Abstract: P-040

An Update: Long Acting Reversible Contraception Knowledge, Perceptions and Practices Among Current Us Obstetrics and Gynecology Residents.

Presenter: Josette Dawkins


Abstract


OBJECTIVE: To evaluate the knowledge, perception and practice of Long Acting Reversible Contraception (LARC) among current Obstetrics and Gynecology Residents in the USA.
DESIGN: Web based cross sectional study involving residents enrolled in ACGME accredited Obstetrics and Gynecology Programs in the USA. The LARC included were the Hormonal IUD (Mirena, Liletta, Kyleena and Skyla), the Copper IUD and the Etonogestrel subdermal implant. view more

OBJECTIVE: To evaluate the knowledge, perception and practice of Long Acting Reversible Contraception (LARC) among current Obstetrics and Gynecology Residents in the USA.
DESIGN: Web based cross sectional study involving residents enrolled in ACGME accredited Obstetrics and Gynecology Programs in the USA. The LARC included were the Hormonal IUD (Mirena, Liletta, Kyleena and Skyla), the Copper IUD and the Etonogestrel subdermal implant.
MATERIALS AND METHODS: Data was collected using SurveyMonkey. Results were analyzed using descriptive statistics and SPSS 24 for statistical tests. Differences in year of training, geographical location & the presence of a family planning rotation were compared.
RESULTS: There were 521 respondents (34.6%)from a pool of 1505 residents in 68 programs, from 37 states, representing all four postgraduate years and US regions. The majority (99%) had received didactic or simulation training on LARC placement, 98% had already placed a LARC, 97.4 % were moderately to extremely confident in their counseling ability, and more than 99% would recommend a different contraception method, regardless of year of training, geographical region or religious affiliation of program. A total of 53% reported using a mobile device app to aid in knowledge and practice.
The Hormonal IUD (specifically MIrena) was the most placed among multiparas and in other medical conditions. The etonogestrel subdermal implant was most favored for nulliparas. Perceived barriers affecting LARC uptake were patients' negative beliefs and prior experiences (53%), financial (lack of patient insurance or provider reimbursement (45.8%), and institutional or state restrictions affecting LARC provision (10.7%.). Respondents highlighted that factors facilitating LARC uptake included increased coverage for immediate postpartum/pregnancy loss placement (30.5% ), Medicaid expansion with the provision of low/no cost IUDs (27.1%), and increased resident exposure due to dedicated family planning rotations/Ryan Programs (13%).

Table 1: Demographic characteristics associated with respondents
Variable Number,  Percent( n=521, %)
Postgraduate year of training PGY1 (129, 24.8%) PGY2(130, 25.0%) PGY3 (168, 32.2%) PGY4 ( 94, 18.0%) -
Gender Male (66, 12.7%) Female (450, 86.4%) Other/Undisclosed(5, 1.0%) - -
Religious affiliation affecting education or provision of LARC Yes (64, 12.3%) No (454, 87.1 %) Unsure(3, 0.2%)
RYAN Program Yes (219, 41.9%) No (302, 58.1%) -
Planned Subspecialty General practice (299, 57.4%) Oncology/REI/Minimally Invasive/Urogyn (96, 18.4%) MFM/Pediatric GYN(48, 9.2%) Family Planning (21, 4%) Unsure(57, 11%)
Region NorthEast (188, 36.1% MidWest(119, 22.8% Southwest/SouthEast (152, 29.2%) West( 62, 11.9%) -

CONCLUSIONS: Current US OBGYN residents are more confident in their knowledge and skills in LARC placement compared to previous studies1,2. Residents attribute their experience to the increased availability of low or no cost IUDs and immediate postpartum placement, increased public awareness and increased faculty support3,4. Technological advances such as apps are important educational tools that can increase resident comfort and confidence in providing evidenced based care.

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