Barriers to and Facilitators of Contraceptive Implant Training in New Jersey Family Medicine Residencies: A Qualitative Study

Abstract

Background and Objectives: The aim of this study was to examine experiences of New Jersey family medicine residents and preceptors with the etonogestrel subdermal contraceptive implant and to explore barriers to and facilitators of training. Methods: In this qualitative study, we conducted semistructured individual interviews to explore residents’ and preceptors’ experiences with contraceptive implant procedural training. We invited residents and preceptors from programs with high (5.2–10.9) and low (0.0–0.1) implant procedures per resident to participate. Participants discussed factors that supported or inhibited implant training and provision. We transcribed, coded, and analyzed interviews on a rolling basis. We used memoing to reflect on the data and identify saturation. We developed and refined our codebook using a collaborative, iterative process. We analyzed interviews using deductive and inductive techniques to identify themes. Results: We interviewed 25 subjects: 14 residents and 11 preceptors from four family medicine residency programs with the highest and lowest implant training numbers. Common barriers included lack of hands-on experience with the procedure, lack of teaching with the procedure, and difficulty scheduling patients. Facilitators included formal training and inclusion of contraception in residency curricula, preceptors’ comfort with the procedure, office sessions dedicated to procedures or gynecology visits, and patient familiarity with the implant. Conclusions: Family medicine residencies provide unique opportunities to impact provision of long-acting reversible contraception (LARC). We identified potential interventions, including formal implant training sessions, dedicated procedure office sessions, stocking of devices in the office, and staff focused on reproductive health that can aid in scheduling, obtaining devices, and setup.

Clinical Approaches to Nestorone Subdermal Implant Therapy in Women’s Health

“…Since then, several studies have demonstrated that this route of administration provides a safety profile and effective therapy without the fluctuations in blood levels commonly seen with transdermal administration [ 10 , 11 , 12 , 13 , 14 ]. The administration of hormone implants has been used worldwide for decades and it has increased after the etonogestrel implant (Nexplanon) was disseminated worldwide as an effective and safe contraceptive method [ 15 ]. In some countries, such as Brazil, non-absorbable implants (Silastic) are widely used to treat menopause, contraception, and endometrioses ( Figure 2 ) [ 16 , 17 , 18 , 19 ].…”