Undergraduate education in obstetrics and gynaecology in Australia and New Zealand, 1989

Pap smears in general practice: a secondary analysis of the Australian Morbidity and Treatment Survey 1990 to 1991

We investigated the characteristics of Australian general practice that predict performance of Pap smears by secondary analysis of the Australian Morbidity and Treatment Survey 1990 to 1991. Chi-squared analysis identified potential associations between Pap smear rate and patient, doctor and practice variables. Significant associations were examined using logistic regression and generalised estimating equations. Participants were 495 general practitioners who collected information on 113,468 doctor-patient encounters, of which 43,211 encounters involved females aged 18 to 70 years. Pap smear encounter (2449) were identified and classified as patient-requested (62 per cent), diagnostic (5 per cent) or opportunistic (33 per cent). The large difference in the unadjusted Pap smear rates per 100 female encounters for female general practitioners (11.7) and male general practitioners (4.2) required separate analysis by sex of the general practitioner. For male general practitioners, a Pap smear was less likely: as patient age increased; for new patients; for general practitioners with less general practice experience; for general practitioners with no postgraduate qualifications; with metropolitan practice location; and if the practice had more than 25 per cent of patients with English as a second language. For female general practitioners, a Pap smear was less likely: for older known patients; as the age of the general practitioners increased; and for management of fewer problems per 100 encounters. A Pap smear was less likely to be opportunistic: as patient age increased; for general practitioners who were Australian graduates; and for general practitioners with no postgraduate qualifications. Consideration of patient, doctor, and general practice characteristics may facilitate the design of interventions to improve cervical cancer screening.

Obstetric and neonatal competence of medical students

During 1991-1992 a confidential questionnaire was administered to a sample of United Kingdom medical students to determine if undergraduate education improved students' perceived competence at eight practical procedures. Of 2521 students given questionnaires, 1483 (58.8%) replied; 948 (65.5%) had had some obstetric and 866 (60.8%) some neonatal education. Such education did improve students' perceived competence (P < 0.001) on self-assessed Likert scales, but most still believe themselves not to be competent when they have completed their obstetric and neonatal education. Regression models were able to explain much (38.7-65.1%) of the variability in perceived competence at obstetric procedures: obstetric education, performing practical procedures, and witnessing deliveries in a general practitioner unit were all associated with higher competence; but less (4.8-20.8%) of the variability in perceived neonatal competence. It is suggested that undergraduate experience should be congruent with the aims and objectives of obstetric and neonatal education, and that these need to be reviewed in the light of the recent General Medical Council proposed changes to medical education.

Undergraduate obstetrics and gynaecology in the United Kingdom and the Republic of Ireland, 1989

Undergraduate obstetrics and gynaecology has given rise to concern at a time when the community has become increasingly sensitive about genital structure and function and human reproduction. A survey of clinical schools in the United Kingdom and the Republic of Ireland shows that an average of 11 weeks is available for undergraduate learning in the discipline. Nearly all schools provide written aims and objectives for clinical students. Pelvic examination is taught in what is concluded to be a sensible and responsible manner; students are expected to conduct an average minimum of eight deliveries. Family planning instruction is seen as generally inadequate. Comparison of clinical courses with those in Australia and New Zealand shows striking similarities. Undergraduate courses need to be under constant review and revision so that the best students are encouraged to see obstetrics and gynaecology as a desirable career path.