Trainees' interactional skills when performing Pap smears. A needs assessment

Specific interactional behaviours are known to reduce the anxieties and discomforts associated with Papanicolaou (Pap) smears. Few studies have documented doctors use of such strategies or the needs of young doctors to learn them. This descriptive study was conducted to identify trainees learning needs as part of a larger study in the Royal Australian College of General Practitioners (RACCP) Training Program in New South Wales.

Audioptaped consultations with women seeing a trainee for a Pap smear during the first 3 weeks of the CP term were analysed using a 29 item interactional skills rating scale. Intra-rater reliability (i.e. consistency of rating of the researcher) was checked on a random sample of audiotapes.

Rates of specific interactional skills in the 23 audiotaped consultations were low. Trainees explained the procedure in seven consultations (30%). No trainees explained a stop signal. Ten women (43%) were told how to find out the result of their Pap smears. No trainees offered written information Smoking status was ascertained in only two consultations (9%).

This study adds to increasing evidence that undergraduate medical education in Australia fails to equip graduates with practical skills in preventive care. Our findings have implications for GP supervisor and the RACGP Training Program. Specifically, trainees clinical behaviour when taking Pap smears should be observed improved and assessed during supervised training before entry into independent practice.