Knowledge and Training of Intrauterine Devices Among Primary Care Residents: Implications for Graduate Medical Education.

Abstract

Nearly half of pregnancies in the United States are unintended, a rate that has increased recently, contrasted with a worldwide decline.1,2 This lack of progress may be due to low adoption of long-acting reversible contraceptives (LARCs). The United States has the lowest rate of intrauterine device (IUD) use of any industrialized country.3,4 Because IUDs have high user satisfaction and effectiveness, increased adoption could lead to reductions in unplanned pregnancies (and fewer adverse outcomes) and prevent abortions.4,5 Both in public and private sectors, primary care providers have an important role in preventing unintended pregnancies. Although many women receive contraceptive counseling and services from obstetrics and gynecology (ob-gyn) specialists, a significant proportion see family practitioners, internists, and pediatricians (caring for adolescents) for one or both.6 The National Ambulatory Medical Care Survey is designed to meet the need for objective, reliable information about the provision and use of ambulatory medical care services in the United States. According to the latest data available from this survey, 11.5 million visits occurred in 2010 for contraception and family planning counseling.7 It is important, therefore, that all provider types be well informed regarding IUDs. A significant proportion of physicians trained in primary care specialties add further training in subspecialties: subspecialist physicians take care of women with complex medical problems that pose a significant risk for pregnancy. Therefore, contraception knowledge is important to medical and pediatrics subspecialists as well. Although the Accreditation Council for Graduate Medical Education requires training in family planning and contraception as part of the core curriculum for internal medicine, pediatrics, family medicine, and ob-gyn residents, structured teaching in the area of contraception is not necessarily a systematic part of this curriculum (B O X).8