ASSESSING THE KNOWLEDGE OF FUTURE INTERNISTS AND GYNECOLOGISTS IN CARING FOR A WOMAN WITH TETRAPLEGIA

Objective: To assess the knowledge base and comfort level of potential physician ''gatekeepers'' when treating women with spinal cord injuri es. Residents with at least 1 year of training. in either internal med icine (IM) or obstetrics and gynecology (Ob/Gyn) from a large academic urban medical center were surveyed. Study Design: This study used a w ritten questionnaire that included a case scenario of a young woman wi th C6 tetraplegia who presented to her primary care physician for a ro utine visit. Information about the patient from her history and physic al and laboratory exams was presented in stages, followed by open-ende d queries to elicit information about the residents' problem-solving p rocesses 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 p hysical accessibility, spasticity management, and potential disability related medical complications in pregnancy were found. More Ob/Gyn re sidents were aware of the risk of autonomic hyperreflexia than IM resi dents, whereas the IM residents demonstrated greater awareness of neur ogenic bladder and skin problems. Both,groups indicated they were not very comfortable in managing the patient's fare. Conclusions: The resu lts raise concern about the adequacy of the training of primary care p hysicians to meet the needs of people with severe disabilities. (C) 19 98 by the American Congress of Rehabilitation Medicine and the America n Academy of Physical Medicine and Rehabilitation.