The association between number of Pap smears performed and self-reported confidence in an internal medicine residency

Background: The American Board of Internal Medicine (ABIM) recommends internal medicine residents perform at least 3-5 Pap smears during training. We evaluated whether doing more than the required minimum Pap smears was associated with greater confidence and less desire for more Pap smear training. Methods: We surveyed all 142 internal medicine residents at one university training program. Participants were asked how many Pap smears they had performed during residency and to rank their confidence and desire for more training in performing Pap smears. We compared confidence and desire for more training across three groups of residents reporting varying experience (<= 5, 6-10, > 10 Pap smears performed). Results: Of 101 responding residents (71% eligible), 42 (42%), 19 (19%), and 36 (36%) reported performing <= 5, 6-10, and > 10 Pap smears, respectively. The number of Pap smears performed was significantly related to confidence and desire for more training in Pap smears (p < 0.05). Of residents who reported <= 5 Pap smears, 64% and 57%, respectively, indicated they were not confident and desired more training. Of those reporting 6-10 Pap smears, 42% were not confident, and 42% desired more training, whereas comparable proportions for those reporting > 10 Pap smears were 14% and 17%, respectively. After adjusting for gender, primary care track, year of training, continuity clinic site, women's health rotation experience, and future plans in primary care, those reporting doing > 10 Pap smears were significantly more likely to report confidence (OR 9.08, 95% CI 2.15-36.26) and less likely to want more training (OR 0.23; 0.06-0.93) than those reporting <= 5 Pap smears. Conclusions: Residents who performed over twice the number of Pap smears recommended by ABIM were much more likely to indicate confidence in their Pap smear skills compared with those completing <= 5.