Update on long-acting reversible methods

The Role of Video-Assisted E-Learning in Intrauterine Contraceptive Device Insertion Training

Introduction

Intrauterine contraceptive device (IUCD) insertion is an important procedural skill for primary care physicians. Procedural skill training can be challenging. E-learning has been rapidly employed in medical education. The purpose of this study was to evaluate the role of a video-assisted e-learning module in knowledge and skill transfer for IUCD insertion training.

Methods

We used a quasi-experimental, one-group, pre/posttest study design. Thirty-one primary care doctors (family medicine residents and new medial officers) at a primary care training center participated in the study. All participants assessed the e-learning module at the training center. We performed on-site pre/posttests of knowledge and procedural steps (posttest only). We obtained satisfaction with e-learning and perceived confidence level with an anonymous questionnaire survey.

Results

There was a significant increase in the knowledge test scores from a median interquartile range score of 12 (10-15) to 18 (17-19) post-e-learning (P<.01). All participants attained the minimum passing score of 15 of 20 (75%) post-e-learning. However, only 20 of 31 (64.5%) participants met the minimum passing standard for procedural step test post-e-learning. Ninety-three percent of the participants reported satisfaction with the e-learning course. The median score for confidence level in performing the procedure increased significantly after e-learning.

Conclusion

The e-learning module may be an effective way of delivering instructional content in procedural training. It provides time and location flexibility and is useful for pretraining. Psychomotor skills for clinical procedures, however, may be difficult to acquire by e-learning alone. It must be supplemented with deliberate practice and hands-on learning in simulation workshops.

Intrauterine contraceptive device insertion simulation training in primary care

Background and objectives:

Insertion of a intrauterine contraceptive device (IUCD) is one of the services provided at our public primary care polyclinics. We evaluate the effectiveness of a simulation workshop using low-fidelity mannequins to train primary care doctors.

Methods:

Questionnaire feedback was collected before and after the workshop. Participants rated their confidence level in performing the insertion of IUCDs using a 10-point scale.

Results:

A total of 37 out of 44 (84%) participants completed the survey. The median score for confidence level in performing the procedure increased from 2 out of 10 (interquartile range (IQR) 1 to 5) before the workshop to 8 out of 10 (IQR 7 to 9) after the workshop ( p < 0.01). The increase in confidence level was most pronounced among the participants with no previous experience with the procedure and those who had inserted only one or two IUCDs before the workshop. Participants rated a median score of 9 out of 10 (IQR 8 to 10) in their interest level to perform the procedure after the workshop. The overall experience of the workshop recorded a median score of 5 out of 5 using a five-point Likert scale.

Conclusions:

Bedside procedural training has been challenging. The teaching of the procedure via a structured workshop format including a simulation of the procedure using a low-fidelity mannequin increases the confidence level of participants to perform the procedure. A similar format can be employed for training of other primary care procedural skills.

Institutionalizing postpartum family planning and postpartum intrauterine device services in Nepal: Role of training and mentorship

OBJECTIVE

To explore the perceptions of key stakeholders on different modalities of training and mentoring activities for healthcare providers of postpartum family planning and postpartum intrauterine devices (PPFP/PPIUD).

METHODS

In this qualitative study, data were collected from 40 participants in December 2017 via focus group discussions (FGD) and in-depth interviews (IDI) in three hospitals implementing PPFP/PPIUD services and government line agencies in Nepal. Data were analyzed through content analysis and grouped into themes and categories.

RESULTS

The majority of participants reported that PPFP/PPIUD training and mentoring was useful and contributed to their professional development. Most found that on-the-job training (OJT) was more effective than group-based training (GBT).

CONCLUSION

Training and mentoring activities were perceived to be useful by health providers and OJT was the approach preferred by the majority. Further studies are necessary to explore the existing challenges and long-term effects of each modality of training and mentoring on health providers' competency and attitudes and on the uptake of PPIUD by postpartum mothers.

Changes in body composition in women using long-acting reversible contraception

OBJECTIVE

Users of hormonal long-acting reversible contraception (LARC) report weight gain as a side effect, but few studies have assessed body composition change among LARC users. We evaluated weight and body composition of healthy women using the levonorgestrel intrauterine system (LNG-IUS), copper intrauterine device (copper IUD) or etonogestrel implant (ENG implant). We hypothesized that weight gain and body composition over 12 months would not differ between copper IUD, LNG-IUS and ENG implant users.

STUDY DESIGN

We performed a prospective cohort study of a subgroup of women enrolled in the Contraceptive CHOICE Project who initiated the LNG-IUS, copper IUD or ENG implant. Inclusion criteria included lack of metabolic and eating disorders or change in body weight of more than 5% in the 6 months before enrollment. We measured changes in weight and body composition (body fat percentage, total body fat mass, total lean mass and total body mass) in women who continued their method for 12 months.

RESULTS

We analyzed data from 149 participants: 85 LNG-IUS users, 31 copper IUD users and 33 ENG implant users. The mean age was 25.9 years, 56.4% were White, 82.5% had some college education and 67.6% were nulliparous. Although lean body mass increased over 12 months in LNG-IUS and copper IUD users but not in ENG implant users, changes in body weight and body composition did not differ between the groups. In the adjusted model, Black race was associated with change in total body mass (p<.05).

CONCLUSIONS

Among those who continued the method for 12 months, changes in body weight and composition did not differ between copper IUD, LNG-IUS and ENG implant users.

IMPLICATIONS STATEMENT

Changes in body weight and composition over 12 months did not differ between copper IUD users and LNG-IUS and ENG implant users among those with 12 months of continuous use.

Contraception for the perimenopausal woman

Perimenopause, or the menopause transition, is a time in a woman's life that bridges her reproductive years through to the non-surgical cessation of ovulation, or menopause. For many women this time is one of changes: changes in gynecological issues, onset of symptoms not experienced in her youth and increasing risks for adverse medical conditions. Despite the clear changes that occur for many women during this time, one critical issue is frequently ignored, namely, that, until the onset of menopause, she is exposed to pregnancy if sexually active, and pregnancy for older reproductive women is fraught with considerable increases in morbidity and mortality compared to younger women. This paper will present a review of the reproductive issues of the perimenopause and interventions geared to preventing pregnancy and relieving menopause-related symptoms. As counseling remains a critical aspect in empowering women to make informed choices about their health care, this paper will present current evidence that will help clinicians provide accurate reproductive counseling to women in the menopause transition.