BREAST VERSUS BOTTLE: EDUCATING FAMILY MEDICINE AND OB/GYN RESIDENTS AT BROWN UNIVERSITY

Medicine and Health Rhode Island, May 2004 by Taylor, Julie Scott, Kacmar, Jennifer, Viehmann, Laura, Stumpff, Jeffrey

Experts recommend breastfeeding as the preferred method of feeding for infants for at least one year because of its multiple immediate and long-term benefits for both mother and child. Yet breastfeeding rates in the United States fall below the Healthy People 2010 goals.1,2 We know that parents make decisions about infant feeding methods long before delivery3,4 and that physicians can influence breastfeeding success.5,6 Therefore obstetricians and family practitioners, as physicians who have frequent contact with women before and during pregnancy, can potentially influence breastfeeding success.

Studies from the early 1990s showed that residency training on breastfeeding across specialties was markedly inadequate and that both residents and practicing physicians in obstetrics, family medicine, and pediatrics were ill-prepared to counsel parents on this subject.7-10 Although some educational interventions have since been created for individual residency programs,11 breastfeeding education is still inconsistent across programs and specialties. Anecdotally, at Brown, many resident physicians in family medicine felt that their breastfeeding education was more than adequate if not excessive, but those in obstetrics and gynecology did not. Therefore, we decided to assess breastfeeding education in these two different programs.

We used a written survey to evaluate the breastfeeding knowledge, attitudes, training and experience of resident physicians in family medicine and obstetrics and gynecology at two different hospitals affiliated with Brown Medical School. We sought to assess both residents' current training and their educational needs so that faculty could improve teaching at both sites.

METHODS

SUBJECTS

Subjects included 66 resident physicians in all years of training in family medicine (FM) and obstetrics and gynecology (OB/GYN) at Brown Medical School. The two residency training programs are located at Memorial Hospital of Rhode Island and Women & Infants' Hospital. Residents were given anonymous self-administered questionnaires.

QUESTIONNAIRE DESIGN

The survey instrument was based on the American Academy of Pediatrics Periodic Survey of Fellows #30, an eight-page, forced-choice-format questionnaire for physicians on breastfeeding education, knowledge, experiences, and practices.12 Some questions were omitted and two modifications made to incorporate more specific information about educational and clinical experiences.

First, residents were asked two questions about the source and format of their education on breastfeeding: "From, whom have you learned the most about breastfeeding?" and "Where have you learned the most about breastfeeding?". They were instructed to select and rank the five most important learning experiences from either medical school or residency. For the first question, potential sources included: faculty, inpatient nursing staff, outpatient nursing staff, lactation consultants, patients, other residents, friends / relatives, personal experience, and 'other'. For the second question, options were: lectures, independent readings, prenatal visits, hospital labor & delivery floor, hospital post-partum floor, post-partum visits, well baby visits, and Other'. Respondents were to rank these five in importance from 1 to 5, with 1 the most important.

A second set of questions was added based on Freed's 1995 study of residents and practitioners in family medicine, obstetrics and gynecology, and pediatrics. His research group asked four questions on the clinical experiences of residents providing breastfeeding support. They reported the percentage of residents that had performed these activities five or more times during residency as a reasonable amount of practice necessary to gain competence with breastfeeding promodon.

Our final instrument was six pages, with 23 questions, and took 10 to 15 minutes to complete. It included questions on demographics, personal parenting experience, self-perception of breastfeeding competency (10-point scale), sources of breastfeeding education, clinical knowledge, and clinical experience.

DATA COLLECTION AND ANALYSIS

The survey was pilot-tested by three family medicine maternal-child health fellows. It was distributed in june 2002 during regularly scheduled residency meetings at each site. Two additional mailings were performed that same month, with surveys returned in numbered envelopes to a research assistant to maintain anonymity. Institutional Review Board approval was obtained at both sites. The data were analyzed using SPSS version 11.0.

RESULTS

STUDY SAMPLL

The overall response rate was 88% (58 of 66), with 35 of 39 FM residents participating (90%) and 23 of 27 OB/ GYN residents participating (85%). Respondents and non-respondents were dcmographically similar. (Table 1) The average resident was approximately 30 years old. Three quarters were female. A significant proportion (23% in FM and 30% in OB/GYN) were parents. Overall breastfeeding knowledge was self-reported on a one ("none") to ten ("more than I will ever use") scale. In FM, the average self-reported breastfeeding knowledge was 6.1, 7.1, and 7.3, for years 1, 2, and 3, respectively. In OB/GYN, the average self-reported breastfeeding knowledge was 5.2, 6.2, 7.0, and 6.4, for years 1 to 4, respectively. The overall self-rated breastfeeding knowledge was 6.9 and 6.2 in FM and OB/GYN, respectively (p = 0.70).