Competency-based Learning

The Impact of Targeted Resident Education and Feedback on Pap Smear Adequacy Rates


  • Received from the Section on General Internal Medicine (RSW, WPM), Wake Forest University School of Medicine, Winston-Salem, NC.

Address correspondence and requests for reprints to Dr. Watkins: Department of Internal Medicine, Wake Forest University, 1 Medical Center Boulevard, Winston-Salem, NC 27157 (e-mail:


Little is known about assessing or improving competency in Papanicolau (Pap) smear sampling among internal medicine residents. We hypothesized that a 3-part targeted resident physician educational program (educational presentation by a knowledgeable instructor, skills workshop, and peer comparison feedback) would be effective in increasing the quality of Pap smears obtained by internal medicine residents. We conducted a randomized, pre-post comparison study over a 16-month period to assess the effect of our educational intervention. We found no difference in baseline adequacy rates. Residents who received the intervention were twice as likely to obtain an adequate Pap smear. Our results suggest that a brief multifaceted intervention designed to improve the frequency with which internal medicine residents obtain endocervical cells while performing Pap smears is effective.