Assessing the knowledge of future internists and gynecologists in caring for a woman with tetraplegia

S Oshima, K L Kirschner, A Heinemann, P Semik
Archives of Physical Medicine and Rehabilitation 1998, 79 (10): 1270-6

OBJECTIVE: To assess the knowledge base and comfort level of potential physician "gatekeepers" when treating women with spinal cord injuries. Residents with at least 1 year of training in either internal medicine (IM) or obstetrics and gynecology (Ob/Gyn) from a large academic urban medical center were surveyed.

STUDY DESIGN: This study used a written questionnaire that included a case scenario of a young woman with C6 tetraplegia who presented to her primary care physician for a routine visit. Information about the patient from her history and physical and laboratory exams was presented in stages, followed by open-ended queries to elicit information about the residents' problem-solving processes and management strategies.

RESULTS: Thirty-eight percent (30 of 79) of the IM residents and 64% (14 of 22) of the Ob/Gyn residents completed the questionnaire. Significant deficits in knowledge about physical accessibility, spasticity management, and potential disability-related medical complications in pregnancy were found. More Ob/Gyn residents were aware of the risk of autonomic hyperreflexia than IM residents, whereas the IM residents demonstrated greater awareness of neurogenic bladder and skin problems. Both groups indicated they were not very comfortable in managing the patient's care.

CONCLUSIONS: The results raise concern about the adequacy of the training of primary care physicians to meet the needs of people with severe disabilities.

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