Perceived preparedness to provide preventive counseling
Reports of graduating primary care residents at academic health centers
Accepted: 04 January 2005 DOI:
Cite this article as: Park, E.R., Wolfe, T.J., Gokhale, M. et al. J GEN INTERN MED (2005) 20: 386. doi:10.1111/j.1525-1497.2005.0024.x Abstract To assess the perceived preparedness of residents in adult primary care specialties to counsel patients about preventive care and psychosocial issues. OBJECTIVE: Cross-sectional national mail survey of residents (63% response rate). DESIGN: Nine hundred twenty-eight final-year primary care residents in Internal Medicine (IM), family practice (FP), and Obstetrics/Gynecology (OB/GYN) at 162 U.S. academic health centers. PARTICIPANTS: Residents self-rated preparedness to counsel patients about smoking, diet and exercise, substance abuse, domestic violence, and depression. MEASUREMENTS: Residents felt better prepared to counsel about smoking (62%) and diet and exercise (53%) than about depression (37%), substance abuse (36%), or domestic violence (21%). In most areas, females felt better prepared than males. Rates of counseling preparedness varied significantly by specialty after adjustment for gender, race, medical school location, and percent of training spent in ambulatory settings. FP residents felt better prepared than OB/GYN residents to counsel about smoking, diet and exercise, and depression, while OB/GYN residents felt better prepared to address domestic violence than IM or FP residents. IM residents’ perceptions of preparedness were between the other 2 specialties. Proportion of training spent in ambulatory settings was not associated with residents’ perceived preparedness. RESULTS: Physicians completing residencies in adult primary care did not feel very well prepared to counsel patients about preventive and psychosocial issues. Significant differences exist among specialties, even after adjusting for differences in time spent in ambulatory settings. Increasing residency time in ambulatory settings may not alone be sufficient to ensure that residents emerge with adequate counseling skills. CONCLUSIONS: Key words primary care medical education prevention patientdoctor communication
The authors have no conflicts of interest in submission of this manuscript.
See editorial by Williams and Gerrrity, p. 450
This work was supported by a grant from the Common-wealth Fund, New York City, as part of the activities of the Commonwealth Task Force on Academic Health Centers, and by a grant (K24-HL04440) from the National Heart, Lung, and Blood Institute.
U.S. Department of Health and Human Services. Healthy People 2010. Washington, DC: Office of Disease Prevention and Health Promotion; 2000.
Wechsler H, Levine S, Idelson RK, Schor EL, Coakley E
. The physician’s role in health promotion revisited—a survey of primary care practitioners. N Engl J Med. 1996;34:996–8.
Goldstein MG, DePue JD, Monroe AD, et al.
A population-based survey of physician smoking cessation counseling practices. Prev Med. 1998;27:720–9.
Gottlieb NH, Guo J, Blozis SA, Huang PP
. Individual and contextual factors related to family practice residents’ assessment and counseling for tobacco cessation. J Am Board Fam Pract. 2001;14:343–51.
Park ER, DePue JD, Goldstein MG, et al.
Assessing the transtheoretical model of change constructs for physicians counseling smokers. Ann Behav Med. 2003;25:120–6.
Pollack KI, Arredondo EM, Yarnall KSH, et al.
How do residents prioritize smoking cessation for young “high-risk” women? Factors associated with addressing smoking cessation. Prev Med. 2001;33:292–9.
Moran S, Thorndike AN, Armstrong K, Rigotti NA
. Physicians’ missed opportunities to address tobacco use during prenatal care. Nicotine Tob Res. 2003;5:363–8.
Thorndike AN, Rigotti NA, Stafford RS, Singer DE
. National patterns in the treatment of smokers by physicians. JAMA. 1998;279:604–8.
Arndt S, Schultz SK, Turvey C, Petersen A
. Screening for alcoholism in the primary care setting: are we talking to the right people? J Fam Pract. 2002;51:41–6.
Buchsbaum DG, Buchanan RG, Poses RM, Schnoll SH, Lawton MJ
. Physician detection of drinking problems in patients attending a general medicine practice. J Gen Intern Med. 1992;7:517–21.
. Strategies to increase alcohol screening in health care settings. Alcohol Health Res World. 1997;21:340–7.
Friedmann PD, McCullough D, Chin MH, Saitz R
. Screening and intervention for alcohol problems. A national survey of primary care physicians and psychiatrists. J Gen Intern Med. 2000;15:84–91.
Spandorfer JM, Yedy I, Turner BJ
. Primary care physicians’ views on screening and management of alcohol abuse: inconsistencies with national guidelines. J Fam Pract. 1999;48:899–902.
Galuska DA, Will JC, Serdula MK, Ford ES
. Are health care professionals advising obese patients to lose weight? JAMA. 1999;282:1576–8.
Glasgow RE, Eakin EG, Fisher EB, Bacak SJ, Brownson RC
. Physician advice and support for physical activity: results from a national survey. Am J Prev Med. 2001;21:189–96.
. Barriers to providing nutrition counseling by physicians: a survey of primary care practitioners. Prev Med. 1995;24:546–52.
Nawaz H, Adams ML, Katz DL
. Weight loss counseling by health care providers. Am J Public Health. 1999;89:764–7.
Stafford RS, Farhat JK, Misra B, Schoenfeld DA
. National patterns of physician activities related to obesity management. Arch Fam Med. 2000;9:631–8.
Coyne JC, Schwenk TL, Fechner-Bates S
. Nondetection of depression by primary care physicians reconsidered. Gen Hosp Psychiatry. 1995;17:3–12.
. Barriers to the diagnosis of depression in primary care. J Clin Psychiatry. 1997;58:5–10.
Penn JV, Boland R, McCartney JR, Kohn R, Mulvey T
. Recognition and treatment of depressive disorders by Internal Medicine attendings and housestaff. Gen Hosp Psychiatry. 1997;19:179–84.
Simon GE, Von Korff M
. Recognition, treatment, management and outcomes of depression in primary care. Arch Fam Med. 1995;4:99–105.
Caralis PV, Musialowski R
. Women’s experiences with domestic violence and their attitudes and expectations regarding medical care of abuse victims. South Med J. 1997;90:1075–80.
Elliott L, Nerney M, Jones T, Friedmann PD
. Barriers to screening for domestic violence. J Gen Intern Med. 2002;17:112–6.
Hamberger LK, Saunders DG, Hovey M
. Prevalence of domestic violence in community practice and rate of physician inquiry. Fam Med. 1992;24:283–7.
Rivo ML, Saultz JW, Wartman SA, DeWitt TG
. Defining the generalist physician’s training. JAMA. 1994;271:1499–504.
Seltzer VL, Fishburne JI, Jonas HS
. Obstetrics and gynecology residencies: education in preventive and primary health care for women. Obstet Gynecol. 1998;91:305–10.
Accreditation Council on Graduate Medical Education. Residency review committee. Program requirements for residency education in family practice. Available at: http://www.acgme.org. Accessed July 2001.
Accreditation Council on Graduate Medical Education. Residency review committee. Program requirements for residency education in internal medicine. Available at: http://www.acgme.org. Accessed July 2001.
Accreditation Council on Graduate Medical Education. Residency review committee. Program requirements for residency education in obstetrics/gynecology. Available at: http://www.acgme.org. Accessed July 2001.
Blumenthal D, Gokhale M, Campbell EG, Weissman JS
. Preparedness for clinical practice: reports of graduating residents at academic health centers. JAMA. 2001;286:1027–34.
Bertakis KD, Helms LJ, Callahan EJ, Azari R, Robbins JA
. The influence of gender on physician practice style. Med Care. 1995;33:407–16.
Frank E, Kunovich-Frieze T
. Physician’s prevention counseling behaviors: current status and future directions. Prev Med. 1995;24:543–5.
Henderson JT, Weiss CS
. Physician gender effects on preventive screening and counseling: an analysis of male and female patients’ health care experiences. Med Care. 2001;39:1281–92.
Laube DW, Ling FW
. Primary care in obstetrics and gynecology resident education: a baseline survey of residents’ perceptions and experiences. Obstet Gynecol. 1999;94:632–6.
Graduate Medical Education Database 1996–1997. Chicago, IL: American Medical Association; 1996.
Rodriguez MA, Bauer H, McLoughlin E, Grumbach K
. Screening and intervention for intimate partner abuse: practices and attitudes of primary care physicians. JAMA. 1999;282:468–74.
Biernat K, Simpson D, Duthie E Jr, Bragg D, London R
. Primary care residents self assessment skills in dementia. Adv Health Sci Educ. 2003;8:105–10.
Accreditation Council on Graduate Medical Education. ACGME Outcome Project. Available at: http://www.acgme.org/outcome. 2000.
Goroll AH, Sirio C, Duffy FD, et al.
A new model for accreditation of residency programs in internal medicine. Ann Intern Med. 2004;140:902–9.
Parsons LH, Zaccaro D, Wells B, Stovall TG
. Methods of and attitudes toward screening obstetrics and gynecology patients for domestic violence. Am J Obstet Gynecol. 1995;173:381–6.
Schmidt L, Greenberg BD, Holzman GB, Schulkin J
. Treatment of depression by obstetrician-gynecologists: a survey study. Obstet Gynecol. 1997;90:296–300.
Goldstein MG, Niaura R, Willey-Lessne C, et al.
Physicians counseling smokers. A population-based survey of patients’ perceptions of health care provider-delivered smoking cessation interventions. Arch Intern Med. 1997;157:1313–9.
Frank E, Wright EH, Serdula MK, Elon LK, Baldwin G
. Personal and professional nutrition-related practices of U.S. female physicians. Am J Clin Nutr. 2002;75:326–32.
Nichols GA, Brown JB
. Following depression in primary care: do family practice physicians ask about depression at different rates than internal medicine physicians? Arch Fam Med. 2000;9:478–82.
Sciamanna CN, DePue JD, Goldstein MG, et al.
Nutrition counseling in the promoting cancer prevention in primary care study. Prev Med. 2002;35:437–46.
Williams JW, Rost K, Dietrich AJ, Ciotti MC, Zyzanski SJ, Cornell J
. Primary care physicians’ approach to depressive disorders. Arch Fam Med. 1999;8:58–67.
PubMed CrossRef Copyright information
© Society of General Internal Medicine 2005