Chew Ryan B, Chew Lisa D, Bradley Katharine
Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System, Seattle, Washington 98101, USA.
J Womens Health (Larchmt). 2006 Oct;15(8):928-33. doi: 10.1089/jwh.2006.15.928.
The American Board of Internal Medicine (ABIM) recommends internal medicine residents perform at least 3-5 Pap smears during training. We evaluated whether doing more than the required minimum Pap smears was associated with greater confidence and less desire for more Pap smear training.
We surveyed all 142 internal medicine residents at one university training program. Participants were asked how many Pap smears they had performed during residency and to rank their confidence and desire for more training in performing Pap smears. We compared confidence and desire for more training across three groups of residents reporting varying experience (<or=5, 6-10, >10 Pap smears performed).
Of 101 responding residents (71% eligible), 42 (42%), 19 (19%), and 36 (36%) reported performing <or=5, 6-10, and >10 Pap smears, respectively. The number of Pap smears performed was significantly related to confidence and desire for more training in Pap smears (p<0.05). Of residents who reported <or=5 Pap smears, 64% and 57%, respectively, indicated they were not confident and desired more training. Of those reporting 6-10 Pap smears, 42% were not confident, and 42% desired more training, whereas comparable proportions for those reporting >10 Pap smears were 14% and 17%, respectively. After adjusting for gender, primary care track, year of training, continuity clinic site, women's health rotation experience, and future plans in primary care, those reporting doing >10 Pap smears were significantly more likely to report confidence (OR 9.08, 95% CI 2.15-36.26) and less likely to want more training (OR 0.23; 0.06-0.93) than those reporting <or=5 Pap smears.
Residents who performed over twice the number of Pap smears recommended by ABIM were much more likely to indicate confidence in their Pap smear skills compared with those completing <or=5.
美国内科医学委员会（ABIM）建议内科住院医师在培训期间至少进行3 - 5次巴氏涂片检查。我们评估了进行超过规定最低次数的巴氏涂片检查是否与更高的自信心以及对更多巴氏涂片检查培训的更低需求相关。
我们对一所大学培训项目中的所有142名内科住院医师进行了调查。参与者被问及他们在住院期间进行了多少次巴氏涂片检查，并对他们进行巴氏涂片检查的自信心以及对更多培训的需求进行排名。我们比较了三组报告不同经验（进行≤5次、6 - 10次、＞10次巴氏涂片检查）的住院医师在自信心和对更多培训的需求方面的情况。
在101名回复的住院医师中（71%符合条件），分别有42名（42%）、19名（19%）和36名（36%）报告进行了≤5次、6 - 10次和＞10次巴氏涂片检查。进行巴氏涂片检查的次数与进行巴氏涂片检查的自信心和对更多培训的需求显著相关（p＜0.05）。在报告进行≤5次巴氏涂片检查的住院医师中，分别有64%和57%表示他们没有信心并且希望接受更多培训。在报告进行6 - 10次巴氏涂片检查的住院医师中，42%没有信心，42%希望接受更多培训，而在报告进行＞10次巴氏涂片检查的住院医师中，相应比例分别为14%和17%。在对性别、初级保健方向、培训年份、连续性诊所地点、妇女健康轮转经验以及初级保健未来计划进行调整后，报告进行＞10次巴氏涂片检查的住院医师比报告进行≤5次巴氏涂片检查的住院医师更有可能报告有信心（比值比9.08，95%置信区间2.15 - 36.2），并且更不太可能希望接受更多培训（比值比0.23；0.06 - 0.93）。
与完成≤5次巴氏涂片检查的住院医师相比，进行超过ABIM建议次数两倍的巴氏涂片检查的住院医师更有可能对自己的巴氏涂片检查技能表示有信心。
