Journal of Preventive Medicine

Introduction
Colorectal cancer (CRC) is the fourth leading cause of cancer-related deaths worldwide. The incidence of CRC in Middle Eastern countries is estimated to be 3-7 per 100,000 population which is lower than in Western countries. In Iran, the incidence rate of CRC and the related death rate have increased due to lifestyle changes and reduced physical activity. Given the shocking statistics of CRC incidence and death rates, it is important to raise awareness about this cancer type. Knowing the signs and symptoms of CRC can be a vital step in the quick diagnosis of this problem. The early detection of this cancer can lead to better treatment and reduced risk of death. 
Assessing the knowledge and skills of medical students, as future physicians, can be useful to provide feedback to authorities about the curriculum of medical schools. The knowledge and practice of medical students towards CRC can be effective in its quick treatment and prevention of its mortality. Therefore, the present study aims to investigate the knowledge of CRC in medical students of Ahvaz Jundishapur University of Medical Sciences (AJUMS), south of Iran, in 2022.

Methods
The study population consists of 740 clinical students of AJUMS working in teaching hospitals, of whom 210 were included in the study using a convenience sampling method. The entry criteria were the study in clinical medicine and willingness to participate in the study. Unwillingness to cooperate and failure to complete the questionnaire were considered as exclusion criteria. The data collection tool was a researcher-made questionnaire with 25 items that was designed and compiled after reviewing the previous literature, and its validity (based on the opinions of 10 experts) and reliability (α=0.789) were confirmed. It measures CRC symptoms including rectal bleeding and diarrhea (5 items with a total score of 0-5); CRC risk factors including family history, obesity, and male gender (10 items with a total score of 0-10); protective factors including fruit and vegetable consumption (5 items with a total score of 0-5); and screening methods including colonoscopy and occult blood test (5 items with a total score of 0-5). For the questionnaire, the total score ranged from 0 to 25. The data were analyzed in SPSS software, version 18 using descriptive statistics and independent t-test. The significance level was set at 0.05.

Results
The knowledge of less than half of medical students (45.5%) about CRC was favorable. More than two-thirds of medical students (78%) had unfavorable and poor knowledge of CRC symptoms. The knowledge of more than half of the students about CRC risk and protective factors was also unfavorable and poor. However, the knowledge of more than half of the medical students (58%) about CRC screening methods was favorable.
The comparison based on sex, marital status and course of study showed that there was no significant difference between the knowledge scores of male and female students, single and married students, and between externship and internship students regarding symptoms, risk factors and screening methods (P>0.05), but there was a significant difference between students with low and high grade point average (GPA) (P<0.05); the knowledge of students with high GPA about CRC symptoms, risk factors and screening methods was significantly higher than students with low GPA.

Conclusion
The knowledge of CRC in more than half of the medical students at AJUMS is low and unfavorable such that only 22% have good knowledge of CRC symptoms and 41% have good knowledge of CRC risk factors. Also, their knowledge of CRC screening methods is not favorable. It is recommended that appropriate measures should be taken to improve the knowledge of general practitioners about CRC and its screening methods. Revising the curriculum and teaching methods in AJUMS is also recommended.

Ethical Considerations
Compliance with ethical guidelines
This study is a research project approved by the Research Ethics Committee of Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran (Code: IR.AJUMS. MEDICINE.REC.1400.012). In this study, all standards ethical, including hiding the name and identity of medical students has been observed.

Funding
This study was financially supported by Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Authors' contributions
Conceptualization and methodology: Abdolhussein Shakurnia and Fatemeh Abbasi; Resources, financing, sample and data collection: Fatemeh Abbasi; Validation: Abdolhussein Shakurnia and Seyed Saeed Seydian; Project management, analysis, and writing the original draft: Abdolhussein Shakurnia; Research, review and editing: Seyed Saeed Seydian. 

Conflicts of interest
The authors declared no conflict of interest

Acknowledgements
The authors thank all colleagues working in training hospital at the Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

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