Are primary care residents adequately prepared to care for women of reproductive age?

Abstract

A 1991 study of 115 internal medicine and 28 family practice residents at a large inner-city public hospital finds that both groups would perform poorly in providing preconception counseling to women of reproductive age. More than 40% of residents failed to indicate that they would provide a healthy woman with information on rubella immunization and family planning or counseling on sexually transmitted diseases and safer sex. When counseling a diabetic woman seeking pregnancy, 74% would not have discussed congenital anomalies with her and 45% would not have considered discontinuing oral hypoglycemics if she became pregnant. Furthermore, 58% would have neglected to review or change hypertension medications in a newly diagnosed pregnant woman. Although both internal medicine and family practice residents had positive attitudes toward offering preconception care, family practice residents had significantly higher attitude scores. No clear improvement was found in patient management, attitude or knowledge scores as residents progressed from their first to their third year of training.

PIP: In October 1991, 115 internal medicine and 28 family practice residents at Cook County Hospital in Chicago, Illinois, completed a questionnaire designed to assess and compare their knowledge, attitudes, and management skills in caring for women of reproductive age. Researchers planned to use the results as a reference as they update the residency training curricula in this inner-city hospital. The residents frequently did not mention family planning (about 50%) or safer sex and sexually transmitted diseases (36-68%) in the information they provided during counseling sessions with women of reproductive age. They also did not always mention rubella immunization (50-56%). 27-39.3% would not advise a pregnant woman to stop smoking. 74% would not discuss congenital anomalies with a diabetic woman seeking to conceive. 45% would not advise a woman with diabetes to discontinue oral hypoglycemics if she were to become pregnant. 58% would not review or changed hypertension drugs in a newly diagnosed pregnant woman. Both internal medicine residents and family practice residents scored high on attitudes toward preconception care, but, for all three postgraduate years, family practice residents scored higher than internal medicine residents in attitude (p = 0.0076, 0.0003, and 0.0001). Family practice residents did not score better in management skills than internal medicine residents, however. They only scored better in knowledge during the second postgraduate year (p = 0.0379). The knowledge, attitude, and management scores did not increase significantly with increasing number of postgraduate years. The subgroup of residents who had rotated through the high risk prenatal clinic (8 internal medicine and 14 family practice residents) scored higher than their colleagues, however. These findings show that residents are not prepared to take the opportunity to advise a pregnant woman to modify risk behaviors that adversely affect pregnancy outcomes.