A gastroenterologist consultant and a professor in internal medicine with extensive experience in provider and CME training and research recommended topics for the CME sessions. Both CMEs addressed CRC burden, significance for and screening of Vietnamese Americans, and screening guidelines and current practices. In addition, the first CME covered emerging CRC screening tests, such as virtual colonoscopy and fecal DNA testing, and the second CME included management of abnormal findings. At each CME, a locally respected Vietnamese American gastroenterologist and a research scientist delivered PowerPoint presentations and facilitated an interactive session in which the presenters posed questions to engage the audience in a discussion and answered any questions raised by attendees.
Participants were recruited from the roster of the Vietnamese Physician Association of Northern California (the Association). Prior to each CME, we mailed over 200 invitations to all Association members. Each invitation stated the event’s topic, format, location, intended audience, and co-sponsorship between the Association and the Northern California Cancer Center (NCCC). We also produced a newsletter announcing the CMEs and sent it to all Association members as a reminder. Study eligibility criteria included being a self-identified Vietnamese American health care provider and completion of pre- and post-CME questionnaires.
The CME sessions were held as a part of the Association’s regular dinner meetings on May 6 and November 4, 2005 at two Asian restaurants in the study area of Santa Clara County, California. The dinner paid for by the Association was a part of its standard practice. The Association received a grant for the CME speaker honoraria and study conduct. Association members were not required to attend both CMEs. The CME dates, sites, and format were recommended by the Association leadership. At registration, each participant received a package containing an agenda, a pre-CME questionnaire, a (sealed) post-CME questionnaire, and supplies of health education materials. The purpose of the bilingual Vietnamese-English booklet, Kham Ruot Gia De Song Tho (For Long Life, Test The Colon), and the penlight bearing the same slogan was to assist the physicians in counseling their patients about CRC screening and to serve as a reminder. Before the CME presentation, we asked participants to complete and turn in the pre-CME questionnaire. To encourage participants to turn in the questionnaires, we gave a raffle ticket for each returned survey. After the seminars, we asked participants to complete the post-CME questionnaire. Another raffle ticket was given for each submitted post-CME survey. Raffles were held on site immediately after the collection of the post-CME surveys. Raffle prizes were two medical textbooks for the first CME, and two DVD players for the second CME. Following each CME, we mailed a newsletter including the correct answers to the survey questions and a DVD recording of the CMEs to all Association members, regardless of their attendance.
For the first CME, the pre-CME questionnaire was a 27-item survey, with 5 items on participants’ knowledge of the CRC burden in both the Vietnamese American and general U.S. populations, 11 items on screening guidelines and current practices, and 11 items on risk factors for CRC. For the second CME, the pre-CME questionnaire was a 16-item survey, with 7 items regarding CRC screening guidelines and current practices and 9 CRC vignettes to assess the physicians’ screening recommendations to hypothetical patients. On both pre-CME questionnaires, there were demographic questions, e.g., participant’s year of birth, sex, country of medical school completion, medical specialty, years in practice, and site of practice, and questions about their current CRC screening practices. Patient profile questions included the proportion of patients age 50 and older, the number diagnosed with CRC in the past year, patients’ types of medical insurance, and patients’ CRC screening compliance. For both first and second CMEs, the post-CME survey items were identical to the pre-CME items, except that the demographic and patient profile questions were not repeated. Each survey took about 15 minutes to complete. (The CME questions and correct answers appear in and .)
Percentage of Correct Responses on Knowledge of Colorectal Cancer Burden, Screening Guidelines and Practices, and Risk Factors at the First CME (n = 42)
Percentage of Correct Responses on Knowledge of Colorectal Cancer Screening and Treatment at the Second CME (n = 35)
The primary outcome was the change in knowledge between the pre- and post-CME surveys. Responses per item were coded as “0” for incorrect and “1” for correct. Total correct scores and percentages were then calculated for each participant on both pre- and post-CME surveys. For any knowledge-related item, non-responses were included in the analysis as incorrect answers. McNemar’s tests were used to determine if there was a significant change between participants’ pre- and post-CME scores.
The Institutional Review Boards of the Northern California Cancer Center and University of California, San Francisco approved the study protocol.