Training and attitudes about contraceptive management across primary care specialties: a survey of graduating residents

doi:10.1016/j.contraception.2006.01.014

Contraception

Volume 73, Issue 6, June 2006, Pages 618-622

https://doi.org/10.1016/j.contraception.2006.01.014 Get rights and content

Abstract

Purpose

Little is known about how physicians' attitudes and knowledge of contraception could impact the unintended pregnancy rate in the United States. The objective of this study was to analyze survey data from physicians in primary care training programs in Pittsburgh, PA.

Methods

A cross-sectional survey was administered to primary care medical residents in Allegheny County, PA. Descriptive statistics were used to illustrate training, attitudes and knowledge regarding contraceptive management. A multivariable analysis was performed to elucidate associations between training, attitudes and behavior.

Results

Of 143 residents surveyed, 74 (52%) responded. The mean score on contraceptive knowledge assessment was 54%. Obstetrics/gynecology residents performed consistently better on the knowledge index (p<.01). Among nonobstetrics/gynecology residents, formal training in contraception, female gender, ability to insert an intrauterine device and not being a family practitioner were independently associated with improved knowledge (p<.05).

Conclusions

Most of the responding graduating residents view contraception as an important component of primary care. However, young physicians have a contraceptive knowledge base that is inconsistent across primary care specialties. Improvement in this area might improve the unintended pregnancy rate in the United States.

Introduction

The unplanned pregnancy rate in the United States is higher than that of any other developed country. Although a range of effective contraceptives is available for use, nearly half of all pregnancies in the United States are unplanned, and about half of these are carried to term [1]. Unintended pregnancies impose enormous social, emotional and health consequences to societies and individuals [2].

Prevention of unplanned pregnancies is of concern at both national and international levels. Part of the delineated goals of Healthy People 2010 (national health objectives designed to identify and address the most significant threats to health) is to increase the use of contraception and to decrease unplanned pregnancies.

According to a 1996 Gallup poll, the majority of women (56%) rely on health care providers for the information they receive about contraception. In a retrospective chart review of 324 American women seeking abortion [3], miscommunication between patients and their health care providers negatively affected the use of contraceptive method in 14% of patients. A survey among Norwegian women [4] revealed that patients often felt that their contraception consultations were hasty and incomplete. Several of these women cited what they felt was misinformation about their contraceptive method as the reason for its failure and for the resulting unplanned pregnancy. A direct link between provider knowledge and patient adherence to a contraceptive method has not been established, but it is reasonable to surmise that patients are more likely to obtain the appropriate method of contraception, to use it well and to report problems to the prescribing physician when that physician presents information in a knowledgeable and patient-specific manner.

Physician ability to manage contraceptive care represents an important intersection between medical education, health care delivery and public health outcomes. When fertility rates are held constant, increased contraceptive use leads to decreased abortion rates [5]. This effect is magnified when long-term, effective methods of contraception, such as the intrauterine device (IUD), are used [6]. However, the standard medical school curriculum does not extensively cover the topic of contraception [7]. A physician's knowledge base most likely expands during years of clinical training, but while the Accreditation Council for Graduate Medical Education (ACGME) requires that training in family planning and contraception be part of the core curriculum for internal medicine, pediatric, family medicine, and obstetrics and gynecology residents [8], structured teaching in the area of contraception is not necessarily a systematic part of residency curricula.

To assess the range of contraceptive knowledge and attitudes, we surveyed residents graduating from these four training programs about their knowledge and attitudes regarding contraception. We then examined associations between demographic and training characteristics and residents' knowledge of contraceptive management.

Section snippets

Subject recruitment

We conducted a cross-sectional survey of graduating medical residents in four specialties—obstetrics and gynecology, internal medicine, family practice and pediatrics—1 month before matriculation.

Initially, a search was performed on FREIDA, a web-based program of comprehensive medical residency programs supported by the American Medical Association, to identify all residency programs in the Western Pennsylvania/Allegheny County region. We identified three obstetrics/gynecology programs, four

Results

A total of 74 residents participated in the survey for a response rate of 52%. The median age was 32 years, and male and female participants responded in equal numbers (Table 1). Fifty-seven (77%) of the respondents were using some type of contraception at the time of the questionnaire. Twenty-one (28%) respondents were using oral contraceptives, and 30 (41%) used condoms for contraception. Fifty percent of those who used condoms additionally used spermicides or hormonal contraception. Twelve

Discussion

The data from this investigation show that most graduating residents from obstetrics and gynecology, internal medicine, family practice and pediatrics programs who responded to the survey view contraception as an important component of primary care and feel that they have received training in these areas. However, in our study, relatively few have a complete ability to counsel about and manage health issues related to contraception. For example, while 73% reported that they had received formal

References (15)

J.N. Isaacs et al.
Miscommunication between healthcare providers and patients may resulting in unplanned pregnancies
Contraception
(2003)
J. Sundby et al.
Avoiding unwanted pregnancy — the role of communication, information, and knowledge in the use of contraception among young women
Patient Educ Couns
(1999)
C.A. Cwiak et al.
Teaching contraception: an interactive presentation using managing contraception
Am J Obstet Gynecol
(2004)
M. Lipkin
Physician–patient interaction in reproductive counseling
Obstet Gynecol
(1996)
P.D. Blumenthal et al.
Training for Norplant implant removal: assessment of learning curves and competency
Obstet Gynecol
(1997)
S.K. Henshaw
Unintended pregnancy in the United States 1995–1996
Fam Plann Perspect
(1998)

There are more references available in the full text version of this article.

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To assess New York State stakeholders’ perspectives regarding providing reproductive health services in primary care settings, including asking patients about pregnancy intentions and providing long-acting reversible contraception (LARC).
We conducted semistructured key-informant interviews (n = 22) with stakeholders representing diverse sectors, including primary care (family medicine) and specialty (obstetrician/gynecologist) physicians, health educators/promoters, advocates, and public health/health care professionals. Grounded theory methodology informed sampling and thematic analysis within and across sectors.
Key informants across sectors supported integrating reproductive health services into primary care. Pregnancy intention screening was considered appropriate yet required improved measures. Such screening was viewed as fostering childbearing discussions and counseling for contraception/preconception health that could benefit patients while also requiring attention to concerns from the patient (e.g., potential for coercion, access barriers) and health care systems (e.g., buy-in, training) contexts. Three themes related to LARC included provider bias, knowledge and training, counseling and patient education, and logistics/financial situation, which were differentially emphasized by stakeholder sector; providers expressed greater concern regarding training, bias, and logistical considerations, whereas health educators and advocates focused on patient education and autonomous decision-making. Similarly, awareness of reproductive justice principles varied by sector.
There is consensus among informants from the 5 sectors for expanding reproductive health services in primary care. This will require reproductive health-related training for providers, organizational buy-in, and system protocol changes, including unbiased contraceptive counseling of all methods, specifically balancing discussion of LARC effectiveness with information regarding side effects. Incorporating reproductive justice principles may increase informed patient decision-making and reproductive autonomy.
Expanding reproductive health services in primary care requires provider training and protocols for patient-centered care, including unbiased provision of all contraceptive options. The reproductive justice framework offers the possibility of addressing diverse stakeholders’ concerns for both preconception and contraceptive care with patient decision-making at the forefront.
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Citation Excerpt :
Furthermore, structured teaching in family planning and contraception is not necessarily a systematic part of residency curricula. The clinical training in this area is still limited.22 These results suggest that LARC-first education and training for healthcare professionals should be emphasized in general practice if the goal of increased provision of long-acting contraceptive methods for adolescents and young woman is to be realized.
To assess whether improving providers’ education by video training using a mobile phone could affect providers’ knowledge and attitude toward long-acting reversible contraceptives (LARCs), and thus further affect adolescents’ and young nulliparous women's decisions to use LARCs.
This prospective case-control study was performed between 2019 and 2020. A total of 40 healthcare providers participated, of which 20 received “LARC First” video training, whereas the other 20 served as the control group and received no training. Surveys were conducted of 244 adolescents and young women who were consulted by these 2 groups of healthcare providers before abortion surgery. The data were used to analyze the relationship between providers’ knowledge scores and the percentage of women who received counseling on LARCs decided to use LARCs, and what percentage continued to do so 12 months after surgery.
Providers from the study group scored higher in LARC knowledge than the control group. Compared to the control group, women in the study group reported receiving more counseling on LARCs (81.4% vs 7.9%) and more often chose to use LARCs (24.6% vs 2.4%). Twelve months later, there was no significant difference in contraceptive continuation between study and control groups, but study group participants were more likely to be using LARCs (P < .001).
Video training for providers improved both their knowledge and willingness to recommend LARCs and increased the probability of adolescent and young nulliparous women using these methods to reduce unintended pregnancy.
Obstetrics–gynecology resident long-acting reversible contraception training: the role of resident and program characteristics
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Although almost no literature has reported race/ethnicity differences in family planning training, previous work suggests gender differences in family planning training. A 2006 study reported that female residents may have better knowledge of LARC than male residents, demonstrated as greater scores on a LARC knowledge index.3 Data from the current study do not suggest differences in LARC insertion experience by gender (Table 3).
Obstetrics–gynecology residents should graduate with competence in comprehensive contraceptive care, including long-acting reversible contraception. Lack of hands-on training and deficits in provider education are barriers to long-acting reversible contraception access. Identifying the number of long-acting reversible contraception insertions performed by obstetrics–gynecology residents could provide insight into the depth and breadth of long-acting reversible contraception training available to obstetrics–gynecology residents in Accreditation Council for Graduate Medical Education–accredited residency programs.
Our study investigates long-acting reversible contraception–specific training in obstetrics–gynecology residency programs across the United States, including the self-reported number of long-acting reversible contraception insertions per resident and the impact of resident demographic characteristics and residency program characteristics on training.
Obstetrics–gynecology residents completed a voluntary electronic survey during the 2016 Council on Resident Education in Obstetrics and Gynecology examination. The survey included resident demographic characteristics and residency program characteristics as well as resident education and training in long-acting reversible contraception (number of intrauterine devices and implants inserted, training in immediate postpartum intrauterine device placement). A binary “long-acting reversible contraception insertion experience” variable dichotomized respondents as having a low level of long-acting reversible contraception insertions (0 implants and/or 10 or fewer intrauterine devices ) or a high level of long-acting reversible contraception insertions (1 or more implants and/or 11 or more intrauterine devices). χ² tests were used to compare the presence of long-acting reversible contraception insertion experience by postgraduate year, resident demographic characteristics, and residency program characteristics. Adjusted logistic regression was performed to ascertain the independent effects of gender, race/ethnicity (non-Hispanic white vs other), residency program type (university vs community), and residency program geographic region on the likelihood of “low” overall long-acting reversible contraception insertion experience.
In total, 5055 obstetrics–gynecology residents completed the survey (85%); analysis included only residents in United States obstetrics–gynecology programs (N=4322). Of the total analytic sample, 1777 (41.2%) had low long-acting reversible contraception insertion experience. As expected, the number of intrauterine device insertions, implant insertions, and overall long-acting reversible contraception experience increased as residents progressed through training. Long-acting reversible contraception insertion experience varied by residency program geographic region: 169 (27.1%) residents in programs in the West had low long-acting reversible contraception insertion experience compared with 498 (39.0%) in the South, 473 (45.3%) in the Midwest, and 615 (46.0%) in the Northeast. Only 152 (14.9%) of all postgraduate year 4 residents had low long-acting reversible contraception insertion experience. Among postgraduate year 4 residents, low long-acting reversible contraception insertion experience was significantly associated racial/ethnic minority status and community-based residency program type (compared with university-based). Postgraduate year 4 residents in programs located in the Northeast and Midwest had 4.25 (95% confidence interval, 2.04–8.85) and 2.75 (95% confidence interval, 1.27–5.97) times the odds of low long-acting reversible contraception experience compared with those in residency programs in the West, even after adjusting for other respondent characteristics and other residency program characteristics.
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Original research articleTraining and attitudes about contraceptive management across primary care specialties: a survey of graduating residents

Abstract

Purpose

Methods

Results

Conclusions

Introduction

Section snippets

Subject recruitment

Results

Discussion

Contraception

Patient Educ Couns

Am J Obstet Gynecol

Obstet Gynecol

Obstet Gynecol

Unintended pregnancy in the United States 1995–1996

Fam Plann Perspect

Original research article
Training and attitudes about contraceptive management across primary care specialties: a survey of graduating residents