THE LEVEL OF PREVENTIVE HEALTH-CARE IN AN INTERNAL-MEDICINE RESIDENCYCLINIC - STILL ONLY AN OUNCE OF PREVENTION

Background. Clinical prevention is a critical component of primary car e residency training. Wow well residents do preventive services is one measure of the adequacy of their training. Methods. To assess the lev el of preventive health care in a university internal medicine residen cy clinic, we conducted a randomized retrospective review of 225 patie nt records. Results. We documented preventive services in only 39% of potentially appropriate instances. Cholesterol screening occurred in 5 3% of eligible cases, breast examination in 41%, mammogram in 69%, Pap anicolaou's smear in 53%, estrogen replacement therapy (ERT) in 41%, f ecal occult blood testing in 30%, flexible sigmoidoscopy in 18%, influ enza vaccination in 65%, pneumococcal vaccination in 44%, and tetanus immunization in only 9%. Male residents were significantly less likely than females to order mammograms or offer ERT. Conclusions. Compared to earlier studies of similar design, we found that the level of preve ntive health care has improved during residency training, but remains unacceptably low.