Quality Management Activities for Improving the Pap Smear Sampling Performance with Adequate Specimens among Family Medicine Residents

Abstract

Background: The clinical skills test of the Korean Medical Licensing Examination has been driving medical schools to improve undergraduate education through clerkships and skills training on the published test topics, including Pap smear. There have been few studies evaluating the ability of family medicine residents to perform the Pap smear procedure. We conducted this study in order to investigate family medicine residents’ performance based on the requisition rate of endocervical cell/transformation zone (EC/TZ) in Pap smear specimens, and to evaluate the effects of quality improvement measures. Methods: A retrospective study was conducted reviewing the results from liquid-based cervical Pap smear tests performed at a university hospital health check-up center between March 2013 and June 2015. An obstetrics and gynaecology (OB/GYN) professor and 12 family residents were observed with action research and structured interview. Results: Of the total 6,462 cervical Pap smear tests performed, 2,573 (39.8%) were reported to be lacking an EC/TZ component. In 2013, the presence rate of an EC/TZ component in cytology specimens taken by family medicine residents improved from 37.0%±11.8% to 80.3%±8.8% after a quality improvement intervention. The presence rate of an EC/TZ component was higher in specimens taken by residents compared with those by an OB/ GYN specialist (69.3%±10.9% vs. 44.7%±5.0%, P=0.0002). The baseline individual monthly requisition rate of the EC/TZ component improved after quality management intervention (50.0%±18.3% vs. 75.8%±15.8%, P=0.01). The presence of an EC/TZ sample varied among residents. Transfer activities of the task, topic conferences, self-directed learning from online educational materials, gynecologic training, and self-monitoring of laboratory results had a positive effect on quality improvement. Conclusion: Quality management activities at the individual level of family medicine residents improved the requisition rate of the EC/TZ component in Pap smear specimens. Further studies are needed in order to develop more efficient educational modules for improving Pap smear sampling quality.