Medical training fails to prepare providers to care for patients with chronic hepatitis B infection

Table 5 Associations of training level and other characteristics with correct (compared with incorrect) responses to questions about hepatitis B knowledge and clinical practice

Question	Characteristic	Relative risk1	(95%CI)	P value
Which blood test(s) would you order to screen for chronic hepatitis B infection?2
	Incoming intern	1.0	(Reference)
	Outgoing intern	1.2	(0.5-3.1)
	Senior resident	2.1	(0.7-6.1)
	Attending	2.0	(0.7-5.7)
Do you routinely screen asymptomatic patients for chronic hepatitis B in your practice? (yes vs no)
	Incoming intern	1.0	(Reference)
	Outgoing intern	1.1	(0.4-3.1)
	Senior resident	1.5	(0.5-5.2)
	Attending	1.5	(0.4-5.3)
According to California law, who is/are required to report new hepatitis B diagnoses?2
	Incoming intern	1.0	(Reference)
	Outgoing intern	0.7	(0.3-2.1)
	Senior resident	0.2	(0.02-1.6)
	Attending	0.6	(0.1-2.4)
A patient has been told by a previous physician that he is a healthy hepatitis B carrier. What are the appropriate next steps, if any?2
	Incoming intern	1.0	(Reference)
	Outgoing intern	1.8	(0.5-6.7)
	Senior resident	1.4	(0.2-8.7)
	Attending	0.9	(0.1-7.8)
	Not confident in knowledge about referral for chronic hepatitis B3	1.0	(Reference)
	Confident in knowledge about referral for chronic hepatitis B3	6.0	(2.4-15.0)	0.0001
What is the relative prevalence of chronic hepatitis B in Caucasians, African Americans, Asians, and Hispanics/Latinos?2
	Incoming intern	1.0	(Reference)
	Outgoing intern	0.8	(0.4-1.7)
	Senior resident	1.8	(0.7-4.6)
	Attending	1.2	(0.5-2.9)
Which of the following is most likely to result in chronic infection with hepatitis B?2
	Incoming intern	1.0	(Reference)
	Outgoing intern	2.0	(1.0-4.2)
	Senior resident	3.3	(1.2-9.0)
	Attending	1.9	(0.7-5.0)	0.080
Without proper monitoring, what is the chance of dying from chronic hepatitis B?2
	Incoming intern	1.0	(Reference)
	Outgoing intern	0.8	(0.3-1.9)
	Senior resident	0.3	(0.1-1.5)
	Attending	0.6	(0.2-2.3)
According to the American Association for the Study of Liver Diseases guidelines, which of the following are appropriate screening tests for liver cancer?2
	Incoming intern	1.0	(Reference)
	Outgoing intern	3.6	(1.5-8.7)
	Senior resident	5.6	(1.9-16.4)
	Attending	4.8	(1.6-14.9)	0.005
	Age (5-yr increase)	0.7	(0.5-0.9)	0.005

¹All estimates adjusted for age (continuous years);

²Questions included in calculation of total hepatitis B knowledge score;

³"Confident": respondent "strongly agrees" or "agrees" that he or she is confident about knowledge; "not confident": respondent "disagrees," "strongly disagrees," or is neutral.