Knowledge, attitude and practice of medical residents and fellows in a tertiary hospital on hemochromatosis

Maria Christine Joy Nazario-Sarmiento, Catherine Cruz-Rosales

Objectives: To assess the knowledge, attitudes and practices of a series of medical residents and fellows in training at St. Luke’s Medical Center, Quezon City regarding hemochromatosis.

Methodology: A prospectively collected cross-sectional survey was conducted among 121 medical residents and fellows for a period of 1 week. The data collected through a validated questionnaire adapted from the study of Young, M. et al, were entered and analyzed by using SAS system. The association of mean knowledge score of respondents with regards to age, gender, designation, specialty/subspecialty group, average number of patients seen per day and number of years in practice was tested using On-way Analysis of Variance (ANOVA) where there is a significant difference in mean knowledge score at 5% level of significance.

Results: There were 121 questionnaires distributed, 89 (74%) responded and were analyzed. Respondents were familiar with most of the signs and symptoms of hemochromatosis except for polyuria and polydipsia. Forty six percent and 44.94% would only sometimes consider hemochromatosis even in the presence of a family history and elevation of transferrin saturation >45% respectively. Almost all of the participants were aware of the significance of the presence of liver cirrhosis (75.28%) and diabetes mellitus (65.17%) on the prognosis at the time of diagnosis. Majority were aware of the importance of hemoglobin and serum ferritin monitoring during phlebotomy but only very few indicated the correct corresponding levels. There was a higher mean knowledge score for those respondendts who had average number of patients seen per day ranged 32-40 and 6-10 years in practice/training with a p value of <0.05. most of the respondents incorrectly believed that hemochromatosis is less common compared to cystic fibrosis (34.8%) and multiple sclerosis (39.3%). Majority also incorrectly believed that liver biopsy (68.54%) should be performed to confirm the diagnosis. Most are unaware of the need to avoid uncooked fish and vitamin C supplements. Only 29.21% of the respondents will submit patient with a family history of hemochromatosis for genetic testing and only a minority of the respondents will consider evaluation of iron status in the presence of diabetes mellitus (32.58%), arthritis (35.96%) and among post-menopausal females (25.84%). Majority of the participants have low index of suspicion and high degree of uncertainty in management were 64% are not comfortable in managing hemochromatosis and prefer a specialist to manage.

Conclusion: There is inadequate knowledge, poor attitude and practices on hemochromatosis among medical residents and fellows in training at St. Luke’s Medical Center, Quezon City. Educational programs through preferred continuing medical education strategies are recommended to increase the level of awareness and confidence regarding hemochromatosis. A similar survey of post education programs is encouraged for re-evaluation.