LOS ANGELES — Only 21% of internal medicine residents feel “very confident” in their ability to manage patients with acute pancreatitis, a survey administered at a large, urban medical center has found.
“We certainly need to do a better job in our training institutions of equipping our residents with the knowledge and making them feel comfortable in diagnosing and managing the complications of acute pancreatitis,” Dr. Sameer A. Barkatullah said in an interview during a poster session at the annual Digestive Disease Week.
“The big areas of concern were initial diagnostic work-up and also recognizing the complications of pancreatitis. Those seem to be two big areas where residents didn't know as much as perhaps they should.”
In what is thought to be the first study of its kind, Dr. Barkatullah and his associates administered a 23-item questionnaire about acute pancreatitis to 58 internal medicine residents at Rush University Medical Center, Chicago. The multiple-choice questions covered the use of lab tests and radiologic imaging, assessment of severity, use of antibiotics, nutrition, and indication. Nearly two-thirds of the residents (62%) did not recognize hematocrit as the key predictor of acute pancreatitis severity on admission, and 38% could not identify the initial appropriate lab tests to be ordered.
Dr. Barkatullah, a second-year internal medicine resident in the section of gastroenterology and nutrition at Rush University Medical Center, also reported that about 25% of respondents believed that administration of empiric antibiotics for all cases of acute pancreatitis was the standard of care, and 21% thought that the diagnosis was made by identifying inflammation on CT scan.
“In the setting of acute biliary pancreatitis, only 66% identified right upper quadrant ultrasound as the preferred initial imaging modality, and only 59% could identify the appropriate timing and utility of endoscopic retrograde cholangiopancreatography,” the researchers wrote in their poster.
Gaps in knowledge about identifying and managing severe pancreatitis were also seen. For example, most of the residents (81%) underestimated the incidence of pancreatic necrosis, and only 36% believed that early feeding decreases morbidity and mortality in cases of necrotizing pancreatitis. Also, only 55% correlated necrotizing pancreatitis with systematic inflammatory response syndrome.
Two-thirds of the residents surveyed (66%) did not identify appropriate surgical interventions for acute pancreatitis, and only 21% reported being “very confident” in managing the condition.