1. Long Acting Reversible Contraception: Knowledge, Perceptions
and Practices Among Current US Obstetrics and Gynecology Residents
Josette C. Dawkins MD1; Gregory K. Lewis MD1; Earlando O. Thomas MD1; Amy R. Harrington MD2. 1Department of Obstetrics and Gynecology, Rochester Regional Health, Rochester, NY
2Department of Obstetrics and Gynecology, University of Rochester Medical Center , Rochester, NY
RESULTS
BACKGROUND
Table 1: Demographic Characteristics Associated with Respondents
Variable
Number, Percent (N, %) Total number =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 Training 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%)
South (152, 29.2%)
MidWest (119, 22.8%)
West (62, 11.9%)
Figure 1: Distribution by responses by Region in the USA (Number of responses and percentage of total responses)
Contraception counseling and family planning are core components of the curriculum of Obstetrics and Gynecology residency programs.
The unintended pregnancy rate with the use of Long Acting Reversible Contraception (LARC) is superior to that with use of non-LARC .
Women are delaying childbearing in pursuit of other interests. Health care reform with expansion of Medicaid and social media use have been favorable towards LARC uptake.
OBGYN residents have four years to acquire skills to become adept in the provision of longitudinal care tailored to the contraception needs of women across their reproductive cycle.
521 respondents from a pool of 1505 residents (34.6%) in 68 programs, from 38 states
All four postgraduate years and US regions were represented.
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 counselling ability
99% would recommend a LARC regardless of year of training, geographical region or religious affiliation of program.
Knowledge based questions were correct 77%-98% of the time, with improvement based on year of training.
53% reported using a mobile device app to aid in knowledge and practice.
The hormonal IUD was preferred for placement among multiparas and those with chronic medical illnesses. The availability of low cost immediate post partum placement has increased uptake in this patient cohort.
The Etonogestrel subdermal implant was preferred for placement among nulliparous patients
OBJECTIVES
To evaluate the knowledge, perception and practices towards LARC among current Obstetrics and Gynecology residents in the United States.
To compare the attitudes towards LARC of current residents to those in previous studies.
Factors facilitating LARC uptake were
Barriers affecting LARC uptake were
Increased public awareness
Lack of patient insurance
Increased coverage for immediate postpartum/pregnancy loss placement
Negative perceptions and prior experiences among patients
Medicaid expansion with provision of low cost/no cost IUD
Lack of provider reimbursement
Increased resident exposure by faculty
Institutional or state restriction affecting LARC provision
Dedicated family planning rotations/Ryan training programs
DESIGN AND METHODS
Web based cross sectional study involving residents enrolled in ACGME accredited Obstetrics and Gynecology programs across the USA.
LARC included the Levonorgestrel IUD (LNG-IUD) (Mirena, Liletta, Kyleena, Skyla), the Copper T 380 IUD, and the Etonogestrel subdermal implant.
Data was collected using SurveyMonkey.
Results were analyzed using descriptive statistics and SPSS 24 for statistical tests.
CONCLUSIONS
Current US OBGYN residents are more confident in their knowledge and skills in LARC placement compared with residents from previous studies1,2.
Residents attribute their experience to the increased availability of low or no cost IUDs, immediate postpartum placement of LARC, 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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Turok DK, Gawron LM, Lawson S. New developments in long-acting reversible contraception: the promise of intrauterine devices and implants to improve family planning services. Fertil Steril 2016 Nov;106(6):
American College of Obstetricians and Gynecologists' Committee on Obstetric Practice. Committee Opinion No. 670: Immediate Postpartum Long-Acting Reversible Contraception. Obstet Gynecol 2016 Aug;128(2):e32-7. 
REFERENCES