An Expanded Primary Care-Based Women's Health Clinic to Improve Resident Education and Patient Care in Resident Continuity Clinic

Abstract

Background: Internal medicine (IM) residents are underprepared in women's health. Lack of properly trained faculty and clinic culture limits the ability to provide bedside teaching.

Aim: Assess the impact of a primary care-based, women's clinic on residents' quality of care for females.

Setting: Large academic, urban primary care clinic with resident and faculty practices PARTICIPANTS: PGY-2 IM and Med-Peds (MP) residents PROGRAM DESCRIPTION: A weekly half-day, women's clinic to provide expanded women's healthcare to primary care group patients. Residents rotate through the clinic to receive bedside teaching.

Program evaluation: Chart review was performed for a representative sample of reproductive-aged women seen in primary care before and after the establishment of the women's clinic. A total of 666 charts were reviewed (314 pre, 352 post). Improvement was seen in residents' rate of sexual histories (54% vs 75%, p< 0.01) with a significant decrease in women not asked about contraception (15% vs 3%, p<0.01). Overall there was a decrease in gynecology referrals (18 to 11%, p=0.02).

Discussion: After implementing the women's health clinic, more women were asked about sexual health needs, and fewer were referred to gynecology, suggesting increased women's healthcare provided by residents.

Keywords: Contraception; Primary care–based referral clinic; Resident education; Women’s health; Women’s health referral clinic.