Implementation and Assessment of a Lipoprotein(a) Curriculum for Internal Medicine Residents: A Longitudinal Study

TL;DR

A short educational session for medical residents increased their confidence and use of Lp(a) testing for heart disease risk.

Contribution

A brief curriculum for residents improved Lp(a) test ordering and confidence, suggesting a practical approach to enhance clinical practice.

Findings

Resident confidence in Lp(a) testing increased significantly after the presentation.

Lp(a) test orders by participants rose from 15% to 44% post-education.

Abstract

Introduction: Lipoprotein(a) (Lp(a)) is an independent risk factor for the development of atherosclerotic cardiovascular disease (ASCVD) and is recognized in guidelines as a risk-enhancing factor favoring the more aggressive management of lipids. However, the clinical utilization of Lp(a) testing has been low, especially among internal medicine providers.

Methods: We designed a 30-minute presentation for internal medicine residents that included a general overview of ASCVD risk assessment, differences between Lp(a) and regular low-density lipoprotein cholesterol (LDL-C), and examples of how elevated Lp(a) can change clinical management. Resident confidence in ordering and interpreting Lp(a) was assessed by pre- and post-surveys. Data on Lp(a) ordering practices were abstracted from the electronic medical record for the three months prior to and after the presentation.

Results: The presentation was administered to 22 interns in the fall of the 2024-2025 academic year and was associated with an increase in participant confidence, with mean survey scores increasing from 10 to 24 out of a maximum score of 25 (p<0.001). Lp(a) tests ordered by participants increased from seven (15% of all residents' Lp(a) orders) in the three months prior to 28 (44% of all residents' Lp(a) orders) in the subsequent three months (p=0.008).

Discussion: Lp(a) testing is an underutilized adjunct to ASCVD risk stratification. We developed a brief presentation that was associated with increased confidence regarding the topic of Lp(a) testing as well as changes in practice, as evidenced by increased Lp(a) orders. These encouraging single-center results can help inform future educational efforts on the topic of ASCVD prevention.

Conclusion: An Lp(a) curriculum for internal medicine residents showed promise in addressing the lack of awareness of Lp(a) testing. Further research is needed to assess the generalizability and retention of this curriculum.

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