Survey of Fertility Awareness Based Methods Incorporated into Women’s Health Curricula in Family Medicine Residency Programs Lauren Gordon MD, Robert Motley MD, Marguerite Duane MD, Scott Krugman MD Fertility Appreciation Collaborative to Teach the Systems (FACTS) STFM National Meeting, Baltimore, MD May 2 nd, 2013

Background: Family Planning Contraceptive methods Oral contraceptive pills Transdermal patch Norplant®; Implanon®; Nexplanon® Vaginal ring Mirena® IUD Fertility Awareness Based Methods Sympto-thermal Billings Ovulation Creighton FertilityCare Standard Days; Two Day Marquette Sympto-hormonal In the past 40 years, significant evidence-based advances in…

Questions Are Fertility Awareness Based Methods (FABMs) included in women’s health/family planning curricula in family medicine residency programs in a fashion similar to other family planning and contraceptive methods? Are faculty knowledgeable & confident in presenting these methods? What are faculty members’ attitudes & opinions toward FABMs?

Methods Cross sectional survey sent to 120 FMEC Family Medicine residency programs Northeast region of the United States Addressed to Program Director  Women’s Health coordinator 4 cycles; Survey Monkey was survey instrument 1 response requested per program IRB exempt (LVHN), approved (MedStar)

Quantitative Analysis Descriptive statistics for Demographic variables Outcomes Chi Square analysis For associations between demographic variables & outcome measures Likert-type responses were dichotomized

Qualitative analysis Gathered from 3 questions about effectiveness, why patients would/would not be interested, general comments & feedback Methodology included: Open coding: what is described in the data? Data-driven theming: what are the common data patterns? Interpretation of the data: what does the data mean?

Results Who responded? How many years have you been out of residency? 0-5 years 5-10 years years years years >25 years 52 of 120 programs responded = 43%

Results Residency Setting

Results Share of curriculum Mean hours devoted to family planning = 5 (Range 1-20 hours) 38% devoted to hormonal contraception 8% devoted to FABMs 25% of programs do not include FABMs at all Comparing programs with >20 hours of women’s health vs. those with fewer hours 20% vs. 10% believe FA effective, p=0.33 Of those with >20 hours of women’s health: 76% had >4 hours of FABMs vs 35% of those with fewer hours, p=.004

Results Knowledge of FABMs With regard to fertility awareness methods of family planning, please rate your level of familiarity with the methods below using the following scale:

Results Effectiveness relative to OCPs If you are familiar with published evidence about user effectiveness rates of fertility awareness based methods, please rate following methods relative to OCPs:

Faculty perceptions & opinions about level of interest in FABMs Women were more likely than men to think that fertility awareness methods were effective. There was no difference in belief about fertility awareness methods in programs that have a religious affiliation. Programs with more hours dedicated to women’s health were more likely to believe that fertility awareness methods are effective.

Qualitative findings Positive aspects Achieving Pregnancy Alternative to using meds; hormone free Relatively inexpensive, accessible Self knowledge & awareness Constraints Requires education and appropriate application Interest Readiness/motivation Time requirements & convenience Themes based on comments received in questions about effectiveness, patient interest and general comments about the survey

Limitations Pilot study, small sample size Generally, there were trends but not statistically significant Further study is warranted One question in Survey Monkey not formatted to accept multiple choices Q 18 regarding which FABMs included in family planning sessions Over 1/3 of respondents used comments section to list all those included in their presentation Responses from northeastern portion of the US Survey data from other parts of the US would be helpful

Summary & Conclusions FABMs are underrepresented in the women’s health curricula in FM residency programs 25% of program respondents don’t include at all Programs with more women’s health curriculum time are more likely to include FABMs Faculty members have limited awareness of modern FABMs and relative effectiveness for family planning Most familiar with outdated “rhythm” method 47% believe FABMs could be effective with qualifications 65% believe women would be interested in FABMs

Future directions… National survey of residency faculty Addressing the knowledge gap with faculty development & support Evidenced-based information for faculty & residents Patient-centered approach Process to assess patient/partner interest, readiness & motivation Decision support tools Guide interested patients toward “best fit” FABM model Local & online resources for self-care education/support Clinician support of patients who choose an FABM