Formal pathology rotation during obstetrics and gynecology residency: is it beneficial?

BACKGROUND: Our objective was to assess the educational benefits of a formal pathology rotation during an obstetrics and gynecology residency program and to determine the utility of this information in clinical practice. METHODS: In this descriptive study, the benefits of a 2-month rotation in pathology for obstetrics and gynecology residents were analyzed. A computerized listing of surgical cases processed by each resident was sent to the obstetrics and gynecology program director. RESULTS: Our resident accessioned 5.4% of the total pathology cases processed each month. Reports from previous residents (over a 17-year period) and from program directors at the annual educational retreat indicate that such information was not relevant to our graduates in their clinical practice. CONCLUSIONS: A formal pathology rotation for obstetric residents can improve knowledge base, but the usefulness of this knowledge in clinical practice is dubious.

Management of the abnormal Pap smear.

In an outpatient protocol for management of the abnormal Pap smear, it is crucial that physicians rule out the presence of invasive disease. To that end, it is essential to acquire thorough knowledge of cervical cancer risk factors, including human papilloma virus. Physicians must also be familiar with Pap smear reporting systems and the implications of Pap smear reports. Cervical biopsy, colposcopy, and endocervical curettage are important tools in evaluation of the abnormal smear. Recent research underscores the importance of performing colposcopy to assess not only dysplasia, but also atypia and HPV changes.

The use of the Pap smear in Mississippi.

Mississippi physicians participating in this survey generally followed the recommended guidelines for frequency of Pap smear screening in the general population and for high risk groups. While the participating physicians considered the presence of some sexually transmitted diseases to increase the risk of developing cervical cancer, many did not consider other STD's to place a patient at increased risk. Smoking was another risk factor that many physicians overlooked. Many Mississippi physicians also did not consider a Pap smear lacking endocervical cells inadequate. All physicians performing Pap smears need to be aware of the risk factors for the development of cervical cancer. There is a continuing controversy concerning the significance of certain Pap smear findings, the timing of colposcopic intervention, and the management of abnormal findings on these tests. Clinical decisions should be based on the newer concepts of degrees of dysplasia, cytological and descriptive findings, and the potential for rapid progression of lesions. Management of the abnormal Pap smear is the topic of another article in this issue of the Journal.

The Cytobrush effect on Pap smear adequacy.

One hundred twenty-four Papanicolaou smears were studied to compare the yield of endocervical cells obtained with the Cytobrush/Ayre spatula method to that of the cotton-tipped applicator/Ayre spatula method. Forty-nine of the 62 Pap smears (79%) obtained with the combination Cytobrush/Ayre spatula method contained endocervical cells, compared to 22 of the 62 smears (35%) obtained with the cotton swab/Ayre spatula method (chi 2 = 24.02, P less than 0.0001). The Cytobrush/Ayre spatula method obtained endocervical cells in 14 of 17 (82.4%) of the patients with stenotic ora, compared to 0 of 12 (0%) patients for the cotton swab/Ayre spatula method (P less than 0.001). The Cytobrush/Ayre spatula method obtained endocervical cells in 8 of 11 (72.7%) postmenopausal patients, compared to 4 of 14 (28.6%) patients for the cotton swab/Ayre spatula method (P = 0.05). Using the cervical Cytobrush for Pap smears increases the recovery rate of endocervical cells, which may improve the detection of cervical dysplasia in the patient population as a whole, in postmenopausal women, and in women with stenotic cervical ora.