Immediate Postpartum IUD Training Within a Regional Network of Family Medicine Residencies

Abstract

Background and Objective: Immediate postpartum placement of intrauterine devices (PPIUD) offers important benefits to patients. Little is known about PPIUD training or knowledge within family medicine residency programs. We evaluated PPIUD experience and prior training among family medicine residents and faculty. Methods: We conducted a cross-sectional survey of residents and faculty in 24 regional family medicine residency programs in 2018. Survey questions focused on reception of PPIUD training and experience with PPIUD counseling and placement. Results: The final survey sample included 203 residents and 100 faculty with an overall response rate of 39%. About 26% (n=79) of all participants reported receiving prior training for counseling and placement of PPIUDs, while 16% (n=48) of participants had ever placed a PPIUD. Twenty-six percent (n=78) of participants reported that their residency programs offered PPIUD training. Residents and faculty who reported past PPIUD training and/or placement experience were more likely to have ever counseled patients about PPIUD (P<.001) and report that their primary training hospital offered PPIUD to patients (P<.001) and their residency programs offered PPIUD training (P<.001). Conclusions: Few programs offer routine PPIUD training opportunities for family medicine residents and faculty, which may contribute to limited availability of PPIUD to patients. There is a need to improve PPIUD training and placement opportunities for both family medicine residents and faculty.

Procedural skills training during residency

“…9 Not surprisingly, such training also makes residents more likely to offer these options to their patients. 10,11 Finally, it is worth considering the impact of potential expansion of the postgraduate program from 2 to 3 years in length. Although this will naturally provide residents with additional time to practise and solidify their procedural skills, to our knowledge, there are no data to suggest that similar levels of competence could not be achieved in the shorter time span with intentional exposure and education.…”

Formation en habiletés techniques pendant la résidence

“…8 Heureusement, les résidents qui reçoivent une formation pratique directe sur les interventions chirurgicales font état d'une plus grande aisance et d'une plus grande compétence dans ces interventions. 9 Il n'est pas surprenant qu'une telle formation fasse en sorte que les résidents sont plus susceptibles d'offrir ces options à leurs patients 10,11 Enfin, il convient de considérer l'incidence d'un prolongement potentiel du programme de formation postdoctorale qui passerait de deux à trois ans. Même si ce prolongement donnait naturellement plus de temps aux résidents pour améliorer et consolider leurs habiletés techniques, il n'y a pas de données, à notre connaissance, qui indiquent que des niveaux de compétences semblables ne pourraient pas être atteints dans un laps de temps plus court avec une exposition et une formation intentionnelles.…”

How NPs can eliminate practice barriers to intrauterine device use

“…In a survey of 100 family medicine faculty and 203 residents, only 26% had ever received education on PPIUD, 83% had never performed it, and 57% reported their hospitals did not offer it. Only 3% had performed six or more PPIUDs 32…”

“…Immediate postpartum placement of IUDs (PPIUD) minimizes delays in providing effective contraception, and is cost-effective, convenient, and safe for women. Despite evidence for its safety and effectiveness, multiple barriers including lack of provider training limit PPIUD 32. In a survey of 100 family medicine faculty and 203 residents, only 26% had ever received education on PPIUD, 83% had never performed it, and 57% reported their hospitals did not offer it.…”

“…Only 3% had performed six or more PPIUDs. 32 It is also important for providers to recognize that immediately postpartum may be an inappropriate time to begin a conversation about IUD placement as this can be perceived as reproductive coercion. 15 When available, the option for immediate PPIUD should be discussed during routine prenatal care visits and, if the patient opts in favor of PPIUD, affi rmative consent should be obtained again prior to IUD placement.…”