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