Can an Educational Simulation Among Obstetrics and Gynecology Residents Improve Competency in Obtaining a Pap Test?

Abstract

STUDY OBJECTIVE: Investigate influence of physician training level and patient demographics on Pap test transformation zone (TZ) presence. Evaluate the effect of a simulation-based educational intervention. METHODS: Retrospectively reviewed Pap tests from Maine Medical Center obstetrics and gynecology resident clinic July 1, 2011–June 30, 2012. Recorded TZ presence was a proxy for competency in obtaining a Pap test. Collected patient age, body mass index (BMI), menopausal status, pregnancy status, pregnancy trimester, and cervical procedure history (loop electrosurgical excision procedure, cone, cryotherapy). June 2013 incoming interns (n=4) received an educational intervention: 20 minutes of cervical anatomy and examination technique and 20 minutes of pelvic model simulation. Postintervention data collected July 1, 2013–June 30, 2014. Statistical analysis with t test or χ2 test. RESULTS: Preintervention, residents performed 305 Pap tests. Interns were less likely to have a TZ compared with postgraduate year (PGY)-2–PGY-4 residents (P=.028). Pregnant patients were also less likely to have a TZ. No association existed between TZ and BMI, menopausal status, pregnancy trimester, or cervical procedures. Postintervention no difference existed in TZ between interns and PGY-2–PGY-4 residents (P=.43). When data were stratified by patient pregnancy status, there was no difference between interns and PGY-2–PGY-4 residents either preintervention or postintervention. CONCLUSION: We were unable to demonstrate that a brief educational intervention can improve competency in obtaining a Pap test. It is important to include information regarding patient pregnancy status when investigating frequency of Pap test TZ.