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Ramírez SI, Partin M, Snyder AH, Ko E, Aruma J, Castaneda MC, Casas RS. A Scoping Review of Obstetrics and Gynecology Curricula in Primary Care Residency Programs. J Gen Intern Med 2024:10.1007/s11606-024-08987-1. [PMID: 39187722 DOI: 10.1007/s11606-024-08987-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 07/30/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND While Women's Health (WH) is a priority for primary care, (Family Medicine (FM), Internal Medicine (IM), Pediatrics (Peds), and combined Medicine/Pediatrics (Med/Peds)), residency curricula remain heterogeneous with deficits in graduates' WH expertise and skills. The overall objective of this study was to assess the quality of WH curricula at primary care residency programs in the United States (US), with a focus on topics in obstetrics and gynecology (OBGYN). METHODS PubMed®, ERIC, The Cochrane Library, MedEdPORTAL, and professional organization websites were systematically searched in 2019 and updated in 2021. Included studies described OBGYN educational curricula in US primary care residency programs. Following abstract screening and full-text review, data from eligible studies was abstracted and quality assessed using the Medical Education Research Study Quality Instrument (MERSQI). RESULTS A total of 109 studies met the inclusion criteria. Over a quarter of studies were interdepartmental or interdisciplinary. The most common single-department studies were IM (38%) and FM (26%). Twenty (25%) studies addressed comprehensive OBGYN curricula; the most common individual topics were cervical and breast cancer screening (31%) and contraception (16%). Most studies utilized multiple instructional modalities, most commonly didactics (54%), clinical experiences (41%), and/or simulation (21%). Most studies included self-reported outcomes by residents (70%), with few (11%) reporting higher-level assessments (i.e., patient, or clinical outcomes). Most studies were single-group pre- and post-test (42%) with few randomized controlled trials (4%). The mean MERSQI score for studies with sufficient data (90%) was 9.8 (range 3 to 15.5). DISCUSSION OBGYN educational curricula for primary care trainees in the US was varied with gaps in represented residents, content, assessments, and study quality.
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Affiliation(s)
- Sarah I Ramírez
- Department of Family and Community Medicine, Penn State College of Medicine, 500 University Drive; HP 11, Hershey, PA, 17033, USA.
| | - Michael Partin
- Department of Family and Community Medicine, Penn State College of Medicine, 500 University Drive; HP 11, Hershey, PA, 17033, USA
| | - Ashley H Snyder
- Internal Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Elizabeth Ko
- Internal Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Jane Aruma
- Anesthesiology, Northwestern University, Evanston, IL, USA
| | - Marie C Castaneda
- Harrell Health Sciences Library: Research and Learning Commons, Penn State College of Medicine, Hershey, PA, USA
| | - Rachel S Casas
- Internal Medicine, Penn State College of Medicine, Hershey, PA, USA
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Sandhi A, Nguyen CTT, Lin-Lewry M, Lee GT, Kuo SY. Effectiveness of breastfeeding educational interventions to improve breastfeeding knowledge, attitudes, and skills among nursing, midwifery, and medical students: A systematic review and meta-analysis. NURSE EDUCATION TODAY 2023; 126:105813. [PMID: 37105124 DOI: 10.1016/j.nedt.2023.105813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/27/2023] [Accepted: 04/10/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Breastfeeding education programs are necessary to prepare healthcare students to address the breastfeeding needs of families. Various breastfeeding educational modules have been used in academic settings; however, the effectiveness of breastfeeding educational interventions remains unclear. OBJECTIVES To examine the effectiveness of educational interventions to improve the breastfeeding knowledge, attitudes, and skills of nursing, midwifery, and medical students. METHODS A systematic review was conducted searching academic databases from inception to December 22, 2022. Searches were carried out by two authors independently in PubMed, MEDLINE, Web of Science, Scopus, CINAHL Plus, Embase, Cochrane Library, and ERIC. Joanna Briggs Institute critical appraisal checklist was used. The data were extracted for a random-effects meta-analysis to estimate the standardized mean differences (SMDs) with 95 % confidence interval (CI). Subgroup analyses were performed to identify potential moderators. RESULTS Thirty-three quasi-experimental studies (12 two-group studies and 21 one-group studies), which included 1313 nursing students, 204 midwifery students, and 1066 medical students, were identified. The students who received educational interventions had significantly higher scores in breastfeeding knowledge (SMD: 0.67, 95 % CI: 0.46, 0.87 for two-group studies; SMD: 1.42, 95 % CI: 0.91, 1.94 for one-group studies), more positive attitudes toward breastfeeding (SMD: 0.43, 95 % CI: 0.22, 0.63 for two-group studies; SMD: 0.98, 95 % CI: 0.32, 1.63 for one-group studies), and higher scores for breastfeeding skills (SMD: 1.52, 95 % CI: 0.46, 2.58 for two-group studies; SMD: 1.33, 95 % CI: 0.43, 2.23 for one-group studies) than the control groups. As a teaching method, clinical practicums were a significant moderator of both breastfeeding knowledge (p = .035) and skills (p < .001). Few studies (n = 5) described the educational framework underpinning the program development. CONCLUSIONS Breastfeeding educational interventions effectively improve the breastfeeding knowledge, attitudes, and skills of undergraduate nursing, midwifery, and medical students. Incorporating clinical practicums in interventions is important. Future studies to examine useful teaching strategies for enhancing learning outcomes are warranted.
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Affiliation(s)
- Ayyu Sandhi
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Pediatric and Maternity Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Cai Thi Thuy Nguyen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Faculty of Nursing and Midwifery, Hanoi Medical University, Hanoi, Viet Nam.
| | - Marianne Lin-Lewry
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
| | - Gabrielle T Lee
- Applied Psychology, Faculty of Education, Western University, London, ON, Canada.
| | - Shu-Yu Kuo
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
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Mulcahy H, Philpott LF, O'Driscoll M, Bradley R, Leahy-Warren P. Breastfeeding skills training for health care professionals: A systematic review. Heliyon 2022; 8:e11747. [PMID: 36468118 PMCID: PMC9708688 DOI: 10.1016/j.heliyon.2022.e11747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/15/2022] [Accepted: 11/11/2022] [Indexed: 11/19/2022] Open
Abstract
Background Breastfeeding is a public health issue and the response to the low rates in the Global North needs to be multi-faceted. Within this context healthcare professionals have an important role to play in the overall multi-dimensional promotion and support of breastfeeding. As a learned skill, there is a fundamental need to improve breastfeeding skills amongst healthcare professionals. Aim To identify, analyse and evaluate studies on breastfeeding skills education for health care professionals. Methods The review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies from June 2006 to July 2021 that examined the provision of breastfeeding skills-based education for qualified or student healthcare professionals were included. A narrative synthesis was conducted, and risk of bias independently assessed by two reviewers. Findings Of 5,497 papers originally identified, 11 were included in the review. Nine studies were interventional, whilst two were observational. Participants included paediatric residents, midwives, nurses, care co-ordinators and other health care staff. Training took place in classrooms, practical workshops, or clinical settings. Observational or experiential teaching components in combination with theoretical knowledge were found to produce better outcomes than classroom-based interventions. However, the findings need to be interpreted with caution due to the risk of bias regarding study design-specific criteria. Discussion There is both a paucity of studies, and from those available, a lack of quality in terms of educational interventions specifically offering skills-based training to healthcare professionals. Breastfeeding education needs to incorporate practical breastfeeding skills not just theoretical training. Lack of standardisation currently exists across guiding frameworks, course content, educator qualification and assessment strategies which impedes the optimisation of breastfeeding education and subsequent support for mothers. Serious or high risk of bias was identified in all but one of the studies included in the review. Conclusion There is a need for high quality research evidence to optimise the design and delivery of skills-based breastfeeding education for healthcare professionals. This would have the potential to contribute to the broad suite of interventions necessary to improve support for breastfeeding.
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Affiliation(s)
- Helen Mulcahy
- University College Cork, Ireland
- School of Nursing and Midwifery, University College Cork, Ireland
| | - Lloyd Frank Philpott
- University College Cork, Ireland
- School of Nursing and Midwifery, University College Cork, Ireland
| | - Michelle O'Driscoll
- University College Cork, Ireland
- School of Nursing and Midwifery, University College Cork, Ireland
| | - Róisín Bradley
- University College Cork, Ireland
- School of Nursing and Midwifery, University College Cork, Ireland
| | - Patricia Leahy-Warren
- University College Cork, Ireland
- School of Nursing and Midwifery, University College Cork, Ireland
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Stave EA, Greenberg L, Hamburger E, Ottolini M, Agrawal D, Lewis K, Barber JR, Bost JE, Harahsheh AS. An educational intervention to facilitate appropriate subspecialty referrals: a study assessing resident communication skills. BMC MEDICAL EDUCATION 2022; 22:533. [PMID: 35804336 PMCID: PMC9270829 DOI: 10.1186/s12909-022-03592-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/28/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Our goal was to improve pediatric residents' advanced communication skills in the setting of referral to address the entrustable professional activity of subspecialty referral identified by the American Board of Pediatrics. To accomplish this aim, we created a referral and consultation curriculum to teach and assess core communication skills in subspecialty referral involving an adolescent with syncope, an anxiety-provoking symptom that is rarely associated with serious pathology. METHODS We utilized blended multimodal educational interventions to improve resident communication skills in referral of patients. Trainees participated in 1) an interactive online module on syncope focusing on "red-flag" symptoms that would warrant a subspecialty cardiology referral and 2) a 4-h intervention with Standardized Parents (SPs), focusing on the case-based application of communication skills. Communication skills were assessed by two pre- and post- Objective Structured Clinical Examination encounters of patients with syncope, with an SP evaluation using a 20-item checklist. Analysis was performed with Sign test and McNemar's test. Trainees provided feedback on a Critical Incident Questionnaire, which was analyzed qualitatively. RESULTS Sixty-four residents participated. There was an overall improvement in communication skills based on SP scores (82.7 ± 10.9% to 91.7 ± 5.0%, p < 0.001), and 13/20 items demonstrated significant improvement post-intervention. Residents' improved performance enabled them to address patient/family emotions, explain referral logistics, and clarify concerns to agree on a plan. CONCLUSIONS By participating in this curriculum, residents' communication skills improved immediately post-intervention. Further research is needed to assess if this intervention improves patient care by providing residents with enduring skills to judiciously manage the referral process.
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Affiliation(s)
- Elise A Stave
- Pediatrics, Children's National Hospital, Washington, DC, USA
| | - Larrie Greenberg
- Pediatrics, Children's National Hospital, Washington, DC, USA
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Ellen Hamburger
- Pediatrics, Children's National Hospital, Washington, DC, USA
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | - Dewesh Agrawal
- Pediatrics, Children's National Hospital, Washington, DC, USA
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Karen Lewis
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - John R Barber
- Pediatrics, Children's National Hospital, Washington, DC, USA
| | - James E Bost
- Pediatrics, Children's National Hospital, Washington, DC, USA
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Ashraf S Harahsheh
- Pediatrics, Children's National Hospital, Washington, DC, USA.
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
- Division of Cardiology, Children's National Hospital, 111 Michigan Ave, Washington, DC, NW, 20010, USA.
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Grover-Baltazar GA, Macedo-Ojeda G, Elicerio-Conchas D, Rodriguez-Sandoval A, Martínez-Vizmanos M, Díaz-Esquivel MA, Vizmanos B. Breastfeeding training in Mexican health students may not be enough: A case analysis. NURSE EDUCATION TODAY 2022; 108:105172. [PMID: 34741913 DOI: 10.1016/j.nedt.2021.105172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 10/03/2021] [Accepted: 10/12/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Breastfeeding education is key to undergraduate nursing, nutrition, and medicine students' study programs. All students should be prepared to support and inform mothers about the best infant feeding methods. However, students may not be receiving adequate training to provide this support during their preparation. OBJECTIVES The objective of this study was to explore if the Learning Units of the study programs of the bachelor's degrees in medicine, nursing, and nutrition, incorporate theoretical/practical content regarding breastfeeding and to evaluate whether these contents cover requirements related to knowledge and skills in breastfeeding recommended by international organizations for student's health area. DESIGN Descriptive. METHODS In the study programs of the bachelor's degrees, we identified the Learning Units that described theoretical/practical contents related to the subject of breastfeeding, to later contrast this training with the objectives in knowledge and skills in breastfeeding that the students in the health area should receive during their academic education, according to international recommendations. RESULTS The three study programs offer content on breastfeeding. The degrees in nursing and medicine manage to review a more significant number of training contents, unlike nutrition. However, the knowledge and skills targeted and identified do not seem to approach the knowledge and skills recommended by international institutions. CONCLUSIONS Several knowledge and skills need to be addressed during the training of health students. Thematic content and educational strategies must be improved and implemented to improve their breastfeeding training.
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Affiliation(s)
- Gabriela Alejandra Grover-Baltazar
- Doctorado en Ciencias de la Salud Pública Centro Universitario de Ciencias de la Salud (CUCS) Universidad de Guadalajara (UdeG), Dirección: Sierra Mojada 950, Independencia Oriente, C.P. 44340 Guadalajara, Jalisco, Mexico.
| | - Gabriela Macedo-Ojeda
- Doctorado en Ciencias de la Salud Pública Centro Universitario de Ciencias de la Salud (CUCS) Universidad de Guadalajara (UdeG), Dirección: Sierra Mojada 950, Independencia Oriente, C.P. 44340 Guadalajara, Jalisco, Mexico; Instituto de Investigación en Ciencias Biomédicas (IICB), CUCS, UdeG, Sierra Mojada 950, Edificio Q, Colonia Independencia, C.P. 44340 Guadalajara, Jalisco, Mexico.
| | - David Elicerio-Conchas
- Departamento de Psicología Aplicada, CUCS, UdeG, Sierra Mojada 950, Edificio H, Colonia Independencia, C.P. 44340 Guadalajara, Jalisco, Mexico.
| | - Ana Rodriguez-Sandoval
- Instituto de Biología Molecular en Medicina, CUCS, UdeG, Sierra Mojada 950, Edificio Q, Colonia Independencia, C.P. 44340 Guadalajara, Jalisco, Mexico.
| | - Marianne Martínez-Vizmanos
- Licenciatura en Médico Cirujano y Partero, CUCS, UdeG, Sierra Mojada 950, Edificio N, Colonia Independencia, C.P. 44340 Guadalajara, Jalisco, Mexico.
| | - Minerva Araceli Díaz-Esquivel
- Licenciatura en Médico Cirujano y Partero, CUCS, UdeG, Sierra Mojada 950, Edificio N, Colonia Independencia, C.P. 44340 Guadalajara, Jalisco, Mexico.
| | - Barbara Vizmanos
- Doctorado en Ciencias de la Salud Pública Centro Universitario de Ciencias de la Salud (CUCS) Universidad de Guadalajara (UdeG), Dirección: Sierra Mojada 950, Independencia Oriente, C.P. 44340 Guadalajara, Jalisco, Mexico; Instituto de Nutrigenética y Nutrigenómica Traslacional, CUCS, UdeG, Sierra Mojada 950, Edificio Q, Colonia Independencia, C.P. 44340 Guadalajara, Jalisco, Mexico.
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Boss M, Saxby N, Pritchard D, Pérez-Escamilla R, Clifford R. Interventions supporting medical practitioners in the provision of lactation care: A systematic review and narrative analysis. MATERNAL AND CHILD NUTRITION 2021; 17:e13160. [PMID: 33590635 PMCID: PMC8189190 DOI: 10.1111/mcn.13160] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 12/13/2022]
Abstract
Most children globally are not breastfed to recommendations. Medical practitioners are frequently visited in the first 6 months post‐partum, and the interaction at such visits significantly influences subsequent infant feeding decisions. Medical practitioners report that clinical practice in lactation is often disproportionately reliant on personal experience. This systematic review synthesises the literature on lactation health interventions used to support clinical decision making by medical practitioners. MEDLINE, Embase, PsycINFO, Scopus and Cochrane Library databases were searched for peer‐reviewed empirical studies published after 2000. Two reviewers independently screened and then assessed full‐text articles against inclusion criteria. Quality of reporting and risk of bias were independently assessed using three validated tools. No conclusions can be made regarding the success or failure of implementation strategies used or the outcomes of putting them into effect due to problems with study methodology, intervention reporting and risk of bias. Good‐quality research, which follows proven implementation frameworks, is needed to guide and sustain the incorporation of evidence‐based decision support into medical practitioners' care of breastfeeding mothers and infants.
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Affiliation(s)
- Melinda Boss
- School of Allied Health, Division of Pharmacy, The University of Western Australia, Crawley, Western Australia, Australia
| | - Nicole Saxby
- Women's and Children's Services, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Douglas Pritchard
- School of Medicine, Division of General Practice, The University of Western Australia, Crawley, Western Australia, Australia
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Rhonda Clifford
- School of Allied Health, Division of Pharmacy, The University of Western Australia, Crawley, Western Australia, Australia
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Mandelbaum J, Mesa A, Alhabas M, Blake CE. Early Initiation of Combination Feeding among Latina Mothers in the Deep South: Perspectives for Clinicians. South Med J 2021; 114:32-34. [PMID: 33398358 DOI: 10.14423/smj.0000000000001188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jennifer Mandelbaum
- From the Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia
| | - Anna Mesa
- From the Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia
| | - Maryam Alhabas
- From the Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia
| | - Christine E Blake
- From the Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia
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Huang PH, Haywood M, O'Sullivan A, Shulruf B. A meta-analysis for comparing effective teaching in clinical education. MEDICAL TEACHER 2019; 41:1129-1142. [PMID: 31203692 DOI: 10.1080/0142159x.2019.1623386] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Aim: Many factors affect learning outcomes, however studies comparing the effectiveness of different clinical teaching methods are limited. We utilize the list of influences on educational achievement compiled by John Hattie to inform a meta-analysis of learning effect sizes (ESs) associated with teaching-learning factors (TLFs) in clinical education. Methods: A literature search was conducted in PubMed to identify articles examining clinically relevant TLFs. Selection criteria were applied to identify learner-focused studies, with subsequent categorization by study design (pretest-posttest or controlled group). The Cohen's ES (d) for each TLF was extracted and a pooled ES determined. Results: From 3454 studies, 132 suitable articles enabled analysis of 16 TLFs' ESs. In general, ESs derived from pretest-posttest data were larger than those from controlled group designs, probably due to learner maturation effect. The TLFs of mastery learning, small group learning and goal settings possessed the largest ESs (d ≥ 0.8), while worked examples, play programs, questioning, concept mapping, meta-cognitive strategies, visual-perception programs and teaching strategies demonstrated ESs between 0.4 and 0.8. Conclusions: This is the first study to provide a rigorous and comprehensive overview of the effectiveness of TLFs in clinical education. We discuss the practical traits shared by effective TLFs which may assist teaching design.
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Affiliation(s)
- Pin-Hsiang Huang
- Office of Medical Education, University of New South Wales , Sydney , Australia
| | - Matthew Haywood
- Office of Medical Education, University of New South Wales , Sydney , Australia
| | - Anthony O'Sullivan
- Faculty of Medicine, University of New South Wales , Sydney , Australia
- Department of Endocrinology, St George and Sutherland Clinical School , Sydney , Australia
| | - Boaz Shulruf
- Office of Medical Education, University of New South Wales , Sydney , Australia
- Centre for Medical and Health Sciences Education, University of Auckland , Auckland , New Zealand
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Haase B, Brennan E, Wagner CL. Effectiveness of the IBCLC: Have we Made an Impact on the Care of Breastfeeding Families Over the Past Decade? J Hum Lact 2019; 35:441-452. [PMID: 31206324 DOI: 10.1177/0890334419851805] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND International Board Certified Lactation Consultants (IBCLCs) have been in existence for over 3 decades, are currently represented in 110 countries, and have the only internationally recognized certification to provide safe and evidenced-based care for breastfeeding women and their infants. RESEARCH AIM To review the literature about the efficacy of IBCLCs on breastfeeding outcomes as well as studies that have examined the effectiveness of the IBCLC's role. METHODS The design was a scoping review of the literature and critical analysis using PRISMA guidelines of existing studies published from 2008-2019. Qualitative and quantitative studies were reviewed. RESULTS Twelve (N =12) studies met inclusion criteria. Seven themes emerged in the analysis including studies of the role of IBCLCs in resident physician education; IBCLC's role in breastfeeding interventions and the management of breastfeeding problems; the impact of IBCLCs in inpatient and outpatient settings; and the impact of geographic access to IBCLCs on breastfeeding rates. Certification of and ongoing professional development of IBCLCs are also discussed. CONCLUSION In this scoping review of existing literature assessing the effectiveness of IBCLCs in promoting and supporting breastfeeding, it is clear that IBCLCs play a positive role in supporting breastfeeding throughout the world. However, there are certain limitations that must be addressed. Recommendations for future research and clinical practice are discussed in the context of present limitations to breastfeeding expertise and support.
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Affiliation(s)
- Barbara Haase
- 1 Medical University Of South Carolina, Department of Women's and Children's Services, Charleston, SC 29425, USA
| | - Emily Brennan
- 2 Medical University of South Carolina (MUSC) Library, Charleston, SC, USA
| | - Carol L Wagner
- 3 Medical University of South Carolina, Department of Pediatrics, Charleston, SC, USA
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Meek JY. Educational Objectives and Skills for the Physician with Respect to Breastfeeding, Revised 2018. Breastfeed Med 2019; 14:5-13. [PMID: 30614733 DOI: 10.1089/bfm.2018.29113.jym] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The Academy of Breastfeeding Medicine is a worldwide organization of physicians dedicated to the promotion, protection and support of breastfeeding and human lactation. Our mission is to unite into one association members of the various medical specialties with this common purpose.
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Affiliation(s)
- Joan Younger Meek
- Department of Clinical Sciences, Florida State University College of Medicine, Orlando, Florida
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11
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Al-Hreashy F, Al-Kadri H, Al-Mobeirek A, Scherpbier A. A mixed-method evaluation of the views of medical teachers on the applicability of the 'infant and young child feeding chapter' in Saudi medical colleges. BMC MEDICAL EDUCATION 2018; 18:232. [PMID: 30296933 PMCID: PMC6176500 DOI: 10.1186/s12909-018-1282-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 07/19/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Lack of sufficient preparation of physicians for the provision of breastfeeding support and counselling has been well-documented. The development of training in breastfeeding medicine for medical students is currently ongoing worldwide. This study was conducted to gain insights into a potential framework for a breastfeeding education curriculum. METHODS A mixed-method design was used to evaluate the opinions of medical teachers regarding current lactation education and the applicability of the World Health Organization 'Infant and young child feeding: model chapter for textbooks for medical students and allied health professionals' in medical colleges in Riyadh, Saudi Arabia. Twelve teachers from three medical schools were invited to participate in three rounds of research. The first round was carried out through an interview using open-ended questions under three headings: 1) The general opinion on breastfeeding medicine education in medical colleges; 2) The opinion on the contents of the chapter under investigation; and 3) The opinion on cultural points regarding Saudi Arabia and breastfeeding education in medical colleges. This was followed by a thematic analysis. Self-administered, closed-ended questionnaires were created for the second round based the results of the first round. The third round addressed areas of disagreement in opinions. To assess the degree of agreement objectively, rounds 2 and 3 were analyzed according to the 5-point Likert scale, with responses merged to a 3-point Likert scale where appropriate. A consensus was reached when greater than 70% agreement achieved. RESULTS All participants agreed that breastfeeding education is suboptimal. Although they considered the world health organization resource on infant and young child chapter a suitable reference for the curriculum, they agreed that modifications to suit the Saudi Arabian context are necessary. The medical teachers suggested a unique curriculum for medical students, which is similar for both genders. However, disagreement existed regarding the provision of extra clinical training to female students. CONCLUSIONS Breastfeeding medicine education in medical colleges should be developed using resources that are rich in content, are physician-specific and take into consideration the culture.
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Affiliation(s)
- Fouzia Al-Hreashy
- Department of Family Medicine, College of Medicine, Al-Imam Mohammad Ibn Saud Islamic University (IMSIU), PO BOX 62510, Riyadh, 11595 Saudi Arabia
| | - Hanan Al-Kadri
- Department of Obstetrics and Gynecology, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | - Albert Scherpbier
- Department of Educational Development and Research, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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12
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Wallace LM, Ma Y, Qiu LQ, Dunn OM. Educational videos for practitioners attending Baby Friendly Hospital Initiative workshops supporting breastfeeding positioning, attachment and hand expression skills: Effects on knowledge and confidence. Nurse Educ Pract 2018; 31:7-13. [PMID: 29727794 DOI: 10.1016/j.nepr.2018.04.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 04/13/2018] [Accepted: 04/22/2018] [Indexed: 11/28/2022]
Abstract
UNICEF Baby Friendly Initiative (BFHI) is the global standard for maternity and community services requiring all practitioners to be trained to support mothers in the essential skills of supporting positioning and attachment, and hand expression. These studies aim to rigorously assess knowledge in nurses, midwives, and doctors in these skills, tested before and after watching short videos demonstrating these skills. Practitioners were attending BFHI education, and the video study was additional. In Phase 1 clinicians in England were randomised to one of two videos (practitioner role play or clinical demonstration). The results showed improvements in knowledge and confidence, and a preference for clinical demonstration by mothers and infants. The clinical demonstration video was evaluated in China in Phase 2 where expert trainers viewed the video after completing the BHFI workshop, and in Phase 3 practitioners viewed the video before the BHFI workshop. Phase 2 with expert trainers only showed improvement in knowledge of hand expression but not positioning and attachment. In Phase 3 clinicians showed improved knowledge for both skills. In all Phases there were statistically significant improvements in confidence in practice in both skills. Viewing short videos increased knowledge, particularly about teaching hand expression, and confidence in both skills.
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Affiliation(s)
| | - Yuanying Ma
- Women's Hospital, School of Medicine, Zhejiang University, China.
| | - Li Qian Qiu
- Women's Hospital, School of Medicine, Zhejiang University, China
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Anstey EH, Coulter M, Jevitt CM, Perrin KM, Dabrow S, Klasko-Foster LB, Daley EM. Lactation Consultants' Perceived Barriers to Providing Professional Breastfeeding Support. J Hum Lact 2018; 34:51-67. [PMID: 28820951 DOI: 10.1177/0890334417726305] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Addressing suboptimal breastfeeding initiation and duration rates is a priority in the United States. To address challenges to improving these rates, the voices of the providers who work with breastfeeding mothers should be heard. Research aim: The purpose of this study was to explore lactation consultants' perceived barriers to managing early breastfeeding problems. METHODS This qualitative study was conducted with a grounded theory methodological approach. In-depth interviews were conducted with 30 International Board Certified Lactation Consultants across Florida. Lactation consultants were from a range of practice settings, including hospitals, Special Supplemental Nutrition Program for Women, Infants, and Children clinics, private practice, and pediatric offices. Data were digitally recorded, transcribed, and analyzed in Atlas.ti. RESULTS A range of barriers was identified and grouped into the following categories/themes: indirect barriers (social norms, knowledge, attitudes); direct occupational barriers (institutional constraints, lack of coordination, poor service delivery); and direct individual barriers (social support, mother's self-efficacy). A model was developed illustrating the factors that influence the role enactment of lactation consultants in managing breastfeeding problems. CONCLUSION Inadequate support for addressing early breastfeeding challenges is compounded by a lack of collaboration among various healthcare providers and the family. Findings provide insight into the professional management issues of early breastfeeding problems faced by lactation consultants. Team-based, interprofessional approaches to breastfeeding support for mothers and their families are needed; improving interdisciplinary collaboration could lead to better integration of lactation consultants who are educated and experienced in providing lactation support and management of breastfeeding problems.
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Affiliation(s)
- Erica H Anstey
- 1 Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Martha Coulter
- 1 Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA
| | | | - Kay M Perrin
- 1 Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Sharon Dabrow
- 3 Department of Pediatrics, College of Medicine, University of South Florida, Tampa, FL, USA
| | - Lynne B Klasko-Foster
- 1 Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Ellen M Daley
- 1 Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA
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Albert JB, Heinrichs-Breen J, Belmonte FW. Development and Evaluation of a Lactation Rotation for a Pediatric Residency Program. J Hum Lact 2017; 33:748-756. [PMID: 28984530 DOI: 10.1177/0890334416679381] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The American Academy of Pediatrics recommends that pediatricians promote and help manage breastfeeding. However, research has shown that they are not adequately prepared. To address this gap, a 2-week mandatory lactation rotation program was developed for first-year pediatric residents. Research aim: The aim of the study was to provide a lactation education program and to measure the residents' knowledge and perceived confidence regarding breastfeeding. METHODS This longitudinal self-report pretest/posttest study was conducted with a convenience sample of 45 first-year pediatric residents. Each resident spent a minimum of 50 hours with an International Board Certified Lactation Consultant. To measure breastfeeding knowledge and clinical confidence, the American Academy of Pediatrics' Breastfeeding Residency Curriculum pretest was used 4 times: first and last day of the rotation and at 6 and 12 months postrotation. RESULTS Test and confidence scores were evaluated. Statistically significant differences in knowledge were found between test 1 when compared with tests 2, 3, and 4 ( p < .001). No significant differences were found between tests 2, 3, and 4 ( p > .05). The abilities to "adequately address parents' questions" and to "completely manage common problems" were significant, with confidence increasing in tests 2, 3, and 4 ( p < .001). CONCLUSION As a result of an innovative, comprehensive educational lactation program, the pediatric residents' knowledge and perceived confidence related to breastfeeding significantly increased.
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Haile ZT, Elmasry M, Chavan B, Azulay Chertok IR. Association Between Type of Health Professional at Birth and Exclusive Breastfeeding. J Midwifery Womens Health 2017; 62:562-571. [PMID: 28940707 DOI: 10.1111/jmwh.12657] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 06/27/2017] [Accepted: 07/06/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Although benefits of breastfeeding for infants, women, and society are well established, breastfeeding rates in the United States remain below the Healthy People 2020 goals. Various factors are known to influence breastfeeding practices. Limited research has been conducted to examine the influence of type of birth attendant on exclusive breastfeeding. METHODS A cross-sectional analysis was conducted using data from the Infant Feeding Practices Study II collected between May 2005 and June 2007. RESULTS The study sample included 2026 women, aged 18 years or older. At discharge, 74.6% of women exclusively breastfed, and 27.6% exclusively breastfed at 3 months postpartum. Bivariate analysis showed a statistically significant association between type of health professional at birth and exclusive breastfeeding at discharge (P = .001) and 3 months postpartum (P < .001). After adjusting for potential confounders, the association between type of health professional at birth and exclusive breastfeeding at discharge was no longer significant. However, the odds of exclusive breastfeeding at 3 months postpartum were higher among women whose birth was attended by a midwife or nurse-midwife compared to those whose birth was attended by an obstetrician (odds ratio [OR], 1.87; 95% confidence interval [CI], 1.34-2.61; P < .001). DISCUSSION Exclusive breastfeeding continuation may be influenced by the type of health professional attending the birth. In addition to having a skilled workforce, health care professionals involved in perinatal care need to be educated and trained to promote and support exclusive breastfeeding as recommended. The complex and multifactorial nature of the maternal decision to exclusively breastfeed requires broader understanding of contextual factors.
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Sigman-Grant M, Kim Y. Breastfeeding Knowledge and Attitudes of Nevada Health Care Professionals Remain Virtually Unchanged over 10 Years. J Hum Lact 2016; 32:350-4. [PMID: 26446097 DOI: 10.1177/0890334415609916] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 09/14/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND It is prudent that health care professionals remain cognizant of breastfeeding-related issues to support nursing mothers. In 1995, Freed and colleagues noted deficits in breastfeeding knowledge among family medicine, pediatric, and obstetrics/gynecology residents and practitioners. Others reported similar findings despite calls to action and reports of successful breastfeeding interventions. OBJECTIVE This retrospective study compared baseline breastfeeding knowledge and attitude scores from Nevada health care professionals from 2004 through 2013. METHODS In-training and practicing professionals (pediatric/family practice/obstetric residents and attending physicians; hospital nursing staff; nursing and medical students) attended a 90-minute workshop at their sites. Following each session, attendees voluntarily completed a survey consisting of 2 knowledge and 2 attitudinal questions, using the post:pre-evaluation method, which diminishes overinflation of pretest scores as respondents can more accurately reflect their baseline levels. A Kruskal-Wallis test evaluated differences in baseline knowledge and attitude scores among 3 professional groups and for physicians over the 10-year period using Bonferroni post-hoc analyses. RESULTS A total of 889 professionals participated, with only physicians represented yearly. Except for knowledge of milk production, physician median baseline scores did not differ significantly over time. Overall, hospital nurses had significantly higher median baseline knowledge scores about initiation and frequent feeding than physicians and students. Nurses also had higher median attitude scores (likelihood of and confidence in talking with parents about breastfeeding) than physicians who had higher scores than students. CONCLUSION Despite growing societal enthusiasm and support, the baseline knowledge of and attitudes toward breastfeeding showed minimal change over 10 years.
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Affiliation(s)
| | - Yaebin Kim
- University of Nevada Cooperative Extension, Las Vegas, NV, USA
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