title: Hepatitis B learning needs assessment of family medicine trainees in Canada: results of a nationwide survey.
abstract: BACKGROUND
  An estimated 350 million people worldwide have chronic hepatitis B (CHB), which is a major cause of cirrhosis and hepatocellular carcinoma.
  
  
  OBJECTIVE
  To assess the level of knowledge among family medicine trainees regarding the identification and management of CHB.
  
  
  METHODS
  questionnaire to assess knowledge regarding screening and management of patients with CHB and cirrhosis was developed. The questionnaire was pilot tested among primary care physicians, subsequently revised and distributed to family medicine trainees across Canada through an online survey program (QuestionPro).
  
  
  RESULTS
  A total of 158 trainees completed the questionnaire. Of these, 54% to 56% routinely offered vaccination against hepatitis A or hepatitis B virus (HBV), and 42% regularly screened patients for HBV risk factors. The percentage who recognized the need to screen highrisk populations for CHB, ie, individuals from an HBV-endemic country, men who have sex with men, or intravenous drug users was 73%, 66% and 74%, respectively. While less than 50% of respondents used the appropriate HBV screening tests, 86% to 91% correctly interpreted various HBV serological patterns. Only 3% recognized cirrhosis in our case scenario. Almost 80% of respondents inappropriately preferred prescribing a narcotic or nonsteroidal anti-inflammatory drug over acetaminophen (4%) for pain control in a patient with cirrhosis. While less than 60% recognized HBeAg negative CHB as an indication for referral and treatment, 90% would have referred a patient in the immune-tolerant phase, even though treatment is not indicated.
  
  
  CONCLUSIONS
  Knowledge gaps regarding CHB among family medicine trainees in the areas of primary prevention, disease recognition and management of cirrhosis were identified. Results suggest that opportunities to prevent potentially life-threatening complications are being missed.
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Ontario.
authors.forename: Justina Joyce
authors.initials: JJ
authors.lastname: Sam
authors.forename: E Jenny
authors.initials: EJ
authors.lastname: Heathcote
authors.forename: David Kh
authors.initials: DKh
authors.lastname: Wong
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Wooster
authors.forename: Hemant
authors.initials: H
authors.lastname: Shah
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D002170:Canada / Q000453:epidemiology; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000517:prevention & control*; D019468:Disease Management; D005260:Female; D006515:Hepatitis B virus / Q000187:drug effects / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000150:complications / Q000453:epidemiology* / Q000276:immunology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008403:Mass Screening; D010821:Physicians, Family / Q000592:standards*; D011320:Primary Health Care / Q000592:standards; D011787:Quality of Health Care; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014611:Vaccination
chemical_list: D000998:Antiviral Agents