Knowledge and Training of Intrauterine Devices Among Primary Care Residents: Implications for Graduate Medical Education

• DOI: 10.4300/jgme-d-14-00010.1
• Publication Date: 2015-03-02T23:41:03Z
• Authors: Aparna Sridhar; Elizabeth Ruppel ...; Kelly Mooney; Radhika Rible
• Keywords: Graduate medical education

Nearly half of pregnancies in the United States are unintended, a rate that has increased recently, contrasted with worldwide decline.1,2 This lack progress may be due to low adoption long-acting reversible contraceptives (LARCs). The lowest intrauterine device (IUD) use any industrialized country.3,4 Because IUDs have high user satisfaction and effectiveness, could lead reductions unplanned (and fewer adverse outcomes) prevent abortions.4,5Both public private sectors, primary care providers an important role preventing unintended pregnancies. Although many women receive contraceptive counseling services from obstetrics gynecology (ob-gyn) specialists, significant proportion see family practitioners, internists, pediatricians (caring for adolescents) one or both.6 National Ambulatory Medical Care Survey is designed meet need objective, reliable information about provision ambulatory medical States. According latest data available this survey, 11.5 million visits occurred 2010 contraception planning counseling.7 It important, therefore, all provider types well informed regarding IUDs.A physicians trained specialties add further training subspecialties: subspecialist take complex problems pose risk pregnancy. Therefore, knowledge pediatrics subspecialists as well. Accreditation Council Graduate Education requires part core curriculum internal medicine, pediatrics, ob-gyn residents, structured teaching area not necessarily systematic (box).8Clinician patient misconceptions major contributors underuse Some concerns based on poor evidence; some truth simply require additional information. There clear evidence suggesting among reproductive age. Russo et al9 outlined list patient-related myths IUD usage. These include pelvic inflammatory disease, future fertility, ectopic pregnancy, weight gain, others.9 Health play patients bust IUDs, but health themselves aware uses benefits IUDs. In addition misconceptions, barriers, such concern expulsions, perforation, delayed return IUDs.10–17With implementation Affordable Act (ACA), approximately 20 who previously lacked insurance process obtaining coverage. Most these will interface clinician can address needs within context ongoing conditions, highlighting critical prevention barriers cost access highly effective decrease because ACA18 most new nongrandfathered plans cover full range services, including without sharing women.A Pennsylvania study19 measuring general residents suggested that, although view care, their bases inconsistent across specialties. That study did survey particular residents.19 Even seemed benefits, demonstrated nationwide web-based chief by Tang al.20 results surveys indicate continued evaluation residents' they women's health. help residencies determine design appropriate education curricula, which will, turn, empower graduates appropriately advise options.To understand we conducted cross-sectional residency programs—ob-gyn, combined medicine-pediatrics pediatrics—at David Geffen School Medicine at University California, Los Angeles (UCLA). We distributed 220 5 questions aimed identify common surrounding providers. Sixty-six participated response 30%. were significantly more female respondents than male (73% versus 27%). Only 9% considered going into practice, wanted pursue subspecialty fellowships (42%) academic faculty positions (30%) future.Not surprisingly, had highest mean scores compared other program types. All resident responders practice felt comfortable statistic was lower, however, specialties, only one-half medicine 61% place patients. None inserting whereas 10% responding table shows comparison respect IUDs.Although complete understanding awareness practices, surveys, our own, demonstrate skills gap, residents. Knowledge methods, especially long-acting, essential specialists. Residency programs existing gaps knowledge. This, change curricula training. Resident tool population benefits. Cross-specialty sessions, grand rounds, workshops organized centers achieve goal. As leaders way start collaborative efforts. At UCLA, initiated cross-training efforts improve different methods general, LARCs particular. been workshops—morning reports centered experts provide held medicine-pediatrics. Residents didactic importance LARCs, followed hands-on workshop. Spreading Eligibility Criteria Contraceptive Use, provides medically challenging published Centers Disease Control Prevention, also sessions.Knowledge key should promote didactics pregnancy rates