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

Abstract

Materials and Methods: A Markov model of antibiotic side effects, infection and infection sequelae (ectopic, chronic pain and infertility) was developed. Three options were considered: no antibiotics, prophylactic antibiotics (pre-abortion single-dose) and treatment-dose antibiotics (postabortion multiple-dose). Two models were run using either a 20-year-old or a 30-year-old woman who desires children in the future. One-way, two-way and Monte Carlo sensitivity analyses were performed. A $50 000 per quality-adjusted life year threshold was used for cost-effectiveness. Results: For a 20-or 30-year-old woman, no antibiotic is favored if the baseline infection risk is b 0.6% or b 0.8%, respectively. Treatment-dose antibiotics is favored if the risk of infection exceeds 3.7% or 4.8%, respectively. Otherwise, prophylactic antibiotics are favored. Discussion: Results were sensitive to varying relative infection risk between prophylactic and treatment regimens but were robust to variation of other cost and outcome parameters. Conclusion: Further study is needed to examine antibiotic use in settings with a low incidence of postabortal infection and to compare prophylactic and treatment regimens directly. Further delineation of the sequelae of postabortal infection is also needed.

Health care providers' knowledge about contraceptive evidence: a barrier to quality family planning care?

“…The lower level of contraceptive knowledge among family medicine providers is consistent with a previous study of residents in obstetrics and gynecology and family medicine [14]. This is not surprising, as several previous studies have found that family medicine residency programs are lacking in contraceptive training [14, 25, 26]. As family medicine providers provide a substantial amount of contraceptive care in the United States [27], a focus on improving contraceptive education in residency programs and CME programs could improve the care provided to women.…”

“…For older providers, attention to continuing medical education (CME) with emphasis on evidence-based resources, such as the WHO recommendations [12], has the potential to improve knowledge. The lower level of contraceptive knowledge among family medicine providers is consistent with a previous study of residents in obstetrics and gynecology and family medicine [14]. This is not surprising, as several previous studies have found that family medicine residency programs are lacking in contraceptive training [14, 25, 26].…”

“…Another study assessed the contraceptive knowledge of family medicine, obstetrics and gynecology, pediatric and internal medicine residents on a variety of topics and found that, overall, residents answered just over 50% of these questions correctly. Being an obstetrician-gynecologist, being female, and inserting IUC were associated with higher levels of knowledge [14]. …”

A Didactic Intervention to Improve Fertility Knowledge Among Resident Physicians

“…Internal Medicine physicians are frequently the first line of counseling for men and women of reproductive age. 1,14 These physicians often have access to their patients during both well and sick visits well before any fertility issues arise, and can preemptively provide family planning and fertility counseling. The American Board of Internal Medicine Core Competencies specifically include family planning and reproductive health as part of appropriate care in the area of women's health.…”