Abstract
Background: Inflammatory bowel disease requires long-term management, recognition of factors associated with relapse, and careful interpretation of adjunctive treatments. Medical trainees may understand general concepts while remaining uncertain about disease-specific details, including the contrasting association of smoking with Crohn disease and ulcerative colitis and the limited, strain-specific evidence for probiotics. This study assessed knowledge and perceptions of relapse-related factors, the gut microbiome, and probiotic therapy among medical students and physicians.
Methods: A descriptive cross-sectional survey was conducted among 160 participants comprising preclinical medical students, clinical-stage students, and specialist physicians. A structured online questionnaire collected educational characteristics, prior exposure to inflammatory bowel disease, agreement with five possible relapse-related factors, knowledge of smoking, perceived probiotic mechanisms and indications, curriculum coverage, and anticipated prescribing barriers. Frequencies, percentages, means, and Pearson chi-square tests were used. Statistical significance was set at p < 0.05.
Results: Gastrointestinal infections received the highest agreement as a relapse-related factor (69.4%; mean 3.71), followed by psychological stress (63.1%; mean 3.67) and medication nonadherence (58.1%; mean 3.52). Only 23.8% correctly identified the contrasting association of smoking with Crohn disease and ulcerative colitis. Half of participants recognized probiotics as adjunctive rather than replacement therapy, whereas 26.3% viewed them as a complete alternative in mild disease. Ulcerative colitis and pouchitis were selected as the best-supported indications by 32.9%. Inadequate curriculum coverage was reported by 75.6%. Academic stage was associated with perceptions of curriculum adequacy (χ² = 9.90, p = 0.042), but not with self-rated knowledge, recognition of adjunctive use, or correct knowledge of smoking.
Conclusion: Participants showed greater familiarity with broad concepts than with clinically specific distinctions. The largest gaps concerned smoking, evidence-based indications for probiotics, and their position as adjunctive therapy. Focused teaching on IBD relapse prevention, interpretation of microbiome-directed therapies, and appraisal of strain-specific evidence may improve clinical preparedness.