Are IUDs a Neglected Option? Exploring Residents’ Knowledge

Intrauterine devices (IUDs) represent a safe and effective option for preventing unwanted pregnancies. Yet studies have shown that gynecologists still have concerns over its safety and do not utilize evidence-based criteria to assist in the selection of IUD candidates. In order to overcome this obstacle, it is imperative that current obstetric and gynecology residents are receiving correct information on this treatment modality-but are they?

Dr Jennifer Tang and colleagues from Brigham and Women’s Hospital, Boston, conducted an anonymous, cross-sectional, Web-based survey of 699 US obstetrics and gynecology residents. The survey included 47 questions covering demographics, prior IUD experience, family planning training, risks and benefits of IUDs, and IUD best practices. The survey also included clinical vignettes, which were designed to assess residents’ practices when counseling potential IUD candidates. Finally, the survey included an open-ended question: “What more do you wish that you knew about the IUD?” The researchers presented their findings at the American Congress of Obstetricians and Gynecologists’ 59th Annual Clinical Meeting in Washington, DC.

Based on the individual survey results, Tang and associates found a mean IUD knowledge score of 15.7 ± 2.2 (maximum score was 20). The mean IUD practice score was 9.0 ± 3.1 (out of a possible score of 13). As might be expected, postgraduate year 4 (PGY-4) residents had the highest scores (Figure). Female residents did better than their male counterparts. Other variables associated with higher scores included receiving training in the West, having recently placed 3 to 5 Cu-380A IUDs, having recently placed at least 6 LNg IUDs, having attended more than 4 IUD lectures, having completed a family planning rotation, and having a Ryan program for more than 1 year.

Figure. Knowledge and practice scores based on PGY level.

The researchers found some alarming results regarding the knowledge levels of the residents. For instance, almost half the residents did not know that the Cu-380A IUD could be used for emergency contraception. Poor knowledge rates were also found for pelvic inflammatory disease risk after insertion as well as improvement of endometriosis and adenomyosis. Further, only 20% of the residents routinely recommend immediate postplacental IUD insertion. Interestingly, all residents were aware that IUDs did not offer any protection from breast cancer.

“US obstetrics and gynecology residents need more education about the benefits of the IUD and evidence-based recommendations for IUD candidate selection,” the authors concluded. “A number of factors associated with residency training environments predict enhanced IUD education. Efforts should be made to incorporate these factors into more US obstetrics and gynecology residency programs.”

More Information

The Ryan ProgramIntrauterine Devices: American Pregnancy Association

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POLL

Reference

Tang J, Bartz D, Maurer R. Intrauterine device knowledge and practices among US obstetrics and gynecology residents. ACOG Annual Meeting. Poster 14. May 1, 2011.