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Some primary care residents feel unprepared
to provide preventive counseling
Residents may lack confidence to
deal with depression, substance abuse and domestic violence
BOSTON - May 9, 2005 - Many young physicians completing residency
training in primary care specialties do not feel prepared to counsel
patients in areas such as depression, substance abuse and domestic
violence, according to a report from the Institute
for Health Policy at Massachusetts General Hospital (MGH). The
researchers present their analysis of survey responses from residents
in family practice, internal medicine, and obstetrics and gynecology
in the May issue of the Journal of General Internal Medicine.
"Residents may have the knowledge and skills required to provide
this kind of counseling, but when actually called on to do it, they
may not be completely comfortable," says Elyse Park, PhD, the
MGH psychologist who led the study. "They also may find it
hard to bring up such matters in patient visits that have so many
competing priorities and time constraints."
The study examined data from a comprehensive survey of medical residents
taken in 1998 with the support of the Commonwealth Fund Task Force
on Academic Health Centers. The overall survey compiled responses
from more that 4,800 residents completing training in eight specialties
at programs across the country. The current report analyzes the
responses of more than 900 residents in the three specialties that
focus on adult primary care - internal medicine, family practice
and obstetrics/gynecology - to questions about how prepared they
felt to counsel patients about smoking, diet and exercise, substance
abuse, depression, and domestic violence.
While almost two thirds of the residents felt well prepared to advise
patients about smoking and diet/exercise, less than half reported
feeling well prepared to deal with issues involving depression,
substance abuse and domestic violence. There were some differences
by specialty, with the obstetrics/gynecology residents feeling better
prepared to discuss domestic violence and family practitioners more
confident in addressing depression. Although the researchers had
hypothesized that residents spending more time in ambulatory care
settings would be more comfortable counseling patients, time spent
in ambulatory settings actually made no difference.
The researchers note that, while the Accreditation Council on Graduate
Medical Education requires that all primary care programs include
training in counseling, programs should assess the quality of their
instruction in preventive and psychosocial counseling as well as
whether residents have enough time to provide such counseling. The
particular strengths identified in dealing with specific issues
for family practice and obstetrics/gynecology programs could serve
as models to broadly improve training across all specialties.
Park adds, "The residency programs here at MGH do a very good
job of having experienced physicians present when residents see
patients and giving them feedback, which can be very helpful in
building residents' sense of competence." Park is an instructor
in Psychiatry at Harvard Medical School and teaches in the primary
care residency program at MGH.
The study's co-authors are senior author Nancy Rigotti, MD; Taida
Wolfe, MPA; Manjusha Gokhale, MA; and Jonathan Winickoff, MD, PhD,
all of the MGH Institute for Health Policy. In addition to the Commonweath
Fund grant, the study was supported by the National Heart, Lung
and Blood Institute and the Summer Research Trainee Program of the
MGH Multicultural Affairs Office.
Massachusetts General Hospital, established in 1811, is the original
and largest teaching hospital of Harvard Medical School. The MGH
conducts the largest hospital-based research program in the United
States, with an annual research budget of more than $450 million
and major research centers in AIDS, cardiovascular research, cancer,
cutaneous biology, medical imaging, neurodegenerative disorders,
transplantation biology and photomedicine. In 1994, MGH and Brigham
and Women's Hospital joined to form Partners HealthCare System,
an integrated health care delivery system comprising the two academic
medical centers, specialty and community hospitals, a network of
physician groups, and nonacute and home health services.
Media Contact: Sue
McGreevey, MGH Public Affairs
Physician Referral Service: 1-800-388-4644
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