Association of primary care physician sex with cervical cancer and mammography screening.

OBJECTIVE: To assess whether the sex of primary care physicians is associated with differing rates of cervical cancer and mammography screening in a contemporary multicultural context. DESIGN: Structured medical record review of a retrospectively defined cohort. SETTING: Academic urban primary care clinic in Montreal, Que. PARTICIPANTS: Seven male physicians and 9 female physicians, and all female patients aged 14 to 69 years registered to one of the physicians (N = 1948). MAIN OUTCOME MEASURES: Screening compliance rates as measured by the elapsed time between the last visit and cervical cancer screening for all women in the study. In addition, in women aged 50 to 69 years, elapsed time between the last visit and mammography screening. RESULTS: Crude rates of Papanicolaou tests for patients of female primary care physicians were higher than for patients of male primary care physicians in all patient age groups. The lowest rates of Pap testing were among the youngest and oldest patients. After adjustment for patient age, first language, and region of birth, as well as physician age, the odds ratio of having a Pap test was 2.24 (95% CI 1.18 to 4.28) for the patients of female physicians, relative to those of male physicians. The adjusted odds ratio for mammography screening was 1.25 (95% CI 0.97 to 1.61) for patients of female physicians. CONCLUSION: Male primary care physician sex is associated with lower rates of cervical cancer screening in an urban multicultural context. The study did not detect a physician sex effect in the mammography cohort.

Supervised near-peer clinical teaching in the ambulatory clinic: an exploratory study of family medicine residents' perspectives.

Near-peer teaching is used extensively in hospital-based rotations but its use in ambulatory care is less well studied. The objective of this study was to verify the benefits of near-peer teaching found in other contexts and to explore the benefits and challenges of near-peer clinical supervision unique to primary care. A qualitative descriptive design using semi-structured interviews was chosen to accomplish this. A faculty preceptor supervised senior family medicine residents as they supervised a junior resident. We then elicited residents' perceptions of the experience. The study took place at a family medicine teaching unit in Canada. Six first-year and three second-year family medicine residents participated. Both junior and senior residents agreed that near-peer clinical supervision should be an option during family medicine residency training. The senior resident was perceived to benefit the most. Near-peer teaching was found to promote self-reflection and confidence in the supervising resident. Residents felt that observation by a faculty preceptor was required. In conclusion, the benefits of near-peer teaching previously described in hospital settings can be extended to ambulatory care training programmes. However, the perceived need for direct observation in a primary care context may make it more challenging to implement.