To the Editor:
Routine gynecologic health care, including cancer screening and family planning services, is an essential part of primary care for reproductive-age women, but often overlooked by medical trainees with demanding and inflexible schedules. When our fellow obstetrics–gynecology (OB/GYN) residents were performing each other’s Pap smears in the clinic after hours, we realized this might be a systemic problem.
We carried out a needs assessment survey for female house officers (31) and medical students (29) at our institution. We learned that only 43% of female trainees had undergone a well-woman exam within the past year; 41% were either due for a Pap smear or uncertain of their screening status; and 50% reported an unmet need for contraceptive counseling, prescriptions, or procedures. Barriers in care included unpredictable work schedules and placing the duty to work over personal health care. Trainees resoundingly preferred weeknight or weekend appointments over traditional weekday ones.
As our institution’s health system currently offers minimal evening or weekend health maintenance clinics, in February 2020, we and other residents and faculty designed an after-hours gynecology clinic that offered well-woman exams, cervical cancer and sexually transmitted infection (STI) screening, and contraceptive counseling and procedures to female house officers and medical students. The clinic was run by OB/GYN residents and staffed by OB/GYN faculty.
During this pilot clinic, we saw 22 women; there was a 0% no-show rate. Among presenting patients, 8 underwent a procedure for placement of a long-acting reversible contraception device (i.e., an intrauterine device or an etonogestrel implant). These visits are particularly burdensome to trainees, as they typically require a 40-minute procedure visit scheduled months in advance when the trainee’s schedule may still be unknown. Every patient leaving the clinic had her contraceptive needs met and her Pap smear status updated. Patient satisfaction was high, with 100% preferring to return to an evening clinic rather than a daytime one. One patient stated, “THANK YOU! It feels so good to have people looking out for your difficult schedule and wellness,” while another reported that the clinic “definitely allowed me to get my long-overdue Pap smear, which I otherwise would not have.”
Our experience suggests that evening clinics for trainees are preferred, well-attended, and appreciated. Our experience also suggests that for patients, health care systems, and insurance providers, increasing access to gynecologic care improves the health of trainees by preventing unintended pregnancies, preventing complications of undiagnosed STIs, and increasing early identification and treatment of cervical cancer or its precursors. Given the overwhelming preference for evening appointments amongst trainees, we urge other specialties and institutions to offer similar after-hours preventive care services for house officers and medical students.
The authors wish to thank Sarah Block for her assistance with the preparation of this manuscript.