Obstetrician-gynecologists as primary care physicians: The Oregon experience—Early perceptions regarding the effects of legislative action

OBJECTIVE: Our purpose was to assess whether legislative action influenced the role of obstetrician-gynecologists as primary care physicians. STUDY DESIGN: An observational study was performed on the basis of a questionnaire sent to 410 obstetrician-gynecologists and 27 medical directors of managed-care organizations. RESULTS: Of 67% of obstetrician-gynecologists and 96% of medical directors who responded, there was agreement as to the content of primary care, but a minority (38%) of obstetrician-gynecologists identified themselves as primary care providers. A minority of medical directors (35%) felt that obstetrician-gynecologists should serve in that role. Both obstetrician-gynecologists and medical directors felt that legislation had little impact. CONCLUSION: The reticence of obstetrician-gynecologists to assume a major role in primary care appears to be the result of an uneasiness with accepting a more comprehensive role in patient management and gatekeeping. They appear comfortable with the more traditional roles but feel that training and experience has not prepared them well for the management of more complex medical problems. (Am J Obstet Gynecol 1998;178:1222-8.)     

Residency Training in Pediatric and Adolescent Gynecology Across Obstetrics and Gynecology Residency Programs: A Cross-Sectional Study

Study ObjectiveTo estimate the prevalence of Pediatric and Adolescent Gynecology formal training in the United States Obstetric and Gynecology residency programs.DesignProspective, anonymous, cross-sectional study.ParticipantsUnited States program directors of Obstetrics and Gynecology residency programs, N = 242; respondents 104 (43%).Results104 residency programs responded to our survey. Among the 104 residency programs, 63% (n = 65) have no formal, dedicated Pediatric and Adolescent Gynecology clinic, while 83% (n = 87) have no outpatient Pediatric and Adolescent Gynecology rotation. There is no significant difference in the amount of time spent on a Pediatric and Adolescent Gynecology rotation among residents from institutions with a Pediatric and Adolescent Gynecology fellowship (P = .359), however, the number of surgeries performed is significantly higher than those without a Pediatric and Adolescent Gynecology fellowship (P = .0020). When investigating resident competency in Pediatric and Adolescent Gynecology, program directors reported that residents who were taught in a program with a fellowship-trained Pediatric and Adolescent Gynecology faculty were significantly more likely to be able to interpret results of selected tests used to evaluate precocious puberty than those without (P = .03).ConclusionsResidency programs without fellowship trained Pediatric and Adolescent Gynecology faculty or an established Pediatric and Adolescent Gynecology fellowship program may lack formal training and clinical exposure to Pediatric and Adolescent Gynecology. This information enables residency directors to identify deficiencies in their own residency programs and to seek improvement in resident clinical experience in Pediatric and Adolescent training.     

The Care of Adolescents by Obstetrician-Gynecologists: A First Look

Study ObjectiveTo determine whether obstetrician-gynecologists who typically care for adolescent patients, what this care entails, and the adequacy of training opportunities in adolescent health care.DesignA questionnaire designed to elicit information regarding practice patterns of obstetrician-gynecologists mailed to the American College of Obstetricians and Gynecologists Collaborative Ambulatory Practice Network.ParticipantsObstetrician-gynecologists whose patient populations included girls under the age of 18.Main Outcome MeasuresItems in the questionnaire were generated to determine what care obstetrician-gynecologists are providing to adolescents, whether this care meets practice guidelines of major medical organizations, and whether obstetrician-gynecologists are receiving adequate training to provide this care.ResultsObstetrician-gynecologists frequently care for adolescent patients, with 72.6% seeing adolescents either monthly or weekly. The most frequently cited service needs pertained to reproductive health. Obstetrician-gynecologists also provide primary care, with 55.2% currently providing immunizations to adolescent patients. Nearly all (96.5%) plan to provide HPV immunizations. Most (80% or more) considered their residency training in obstetrics-gynecology on reproductive health to be adequate, but many reported inadequate or no training on primary care.ConclusionsObstetrician-gynecologists are an important part of the health care team caring for female adolescent patients. There is a lack of training during residency in obstetrics-gynecology in adolescent primary care issues. Increased training of obstetrician-gynecologists in all aspects of adolescent health care may increase the pool of health care providers who care for adolescents adequately. Collaborative efforts among all adolescent health care providers can improve access to quality health care for adolescents and the health of this population.     

Fetal ultrasound training for obstetrics and gynecology residents

OBJECTIVE: To assess the present state of fetal ultrasound training in the United States from the perspective of obstetrics and gynecology ultrasound program directors and residents. METHODS: One hundred thirty-six ultrasound program directors from 254 accredited obstetrics and gynecology residency programs completed a web-based survey regarding obstetric ultrasound training for residents. Questions were presented in yes-or-no, ranking, short-answer, and open-comment formats that examined general teaching environment and curriculum content. These results were compared with a mandatory fetal ultrasound training survey that was independently administered to 4,666 obstetrics and gynecology residents during the 2003 Council on Resident Education in Obstetrics and Gynecology (CREOG) In-Training Examination. Friedman one-way analysis of variance was used to compare ranked nonparametric data with the Dunn posttest. Statistical significance was taken at the P <.05 level. RESULTS: Fifty-four percent of accredited obstetrics and gynecology residencies responded to the survey of ultrasound directors from November 2000 to April 2003. Nearly all responding directors were obstetrician-gynecologists, many of whom had subspecialty training in maternal-fetal medicine. Full-time faculty and sonographers were the most important individuals contributing to ultrasound training for obstetrics and gynecology residents. Hands-on scanning and observation were the most significant educational activities for ultrasound training. Ultrasound program directors generally rated the overall preparedness of residents as ranging from adequate to excellent. The most important learning obstacles were limited curriculum and faculty time. Most programs evaluated competency by direct observation of scanning skills. According to the CREOG survey, only 16.3% of residents indicated that the performance and interpretation of fetal ultrasound examinations were mandatory program requirements. Nearly two thirds of residents believed that their training would be adequate by the time of graduation. Only 18.4% of residents, however, were planning to perform or interpret fetal ultrasound scans in clinical practice. CONCLUSION: Fetal ultrasound training for obstetrics and gynecology residents is perceived by most ultrasound program directors and residents to be adequate. Future development of standardized guidelines and competency assessment tools should consider that approximately one fifth of obstetrics and gynecology residents are currently planning to use this diagnostic modality in clinical practice. LEVEL OF EVIDENCE: II-2     

Endoscopy teaching in Canada: a survey of obstetrics and gynecology program directors and graduating residents

OBJECTIVE: To examine the current state of basic and advanced gynecologic endoscopy teaching in Canadian Obstetrics and Gynecology (Ob/Gyn) residency programs. METHODS: On Institutional Research Board approval, 2 pretested anonymous questionnaires were developed: one distributed to all Canadian Ob/Gyn program directors and a second to graduating residents (Canadian Task Force classification III). Two mailings were sent to maximize response, and some department chairs received personal telephone calls by the senior author to encourage participation. Residents on maternity leave were excluded from the study. RESULTS: Fifteen of 16 (94%) program directors, and 47 of 62 (76%) residents participated. Directors expect all residents to be knowledgeable and competent performing basic endoscopic procedures on graduation. However, considerable variation exists among programs that teach advanced endoscopy. Some of the more important factors limiting integration of advanced endoscopic teaching include paucity of trained faculty, lack of attending interest, scarcity of operating time, and financial constraints. Most graduating residents consider undertaking additional gynecologic endoscopy fellowships. CONCLUSION: Most Ob/Gyn program directors and graduating residents consider endoscopic surgery essential to contemporary practice. There is consensus to improve resident teaching in gynecologic endoscopy and commitment to better prepare future practitioners to ensure patient safety. Paucity of trained faculty and fiscal constraints appear to be important limiting factors.     

Ob/Gyn residency programs: How will we train primary care physicians? How will we document it?

This study's objective was to determine how primary care data can be incorporated into residency data collection efforts to document primary care training in light of the specialty's current direction. A survey was sent to program directors of 272 accredited residency programs in the United States and Canada to assess resident data collection. The survey included a determination of methods for accurately collecting primary care data. As part of the larger grant funded residency data collection project for our department, we developed a paperless closed loop data collection system that included standard ob/gyn primary care related procedure and diagnosis specific data. Of the 272 accredited programs surveyed, 144 (52.9%) responded. Only 8.3% (12) of program directors indicated having a method for collecting any primary care data. Using our new data collection system over a 6-month period, our program was able to document primary care encounters such as smoking cessation, nutrition counseling, and immunizations. Based on these data, it would be possible to adjust either the program or an individual resident's clinical experience. As increasing numbers of residency programs begin to incorporate primary care into their training programs, the ability to record patient encounters in a database including hypertension, diabetes, substance abuse, smoking cessation, general health screening, wellness counseling, and other non-gynecologic problems will be crucial to document primary care training. Similarly, such procedures as immunizations, breast aspirations, and sigmoidoscopy could be documented.     

Primary and preventive care in a university obstetrics and gynecology group practice

Objective: Our purpose was to determine whether primary and preventive care is practiced by a university obstetrician-gynecologist group practice.Study design: A retrospective chart review spanning 2 years of four academic physicians' private practices was performed. A total of 335 patients were reviewed with 739 patient encounters and 1032 patient problems identified. The definition of a primary care physician according to The American College of Obstetricians and Gynecologists was used to standardize data collection and evaluation.Results: Obstetric complaints accounted for 27.7% of all visits, whereas 65.4% were for gynecologic problems. Almost 7% of all complaints were neither obstetric nor gynecologic, and of those 74.6% were primary care problems completely managed by the obstetrician-gynecologist. Only 19.7% of these were referred for management. More than 89% of all encounters () involved some element of primary care.Conclusion: This study provides evidence that the majority of health care provided by the obstetrician-gynecologists is primary care.     

CURRICULUM TRENDS IN NURSE-MIDWIFERY EDUCATION: Views of Program Directors

The purpose of this study was to determine the extent to which nurse-midwifery education programs are addressing the practice competencies that have been recommended by the Pew Health Professions Commission and others as essential for effective practice in the 21^st century. This study was part of a larger survey of eleven health professions education programs. The 56 nurse-midwifery program directors whose names and addresses were provided by the American College of Nurse-Midwives were surveyed by mailed questionnaire, with a response rate of 59% (n = 33). The study sought to identify current and ideal emphasis placed on 33 broad topics, most important curriculum topics, and barriers to curriculum change as perceived by respondents. Findings revealed that nurse-midwifery program directors would like to see greater emphasis placed on every topic except one (tertiary/quaternary care). Desired increases ranged from .04 to 1.36. The overall mean rating for all topics was 3.51 for current emphasis (5-point scale) and 4.18 for ideal emphasis, both of which were higher than any other survey group. The greatest desired increases (> 1.00) were for “primary care,” “managed care,” “use of electronic information systems,” and “business management of practice.” Respondents identified “primary care,” “health promotion/disease prevention,” and “accountability for cost-effectiveness and patient outcomes” as the most important topics. The top three barriers to curriculum change were identified as “already crowded curriculum,” “inadequate funding,” and “limited availability of clinical learning sites,” the last being statistically significant compared with other survey groups. Findings indicate that nurse-midwifery program directors perceived that they are adequately addressing most of the curriculum topics, while continuing to focus on the need for curriculum change as the health care environment changes.     

A Canadian Survey of Postgraduate Education in Aboriginal Women's Health in Obstetrics and Gynaecology

ObjectiveTo assess Canadian obstetrics and gynaecology residents' knowledge of and experience in Indigenous women's health (IWH), including a self-assessment of competency, and to assess the ability of residency program directors to provide a curriculum in IWH and to assess the resources available to support this initiative.MethodsSurveys for residents and for program directors were distributed to all accredited obstetrics and gynaecology residency programs in Canada. The resident survey consisted of 20 multiple choice questions in four key areas: general knowledge regarding Indigenous peoples in Canada; the impact of the residential school system; clinical experience in IWH; and a self-assessment of competency in IWH The program director survey included an assessment of the content of the curriculum in IWH and of the resources available to support this curriculum.ResultsResidents have little background knowledge of IWH and the determinants of health, and are aware of their knowledge gap Residents are interested in IWH and recognize the importance of IWH training for their future practice. Program directors support the development of an IWH curriculum, but they lack the resources to provide a comprehensive IWH curriculum and would benefit from having a standardized curriculum available.ConclusionA nationwide curriculum initiative may be an effective way to facilitate the provision of education in IWH while decreasing the need for resources in individual programs.     

Obstetrics and Gynecology Residencies: Education in Preventive and Primary Health Care for Women

Objective: To test the hypothesis that the Residency Review Committee program requirements for obstetrics and gynecology residencies, when properly followed, will result in residents being educated in preventive and primary ambulatory health care for women during their residency training program as specialists in obstetrics and gynecology.Methods: The 60 requisite residency training competencies identified as essential to educate generalist physicians, and viewed by some educators as a benchmarking standard, each were evaluated to determine whether residents in obstetrics and gynecology are now being educated in each of these areas. The answer was considered affirmative if any of the following pertained: 1) the Residency Review Committee program requirements indicate that the competency “must” or “should” be taught, 2) the Residency Review Committee requests numerical verification related to the competency on the accreditation review application, or 3) by virtue of a specific rotation required by the Residency Review Committee it can be assumed that the resident will be educated in the competency. To make our assessment, we identified and listed the section of the Residency Review Committee for Obstetrics-Gynecology program requirements, which, when properly followed, would result in education in the particular competency.Results: Fifty-seven of the 60 competencies were considered applicable to obstetrician-gynecologists (care of infants, care of children, and infant/child preventive care were not), and residents in obstetrics and gynecology were found to be educated in 54 (95%).Conclusion: During their residency training programs as specialists in obstetrics and gynecology, residents are being educated to be able to be providers of preventive and ambulatory primary health care for women.     

What Do Patients Attending an Antenatal Clinic Know About the Role of Resident Physicians?

ObjectiveTo assess antenatal patients’ working knowledge of resident physicians involved with their care.MethodsA prospective short-answer survey was distributed to a convenience sample of 120 consecutive patients of a busy obstetrical practice in a teaching hospital in 2006. Patients were asked about resident physicians’ roles and responsibilities, level of education, hours of work, and relationship to the attending physician.ResultsThe majority of patients had attended the teaching hospital within the preceding year and had also previously delivered a baby at the hospital. Only 7% of patient participants correctly identified a resident as actively involved in their care and only 18% correctly identified the attending physician as the residents’ supervisor and/or educator. Most patients correctly identified the resident’s highest level of education as university (90%) and knew that the resident was under the supervision of the attending physician (70%). Except the 5% of participants who answered “don’t know,” all respondents greatly underestimated residents’ average weekly hours of work.ConclusionsPatient knowledge of the role of the resident physician in the health care team is lacking. Increasingly, patients wish to be educated and engaged in their health care management. Given the significant role of residents in patient care in Canada’s teaching centres, further attention should be paid to finding out what patients wish to know about their care providers and providing them with that knowledge.     

Limitations in Correspondence Programs for Cervical Cancer Screening: Who Are the Women We Are Missing?

ObjectiveThis study sought to identify factors associated with gaps in the correspondence program and the characteristics of those women who are not reached with a mailed invitation to screening within an organized cervical cancer screening program.MethodsThis population-based, retrospective observational study examined the factors associated with failed correspondence mailings as part of the Ontario cervical cancer screening program. Administrative databases were used to identify eligible women who were overdue for screening or never screened yet did not receive an invitation to screening as a result of a failed mailing. These women were further characterized on the basis of age, affiliation with a primary care physician, and use of other health services (Canadian Task Force Classification II-2).ResultsA total of 1 350 425 women were eligible, of whom 1 064 637 had a successful mailing (78%). Women who were overdue for screening and who had a failed correspondence were more likely to be younger than 50 (72.5%) and associated with a primary care physician (61.2%), and 66.7% had three or more health care encounters in the preceding 3 years. Underscreened and never-screened women were also more likely to be younger than 50, but only 15% were associated with a primary care physician and only 18.2% had health care encounters in the previous 3 years.ConclusionThis is one of the first studies to evaluate the incidence of failed mailings within correspondence in organized screening programs. Women who are underscreened or never screened are infrequent users of health care services and tend not to have a primary care physician, thus making them less accessible to traditional outreach methods and at further risk of being non-compliant with screening.     

Residents’ Confidence in Performing Robotic Hysterectomy in Obstetrics and Gynecologic Training Programs

Study ObjectiveTo compare residents’ perceptions of readiness to perform robotic-assisted laparoscopic hysterectomy with the perceptions of residency program directors in obstetrics and gynecology programs throughout the United States.DesignA survey was administered to all residents taking the 2019 Council on Resident Education in Obstetrics and Gynecology Exam and concurrently to program directors in all Accreditation Council for Graduate Medical Education–accredited training programs.SettingThe survey was designed to assess resident confidence to perform robotic hysterectomies by the time of graduation.PatientsNo patients were included in the study.InterventionsThe only intervention was administration of the survey.Measurements and Main ResultsDe-identified survey data were analyzed using chi-squared and Fisher's exact tests. A total of 5473 resident respondents and 241 residency program directors were included in the study. Fifty-two percent of graduating residents reported that they felt they were given surgical autonomy to perform robotic hysterectomies, and 53.7% reported that they could perform one independently (if it was an “emergency” and they had to). By the time of graduation, only 59% of residents reported confidence performing a robotic hysterectomy, and only 56% reported they felt that it would be an important procedure for their future career. Program directors were significantly more likely to report that their residents were given autonomy to perform robotic hysterectomy by graduation (61.0% [95% confidence interval (CI), 54.3–67.3]), could perform a robotic hysterectomy independently (60.9% [95% CI, 53.9–67.6]), or could perform a robotic hysterectomy by graduation (70.2% [95% CI, 63.5–76.3]) than residents themselves (38.6% [95% CI, 37.2–40.0], 22.8% [95% CI, 21.6–24.0], 62.6% [95% CI, 61.2–64.0], respectively).ConclusionAt the time of graduation, residents’ confidence in performing robotic hysterectomy independently is lower than their confidence in performing all other approaches to hysterectomy.     

Physician attitudes regarding hypoactive sexual desire disorder in a primary care clinic: a pilot study

IntroductionFemale sexual dysfunction (FSD), in particular, complaints of low desire, affects many American women. Despite the impact FSD may have on these women, many do not present their symptoms to their physicians.AimTo determine physician attitudes and practices regarding hypoactive sexual desire disorder (HSDD) in the primary care setting.Main Outcome MeasuresA 10-item questionnaire regarding HSDD.MethodsAll residents and faculty in an academic primary care clinic were invited to participate in a web-based survey regarding HSDD. Return of the questionnaire was considered consent. Responses were downloaded into Excel and converted into an spss database.ResultsIn total, 53 of 155 physicians responded (46% response rate—41.5% women, 58.5% men). Of respondents, 90% reported little confidence in making the diagnosis of HSDD, 90% of physicians had not screened a patient for HSDD, and 98% of the physicians had not prescribed medication for patients with HSDD. No significant gender differences among physicians were identified, but faculty providers had more confidence in diagnosing and treating HSDD than resident physicians.ConclusionsThese results indicate there is an opportunity to improve patient care and life satisfaction by offering physicians training on diagnosis and management of HSDD. Harsh V, McGarvey EL, and Clayton AH. Physician attitudes regarding hypoactive sexual desire disorder in a primary care clinic: A pilot study     

Professionalism in obstetrics-gynecology residency education: the view of program directors

OBJECTIVE: To define the qualities of professionalism emphasized in obstetrics-gynecology residencies and identify existing means of evaluating them. METHODS: A survey, designed to assess the importance of professionalism in residency programs and what means are utilized for its development, was sent to all 270 obstetrics-gynecology residency program directors in the United States. RESULTS: Two hundred thirteen surveys were returned (79%). Ninety-seven percent of all respondents indicated that they thought the development of professionalism was necessary for training obstetrics-gynecology residents, and 84.3% thought that formal educational training time should be devoted to this development. Over 85% endorsed faculty examples and mentoring as their methods of teaching professionalism. Respondents ranked honesty; accountability to patients, colleagues, and society; respect for patients; integrity; and excellence as the most important qualities of professionalism. Almost 79% believed those qualities were as important and as necessary as qualities of skill and knowledge in residency training. Almost 80% of respondents thought that the establishment of formal professionalism guidelines would be valuable in their training programs. CONCLUSION: A critical quality in resident education is professionalism, which receives emphasis in training programs largely through faculty example and mentoring. The variability inherent in such methods might be reduced by residency wide guidelines for uniform application of standards and to avoid arbitrariness in enforcement.     

The Women''s Health Curriculum by a problem-based learning method for medical students at the University of California, San Francisco

OBJECTIVES: Our objectives were to (1) expand and strengthen the women's health curriculum at the University of California, San Francisco, and (2) evaluate the responses of both medical students and faculty to this curriculum.STUDY DESIGN: A written evaluation of the curriculum in women's health was completed by both students and faculty. Variables studied included mean scores of cases, the overall course score, and the preferences of medical students for faculty specialty in teaching the small groups.RESULTS: The overall course evaluation score was 7.81 (range 1 to 10). For those students who had both faculty from internal medicine or family medicine and obstetrics and gynecology, there was a strong preference that obstetrician-gynecologists teach the majority of the cases.CONCLUSIONS: The new case-based curriculum in women's health was enthusiastically received by both medical students and faculty. (Am J Obstet Gynecol 1997;176:1368-73.)     

After-hours telephone calls to obstetrician-gynecologists

OBJECTIVE: To characterize the pattern, content, and management of after-hours telephone interactions between obstetrician-gynecologists and patients. METHODS: In a prospective observational study, 12 resident and nine private physicians practicing obstetrics and gynecology completed data cards for after-hours telephone interactions with patients. Chief complaints were categorized as related to either women's health or primary care and on whether women were pregnant, postpartum, or not pregnant. Triage dispositions (evaluate now, office follow-up, or home care) were compared between groups. Women also were asked what they would have done if they had been unable to contact their physicians by telephone. RESULTS: One hundred ninety-two of 276 calls evaluated (69. 6%) were from pregnant women, 20 (7.2%) were from postpartum women, and 64 (23.3%) were from nonpregnant women. Calls were related to primary care health issues in 24.1% (n = 45) of pregnant women, 40% (n = 8) of postpartum women, and 28.1% (n = 18) of nonpregnant women. There were no differences between residents and private physicians in the proportion of women triaged to immediate evaluation for pregnancy (35.1% [n = 40] versus 41.9% [n = 31], P =.74) or postpartum (11.1% [n = 1] versus 10% [n = 1],P =.96) problems. Among 139 women triaged to office follow-up, 41% (n = 57) would have come to the hospital for emergency evaluation if they had been unable to reach their physicians. CONCLUSION: Resident and private obstetrician-gynecologists provide primary care and women's health care advice during after-hours telephone calls from patients. More than one third of after-hours telephone calls from pregnant women are triaged to immediate evaluation.     

Identification of educational objectives for obstetrics and gynecology residents in the ambulatory setting

OBJECTIVE: The primary objective of this study was to identify specific educational goals for obstetrics and gynecology residents in the ambulatory setting. STUDY DESIGN: A cross-sectional study of current practice patterns in primary care, benign gynecology, and office procedures was performed with mailings to local private practice obstetrician-gynecologists. Questions for the anonymous written survey were generated using the Council on Resident Education in Obstetrics and Gynecology educational objectives. Telephone interviews with staff from billing offices confirmed practitioner responses. RESULTS: Of 88 practitioners, 43 (49%) responded. Diagnoses made in the office correlated well with the topics considered important for resident knowledge. Most important primary care diagnoses were depression and abdominal pain; important gynecologic diagnoses were abnormal uterine bleeding, chronic pelvic pain, contraception, and vulvovaginal infection. CONCLUSION: This study offers a valid, practical foundation for developing a focused ambulatory resident education program based on current outpatient obstetrics-gynecology practice patterns.     

Residency training in colposcopy: a survey of program directors in obstetrics and gynecology and family practice

OBJECTIVE: Our goal was to identify how colposcopy is being taught to residents in obstetrics and gynecology and family practice programs and to see if the program directors think their residents receive sufficient clinical exposure to be adequately trained in colposcopy. STUDY DESIGN: A 30-question survey was sent to all obstetrics and gynecology and family practice residency program directors. The survey included questions about the didactic nature of the colposcopy curriculum, the type of supervision, how resident skills are evaluated, estimates of the numbers and types of patients evaluated, the numbers and types of procedures being done by each resident, and the program director's perception of residents' competence in colposcopy. RESULTS: The overall response rate was 485 of 752 program directors (64.5%). Significantly fewer family practice than obstetrics and gynecology program directors thought they had adequate numbers of colposcopy patients to train their residents. By their program directors' estimates, 86% of family practice residents evaluate 10 or fewer patients with high-grade lesions (versus 16.5% of obstetrics and gynecology residents); 51.4% evaluate 10 patients or fewer with low-grade lesions (versus 6.7% of obstetrics and gynecology residents), and 40.6% evaluate 10 patients or fewer with atypical squamous cells of undetermined significance (versus 3% of obstetrics and gynecology residents). Experience with vulvar disease is also limited. Program directors thought their residents' colposcopy skills were roughly comparable with their general obstetrics and gynecology skills. CONCLUSIONS: It is possible that many program directors underestimate the number of colposcopic examinations required to achieve and maintain colposcopic skills. Many training programs have insufficient clinical volume to properly train residents in colposcopy.