Werny David M, Saraiya Mona, Carrera Jennifer, Coughlin Steven S, Frank Erica
Epidemiology and Applied Research Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
J Cancer Educ. 2008;23(2):108-13. doi: 10.1080/08858190701860301.
No studies have examined medical students' recommendation and use of prostate-specific antigen (PSA) testing and digital rectal exam (DRE) to screen for prostate cancer. We hypothesized that students' race and extent of training on these techniques would be associated with their administration of them.
We analyzed multiinstitutional longitudinal data from a cohort of 2181 medical students in the class of 2003. We queried students' health behavior, their knowledge of prostate cancer racial disparities, their frequency of performing a PSA test or a DRE on a man 50 years of age or older (senior year only), the perceived relevance of such services to their future practice, and their training on PSA and DRE. We examined predictors of students' administering PSA and DRE tests to patients during the senior year and changes in the predictors over time.
Respectively, 27% and 34% of students reported using the PSA and DRE "usually/always" during their senior year. Black students reported administering the PSA test more often than did students of other races, but race was not a significant predictor of PSA screening after controlling for personal healthy behavior. High perceived relevance to future practice and extensive training on PSA were most strongly associated with administration of PSA.
The association between healthy personal behavior and PSA administration confounded the association between race and PSA screening. These results may help explain differences in prostate cancer screening among physicians and help medical educators tailor their curricula on prostate cancer screening.
尚无研究调查医学生对前列腺特异性抗原（PSA）检测及直肠指检（DRE）用于前列腺癌筛查的推荐及使用情况。我们推测，学生的种族以及这些技术的培训程度会与其实施情况相关。
我们分析了来自2003级2181名医学生队列的多机构纵向数据。我们询问了学生的健康行为、他们对前列腺癌种族差异的了解、他们对50岁及以上男性进行PSA检测或DRE的频率（仅在高年级）、这些服务与他们未来执业的感知相关性，以及他们对PSA和DRE的培训情况。我们研究了高年级学生对患者实施PSA和DRE检测的预测因素以及这些预测因素随时间的变化。
分别有27%和34%的学生报告在高年级时“通常/总是”使用PSA和DRE。黑人学生报告进行PSA检测的频率高于其他种族的学生，但在控制个人健康行为后，种族并非PSA筛查的显著预测因素。对未来执业的高感知相关性以及对PSA进行广泛培训与PSA的实施最密切相关。
个人健康行为与PSA实施之间的关联混淆了种族与PSA筛查之间的关联。这些结果可能有助于解释医生之间前列腺癌筛查的差异，并帮助医学教育工作者调整他们关于前列腺癌筛查的课程。
