500 - Increasing Resident Physician Comfort in Etonogestrel Contraceptive Implant Counseling and Placement

Poster Number: 500
Publication Number: 500.100

Katherine Rand, Childrens Hospital Los Angeles, Los Angeles, CA, United States; Arek Hidirsah, Children's Hospital Los Angeles, CHATSWORTH, CA, United States; Claudia Borzutzky, Children's Hospital Los Angeles, Los Angeles, CA, United States

Background: The American Academy of Pediatrics (AAP) and the American College of Gynecology have issued recommendations in favor of long acting reversible contraception (LARC) for adolescents. LARCs have been shown to be safe, efficacious, and easy to use. Studies show adolescents chose these methods when barriers like knowledge and access were removed. Few pediatricians are trained in LARC placement and removal, despite the AAP 2014 recommendations. The American College of Graduate Medical Education (ACGME) does not include LARC training as a core competency. Training pediatric residents in implant placement/removal may decrease barriers to patient care.

Objective: 1. Increase number of residents trained in etonogestrel contraceptive implant (ECI) placement/removal.
2. Determine if training improves comfort in anticipated counseling on ECI.
3. Determine if training alone improves comfort in anticipated ECI placement/removal.

Design/Methods: Monthly ECI placement/removal trainings were provided for residents on the Adolescent Medicine rotation. To make this possible, a faculty physician from the Division of Adolescent and Young Adult Medicine at Children’s Hospital Los Angeles was certified as a trainer by the manufacturer. Prior to undergoing the training, residents were surveyed on their knowledge and experience with the ECI. After completing the training residents were given a post-survey to assess changes in level of knowledge and anticipated comfort.

Results: Over 11 months, 29 pediatric trainees completed the training. 62% completed the pre-survey and 55% completed the post-survey. Prior to the training, 0% felt “very comfortable” counseling on benefits of the implant. After the training this number increased to 44%. In regards to comfort with anticipated supervised placement, only 22% felt “comfortable” prior to the training. 0% felt “very-comfortable”. After completing the training, 94% endorsed comfort, with 44% reporting feeling “very comfortable”. Comfort anticipating unsupervised placement increased from 6% to 37% after the training (Fig 1).Conclusion(s): Increasing access to training pediatric residents in ECI placement/removal can be done by incorporating it into the ACGME required Adolescent Medicine rotation. This improves comfort in counseling and anticipated supervised placement, however still does not lead to widespread comfort anticipating unsupervised placement. In order to increase comfort with unsupervised placement, the next phase of this project will be to identify opportunities for residents to have direct supervision placing ECIs in the clinical setting.
Increasing Resident Physician Comfort in Etonogestrel Contraceptive Implant Counseling and PlacementCV - Jan 2022.pdf