Some primary care residents feel unprepared to provide preventive counseling


Residents may lack confidence to deal with depression, substance abuse and domestic violence

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.

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Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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