTF, and group practice – were no longer significantly related to adherence. "So basically, those associations were mediated by the degree to which those groups believed in the effectiveness of these tests," she explained.

"We don’t really understand why a third of physicians believe that these are effective ovarian cancer screening tests," Dr. Baldwin commented. "But use of the USPSTF recommendations, and practice in settings that promote interactions between physicians, like group practices, may help dispel misconceptions about the effectiveness of the ovarian cancer screening tests."

"Further research is definitely needed to try to understand what’s going on with these misconceptions and the contribution of potential risk assessment errors to this screening," she concluded.

Dr. Baldwin reported that she had no relevant financial conflicts of interest.