Colorectal cancer results in significant morbidity and mortality in the United States. Screening is a critical component of cancer prevention. However, research has suggested that physicians may inconsistently adhere to surveillance guidelines. Since residency training can significantly impact upon future practice patterns, assessment of postgraduate colorectal cancer education is important. This retrospective chart review of patients > or = 50 years of age compared screening performed by resident physicians' in different internal medicine residency programs at The George Washington University Medical Center. Resident physicians who received multiple lectures in colorectal cancer surveillance or were required to document performance of screening on a medical record preventive care summary form performed significantly more rectal examinations (P < 0.0004), fecal occult blood testing (P < 0.00001), and flexible sigmoidoscopies (P < 0.00001) when compared to other resident physicians. Postgraduate education should employ multiple education techniques and reinforcement procedures to increase physician compliance with cancer screening.