When Training Gaps Follow You Into Practice: Navigating Uncertainty in Outpatient Gynecology

For many clinicians, there is perceived discomfort in outpatient gynecology present in both training and practice environments. Across disciplines, exposure to gynecologic care varies widely. Some clinicians graduate having varied and high exposure to performing pelvic exams, contraceptive counseling, and integration of basic procedures in training which can build confidence in early career. Literature has shown that many educational clinical programs are only able to provide limited, observational, or inconsistent experiences. Low volumes of exposure, decreased student interest or limited access to quality gyn concerns and exams can equate to decreased confidence in practice which can be difficult to overcome over time.

Why Uncertainty Persists

If you've ever hesitated before a pelvic exam, felt unsure managing a gynecologic concern, or avoided offering certain services, you're not alone. Decreased confidence can induce a reinforcing cycle.

Common factors contribute to:

• Inconsistent initial training: Limited hands-on experience can leave gaps in both skill and confidence. Preceptor behavior, institutional culture, and clinical context have been shown to significantly impact student opportunity (Shui, et al., 2025).
• Time since training: Skills not used regularly contribute to skill decay and knowledge decline. Clinical skills accuracy, such as the bimanual exam, speculum exam and interpretation of physical findings can begin to substantially decline even after only 6.5 months of low or no opportunity/volume (Tatel et al., 2025).
• Decreased confidence: persistent decreased confidence can cause a clinician to decrease scope of practice which can increase the risk for diagnostic errors, incomplete exams, incomplete evaluations, and ineffective treatments.

The Impact on Daily Practice

Clinician uncertainty can show up in subtle but meaningful ways:

• Deferring care or referring care
• Relying on outdated or incomplete knowledge
• Hesitancy to discuss or dismissing patient concerns
• Increased clinician stress when navigating gynecologic concerns

Over time, this can affect the quality of patient experiences and contribute to lack of access for patients who may rely on insurance-networked providers, which is seen in the literature. Lack of treatment for people experiencing these concerns can lead to delayed diagnoses, decreased quality of life, and preventable deaths.

Why "Just Picking It Up Over Time" Is Challenging

Many clinicians expect that experience and time alone will fill these gaps. In reality, though, learning while in practice is often constrained by limited clinical opportunities while working, ineffective continuing education pedagogy and lack of access to a clinician with enough volume who can offer support.

Rebuilding Confidence Is Possible

The good news is that confidence in outpatient gynecology, if included in your scope of practice, can be developed at any stage of practice with desire and effective education. Communities of practice (CoP), case-based learning that applies updated knowledge, access to professional resources with evolving evidence and integration into the local practice context can overcome many barriers.

Moving Forward

If you've experienced gaps in your training, feel that distance from training has affected your confidence or you would like to refresh your current knowledge and community of clinicians, you're not alone.

References

Shui M., Lypson M., Sewell T., Ratan RB, Saab, SS (2025). Educational experience and ethical tensions in pelvic examination training: a mixed-methods study in the obstetrics and gynecology clerkship. American Journal of Obstetrics & Gynecology, 2025; 234, 270-278.

Tatel CE, Ackerman PL. Procedural skill retention and decay: A meta-analytic review. Psychol Bull. 2025 Jun;151(6):696-736. doi: 10.1037/bul0000481. Epub 2025 Jun 2. PMID: 40455501.