Impact of a veterans affairs continuity clinic on resident competencies in women’s health

Abstract

BACKGROUND: Education in women’s health is now considered a core curricular component during residency training in Internal Medicine. There is potential for insufficient training in women’s health for residents with a continuity clinic based at a Veterans Affairs (VA) hospital.

OBJECTIVE: To determine the impact of a 3-year continuity clinic based at a VA hospital on residents’ self-reported competencies in women’s health.

DESIGN: Cross sectional survey using an internal website.

SETTING: University-based residency program in Ann Arbor, Michigan.

MEASUREMENTS AND MAIN RESULTS: Comparison of residents with a VA clinic with residents with non-VA clinics (university and community) in self-reported competencies in knowledge base, counseling, and physical exam skills in the area of women’s health. Responses were obtained from 66% (n=72) of eligible residents. When compared to residents with either a university hospital- or community-based clinic site, VA-based residents reported less confidence in the majority of competencies surveyed. Clinic site had the strongest impact in the knowledge base domain, accounting for between 17% and 33% of the variance in each specific competency. For estimated number of Pap smears and breast exams done in the prior year, VA-based residents reported doing, on average, less than 5 of each per year while non-VA residents reported doing between 11 and 20 of each exam.

CONCLUSIONS: Our data suggest that despite other clinical opportunities in women’s health during ambulatory rotations, regular clinical experiences in women’s health in the continuity clinic setting are necessary to improve education in this area.