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Training Residents to Place Immediate Postpartum LARC: An Update Among U.S. Residency Programs
Purpose: To survey U.S. Obstetrics and Gynecology (Ob/Gyn) Residency
Programs on immediate postpartum (IP) long-acting reversible contraception
(LARC) training and challenges.
Background: In 2016, the American College of Obstetricians and
Gynecologists (ACOG) released a committee opinion supporting IP LARC. Growing
evidence describes provider/hospital barriers which hinder IP LARC provision.
We hypothesize similar difficulties have prevented programs from implementing
Methods: We distributed an electronic survey addressing IP LARC
training to 273 U.S. Accredited Council for Graduate Medical Education (ACGME)
Ob/Gyn Residency Program Directors from the 2017-2018 Academic Year. Data
analysis was performed with chi-square and Fisher’s exact test.
Results: Of 86 programs that participated, residents were
trained in the immediate postpartum period to place implants in 54 programs
(63%) and to place intrauterine devices (IUDs) in 52 programs (60%).
2015, only 20% of the programs were training their residents to place IP IUDs.
Thirty-one percent of eligible programs initiated training in 2017. The
majority of programs focused training interns (98%). Patient/provider
convenience motivated 46% of programs to offer IP LARC and compliance motivated
The two barriers
most frequently encountered, regardless of program training status, were
problems with billing and compensation for services (61%) and the pharmacy
that reported primarily seeing patients with insurance, either private or
Medicaid, were more likely to have IP IUD training compared to programs seeing
mostly indigent/uninsured populations (p<0.05).
Discussions: IP LARC training has increased since the ACOG Committee
Opinion was published, however many programs are still facing challenges with
implementation, affecting resident training.
Contraception or Family Planning, Advocacy, Public Health, GME, Systems-Based Practice & Improvement, Patient Care, Residency Coordinator, Residency Director, Osteopathic Faculty, Clerkship Coordinator, Clerkship Director, Faculty, Resident, Student, 2019, CREOG & APGO Annual Meeting,