Proton Pump Inhibitor Safety Knowledge and Stress Ulcer Prophylaxis Appropriateness Among Resident Physicians: A Cross-Sectional Study

Purpose/Introduction: Proton pump inhibitors (PPIs) are commonly prescribed for stress ulcer prophylaxis (SUP) in non-critically ill hospitalized patients despite limited evidence supporting routine use. This leads to unnecessary medication exposure and possible adverse effects. This study evaluated medical residents’ knowledge of PPI-related adverse effects and the appropriateness of SUP indications, and examined differences across specialties and the relationship between safety knowledge and prescribing decisions. Methods: We carried out a cross-sectional electronic survey of medical residents enrolled in Saudi Commission for Health Specialties (SCFHS) accredited programs. The questionnaire was sent by the SCFHS, which had nine Likert-scale items assessing PPI risk knowledge and SUP appropriateness. A response rate could not be calculated because the total number of survey recipients was not available. Composite scores were calculated for knowledge, appropriateness, and overall competency. Group comparisons and correlations were analyzed using standard parametric methods. Results: A total of 119 residents completed the survey. The mean PPI risk knowledge score was 3.31 ± 0.65, with 47.1% achieving competency. The mean SUP appropriateness score was 2.85 ± 0.39, and only 5.9% met the competency threshold. Correct identification of inappropriate SUP use was particularly low for high-dose corticosteroids alone (5.0%), dual antiplatelet therapy alone (10.9%), and mechanical ventilation for less than 24 hours (19.3%). Internal medicine residents demonstrated higher knowledge and overall competency scores than other specialties, while appropriateness scores did not differ by specialty. No significant correlation was observed between knowledge and appropriateness (r = 0.10, p = 0.262). Conclusion: Residents demonstrated moderate awareness of PPI-related risks but limited recognition of appropriate SUP indications in non-critically ill patients. These findings suggest that medication safety knowledge alone may not correspond to guideline-concordant prescribing decisions and highlight opportunities to strengthen targeted educational efforts. Keywords: proton pump inhibitors, stress ulcer prophylaxis, resident physicians, survey, cross-sectional study, prescribing appropriateness