The target population for existing investigations relating to the cognitive level of cancer prevention and screening is predominantly ordinary Chinese inhabitants . There are limited surveys relating to residents undergoing standardized training. Understanding and raising the literacy of residents can effectively optimize and improve cancer prevention and control services. This study investigated the literacy of residents from two dimensions: tumor associations with common carcinogenic factors and tumor screening literacy. We also investigated the training status and relevant demands of the residents. The information obtained from this survey showed that residents had good knowledge of cancer prevention and screening. However, there were shortcomings in some points, and appropriate training still needs to be strengthened. Several studies have reported that oncology teaching in undergraduate medical education and postgraduate residency training is insufficient [17, 18]. The present study indicated distinct cognitive dissonance among residents regarding the correlation between common carcinogenic variables and tumors. Most residents believed that smoking, drinking, infectious factors, air pollution, and secondhand smoke were closely related to tumorigenesis. In contrast, only 26.56, 25, and 23.44% of the residents believed that excessive body weight, an insufficient intake of fruits and dietary fiber, and a lack of exercise were associated with tumor development, respectively. This situation may relate to the fact that current postgraduate training education opportunities to enhance knowledge in cancer prevention are limited . This also might be attributed to incomplete training during the normal study period. Normal instruction was prone to highlight carcinogenic factors with high cognition and ignore poorly understood carcinogenic factors, thus resulting in the absence of teaching relating to the associations between tumors and obesity, a lack of exercise, and an insufficient intake of dietary fiber. There is clear evidence for the close relationship between obesity, exercise and tumors [20, 21]. Therefore, during the training stage, it is vital to reinforce formal training to improve the acceptance and awareness of residents with regards to various carcinogenic factors and provide patients with the most reasonable and comprehensive suggestions. Our research found that the residents had high levels of knowledge with regards to tumor screening technology. However, there were insufficient perceptions regarding the initial screening time and the value of tumor screening, with more emphasis on technology than prevention. Moreover, the present training period appears to focus mainly on disease diagnosis and treatment skills and only provides a limited amount of information relating to systematic training in cancer screening. Cancer screening plays a definite role in improving the early detection rate and reducing tumor mortality [22, 23]. Therefore, standardized teaching should reinforce information regarding the initial screening age and the value of screening for high-risk individuals, promote the initiative of residents with regards to cancer screening services, and improve active awareness during treatment in medical institutions.
In addition, our results demonstrated that gender, education level, residential training duration, and oncology specialism were the primary factors influencing the literacy of cancer prevention and screening literacy in residents. Highly educated and oncology specialty residents had been exposed to more information relating to cancer prevention and control during standardized training, thus improving their grasp of common carcinogenic factors and screening skills. Deeper engagement in exercise and more focus on the harmful consequences of air pollution might be the critical reasons for the high awareness of male residents with regards to the association between a lack of exercise, air pollution and tumor growth. In addition, residential training duration was inversely correlated with the proportion of accurate answers for the question asking to what extent breast cancer mortality might be reduced overall by mammography screening, with the maximum proportion of accurate answers given by physicians in the first training year. However, the overall proportion of correct answers was merely 25%; this was due to the lack of systematic education in different grades and the intersection of turnaround time for the residents.
The results of our study relating to the current training status of residents showed that only 28.13% of the residents received professional cancer prevention and screening training, and that most residents still relied on spontaneous teaching. A study conducted by Cheung et al. found that only 12.5% residents reported more than 1 week of cancer education in their training program and 75% indicated that 1 to 5% of their entire curriculum focused on cancer . Furthermore, 69.37 and 71.26% of the residents believed that their training related to cancer prevention and screening, and their relevant knowledge was insufficient, respectively. Furthermore, the survey revealed that one to five training courses were a feasible modality based on lectures and CBL teaching. Strengthening the oncological knowledge of residents  and the specialized knowledge of oncological physicians  could increase their ability to prevent and control cancer. The prevention of primary and secondary tumors, along with secondary prevention, is essential approaches that can reduce the burden of tumor-related diseases in China [26, 27]. Therefore, residents undergoing standardized training are deemed to require a pivotal window to promote cancer prevention and control and help guide the implementation of public health projects. Training in cancer prevention and screening is an important safeguard to improve the literacy of physicians and the level of cancer prevention and control efforts. However, there is still a significant lack of systematic and standardized training. Therefore, we recommend that experience in oncology departments be arranged for at least one to 2 months during the training period to construct a residency training program that meets the requirements for tumor control and prevention. Furthermore, teachers are required to carry out extensive instruction on cancer prevention and screening to ensure the continuous improvement of literacy in residents.
Several limitations should be considered when interpreting these results. First, the residents were based in a single hospital, this may have caused bias. Therefore, a large multi-center survey is needed to further confirm our results. Secondly, we did not investigate the attitudes and other opinions or intentional behavior of individuals. Thus, our results mainly demonstrate the level of knowledge mastery. Although knowledges relating to cancer prevention and screening represents a basic foundation, attitudes and behavior are also very important. Here, we conducted an ongoing multi-center cross-sectional survey of the attitudes and clinical behavior of residents undergoing standardized training.
In summary, residents with standardized training have an excellent grasp of tumor prevention and screening, although there is still space for improvement. However, training relating to cancer prevention and screening is clearly lacking within the standardized training stage; a systematic and standardized scheme needs to be developed. Therefore, extending the existing training program and integrating cancer prevention and control knowledge into regular instruction will help to improve the literacy of residents and promote cancer prevention and control.