Abstract
OBJECTIVE: This study assesses the readiness of academic general internists to perform and precept a commonly utilized women’s health examination, and procedural and management skills.
DESIGN: Full-time faculty from divisions of general internal medicine and departments of family practice in 9 states reported their encounter frequency with, comfort precepting, and the importance they ascribe to several examination, procedural, and management skills relevant to women’s health care; and their attitudes toward performing the pelvic exam and obtaining a Pap smear.
MEASUREMENTS AND MAIN RESULTS: A total of 331 general internal medicine physicians (GIMs) and 271 family medicine physicians (FPs) completed questionnaires, with response rates of 57% and 64%, respectively. More than 90% of GIMs and FPs indicated they were confident precepting the breast and Pap/pelvic examinations. A relatively small percentage of GIMs expressed confidence precepting the management of dysfunctional uterine bleeding (22%), initiating Depo-Provera (21%), and initiating oral contraceptives (45%), while a substantially larger percentage indicated that these skills were important to primary care practice (43%, 44%, and 85%, respectively). Although GIMs indicated they were confident precepting the Pap/pelvic exam, they were less likely than FPs to agree with the following statements: “Performing routine Pap smears is a good use of my time” (GIMs 65%, FPs 84%); “It is a waste of health care dollars for primary care physicians to refer patients to gynecologists for routine Pap/pelvic exams” (GIMs 69%, FPs 90%); “I feel very well trained to do a routine bimanual exam” (GIMs 71%, FPs 98%), and “The clinic where I practice is well equipped to do a Pap smear” (GIMs 78%, FPs 94%).
CONCLUSIONS: Although most academic GIMs are confident precepting the breast and pelvic examination, only a minority are confident precepting the management of dysfunctional uterine bleeding, initiating Depo-Provera, and initiating oral contraceptives. These findings suggest that a number of academic GIMs may not be prepared or willing to perform or precept important women’s health skills.
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References
Cheney C, Ramsdell JW. Preventive health measures carried out by residents during new and follow-up patient visits. J Med Educ. 1986;61:321–3.
Day SC, Cassel CK, Kimball HR. Training internists in women’s health: recommendations for educators. American Board of Internal Medicine Committee on General Internal Medicine. Am J Med. 1996;100:375–9.
Conway T, Mason E, Hu TC. Attitudes, knowledge, and skills of internal medicine residents regarding pre-conception care. Acad Med. 1994;69:389–91.
McPhee SJ, Mitchell TF, Schroeder SA, Perez-Stable EJ, Bindman AB. Training in a primary care internal medicine residency program. The first ten years. JAMA. 1987;258:1491–5.
Coodley GO, Elliot DL, Goldberg L. Internal medicine training in ambulatory gynecology. J Gen Intern Med. 1992;7:636–9.
Cassel C, Blank L, Braunstein G, Burke W, Fryhofer SA, Pinn V. What internists need to know: core competencies in women’s health. ABIM Subcommittee on Clinical Competence in Women’s Health. Am J Med. 1997;102:507–12.
Accreditation Council for Graduate Medical Education. Special requirements for residency training in internal medicine. Available at: www.acgme.org.
Kwolek DS, Witzke D, Sloan DA. Assessing the need for faculty development in women’s health among internal medicine and family practice teaching faculty. The Women’s Health Education Working Group (WHEWG). J Womens Health Gend Based Med. 1999;8:1195–201.
Wilkerson L, Armstrong E, Lesky L. Faculty development for ambulatory teaching. J Gen Intern Med. 1990;5(suppl):44–53.
Maternity and gynecologic care. Recommended Core Educational Guidelines for Family Practice Residents. American Academy of Family Physicians. Am Fam Physician. 1998;58:275–7.
The American College of Physicians Ad Hoc Committee on Women’s Health. Comprehensive women’s health care: the role and commitment of internal medicine. Am J Med. 1997;103:451–7.
Stokes ME, Davis CS, Koch GG. Categorical Data Analysis Using the SAS System. Cary, NC: SAS Institute Inc.; 1995.
Livingston WW, Healy JM Jr, Jordan HS, Warner CK, Zazzali JL. Assessing the needs of women and clinicians for the management of menopause in an HMO. J Gen Intern Med. 1994;9:385–9.
Fennema K, Meyer DL, Owen N. Sex of physician: patients’ preferences and stereotypes. J Fam Pract. 1990;30:441–6.
Pemberton AG, Margolis KL, Mink PJ, McGovern PG, Lurie N. Women’s preferences for specialists who provide cancer screening and general medical care. J Gen Intern Med. 1998;13:624–6.
Staropoli CA, Moulton AW, Cyr MG. Primary care internal medicine training and women’s health. J Gen Intern Med. 1997;12:129–31.
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This work was supported in part by Grant #2D28PE54004 from the Bureau of Health Professions, Health Resources and Services Administration to the Faculty Development Program for General Internal Medicine, University of North Carolina at Chapel Hill, and by Grant #52285 from the Summa Health System, Akron, Ohio.
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Dixon, J.G., Bognar, B.A., Keyserling, T.C. et al. Teaching women’s health skills. J GEN INTERN MED 18, 411–418 (2003). https://doi.org/10.1046/j.1525-1497.2003.10511.x
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DOI: https://doi.org/10.1046/j.1525-1497.2003.10511.x