SRFP041: Exploring barriers to LARC placement training for family medicine residents (Pearls)

Komal Soin, MD, MPH; Liana Kobayashi, DO, MPH; Thomas Quattlebaum, MD; Chien-Wen Tseng, MD, MPH, MS

Abstract

Context: Long-acting reversible contraception (LARC) such as implants and IUDs are highly effective birth control methods. Physicians’ ability to offer LARCs is important for patient access and LARC training is recommended by the ACGME. At the University of Hawaii Family Medicine Residency Program, we explored residents’ interest in LARCs and difficulties experienced with LARC training. Our goal is to design a better curriculum to train family physicians who are competent and confident to insert LARCs in their future practice. Objectives: To evaluate residents’ interest in providing LARCs and barriers to LARC training. Study Design: Residents received general contraceptive and LARC training in their continuity clinics, OB/GYN rotations, and electives at Planned Parenthood. Evaluation of their LARC training experience consisted of a cross-sectional online survey conducted in May 2021. Setting: Community-based family medicine residency program. Population Studied: Family medicine residents. Results: Of the 21 residents (100% response), nearly all considered it “very important” for family medicine training to include general contraceptive counseling (95%) though this was lower for implant (76%) and IUD training (76%). The most common barrier (“moderate” or “significant”) to LARC training was lack of time (81%). Most residents reported 30 minute or less was sufficient for general contraceptive counseling (95%) but not for same-day implant (24%) or same-day IUD placement (14%). Other barriers included too few patients requiring LARCs (76%), doing initial contraceptive counseling but follow-up LARC placement done by different clinician (58%), and attending not available (38%). Regarding intentions after training, female versus male residents reported much higher rates of being “very likely” to provide general contraceptive counseling (100% vs 40%), implant (90% vs 30%) and IUDs (90% vs 20%) in their future practice. Conclusions: Most residents considered LARC training to be very important for family physicians but interest in providing LARCs in future practice was significantly higher amongst female versus male residents. Major barriers which need to be addressed with LARC training are that LARC placement takes time (scheduling into a procedure clinic may help), needs required volume (may need specific electives with opportunity to place LARCs), and gender differences with regards to interest in contraceptive counseling after training.
Leave a Comment
Jack Westfall
jwestfall@aafp.org 11/21/2021

Thanks for your terrific work on this research. Hope we can connect.

Komal Soin
ksoin@hawaii.edu 11/23/2021

Hi Jack. Thank you. Please email me at the attached email address if you have any specific thoughts or comments! Thanks! Komal

Gillian Bartlett
gillian.bartlett@health.missouri.edu 11/21/2021

This is such an important training area - particularly as we have minimized or dismissed the potential harms for oral contraceptives for women. I really hope you continue in this area and work to improve access/willingness to engage in this training.

Komal Soin
ksoin@hawaii.edu 11/23/2021

Thank you Gillian. Totally agree. Thank you for taking the time to look at our research poster

William R. Phillips
wphllps@uw.edu 11/21/2021

Great within the limitations of your single program. Training clinicians to perform procedures and doing research on that training can both be challenging. Because of the limitations you face, it may be unrealistic to provide adequate training within your program. What resources are available to fill-in the needed training for your residents? How did you take on the fundamental question of how many procedures are the minimum or optimal for adequate training? This is a problem across all research on scope of practice, which is an important area and PC education research. Thanks for sharing your work here at NAPCRG. - Bill Phillips

Komal Soin
ksoin@hawaii.edu 11/23/2021

Hi Bill Thank you for your comment. Yes we are trying to find other resources - have actually linked up the Ob/Gyn residency here where residents now rotate through their clinic and they are getting some more LARC experience there. Additionally residents have apportunities to do family plannign elective with OB/Gyn and planned parenthood. We are hoping this may improve number of LARCs they can insert. The question for minimal/optimal for trainign is difficult as you suggested. In our survey we saw that some residents felt conident with 3-5 insertions while others did not, so this may truly be resident dependent. Thank you again for taking time to look at our poster

Diane Harper
harperdi@med.umich.edu 11/22/2021

We must continue to train all FP in LARC use, appropriate women to use, how to insert and remove. Thank you for sharing your work with NAPCRG!

Komal Soin
ksoin@hawaii.edu 11/23/2021

Thank you for taking the time to read our poster and your comments. Totally agree Komal

Andy Pasternak
avpiv711@sbcglobal.net 11/26/2021

Small study but typically if this is happening in one place, it's happening in others. Well done

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