Primary care program directors' perceptions of women's health education: a gap in graduate medical education persists.

Background: Previous studies found that internal medicine residents are not adequately prepared to provide comprehensive primary care to women. The impact of subsequent national guidelines emphasizing women's health education during residency is unknown.

Methods: We conducted a cross-sectional survey of primary care internal medicine residency program directors (PDs) in the United States. We asked the directors to provide information about themselves and their programs, to rate how strongly they agreed that residents should master each of 13 women's health competencies, to estimate the proportion of their residents who actually master each competency by the end of their residency, and to indicate means by which each competency was taught (articles, lectures, patient care, specialty clinic, other).

Results: Of 69 directors contacted, 42 (61%) responded. Most respondents agreed that residents should master all 13 competencies. However, there were significant discrepancies (p < 0.001) between the proportion of respondents who believed their residents should master competencies concerning 10 of 13 women's health topics and the proportion who believed their residents actually did master them. More than one third of PDs estimated that the majority of their residents would not gain the knowledge to diagnose, treat, or counsel women with incontinence, vaginitis, domestic violence, preconception planning, or birth control needs by the end of residency training. Of 18 potential predictors of quality education, only 2 proved significant: number of years the respondent served as program director (p = 0.02) and number of competencies taught by lecture (p = 0.007).

Conclusions: Despite national guidelines endorsing women's health education, a large discrepancy persists between what PDs believe their residents should master and what they estimate their residents actually master. This study suggests a need for substantial improvements in internal medicine residency training to adequately prepare residents to care for women.