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Heavy menstrual bleeding (HMB) after menarche is common in adolescents. While an immature hypothalamic-pituitary-ovarian axis accounts for most cases, 20-30% of affected adolescents will be diagnosed with an inherited bleeding disorder (IBD). The Council for Resident Education in Obstetrics and Gynecology establishes learning objectives for ObGyn residents to master during training. Despite the high prevalence of HMB and IBDs in adolescents and adults, specific learning objectives on the topic of IBDs is lacking. We therefore sought to determine ObGyn resident exposure to lectures and clinical training, and their overall confidence in the evaluation and management of HMB due to IBDs.
We conducted an IRB-approved prospective survey of ObGyn residents in the U.S. We sent an email invitation to program directors, inviting residents to complete an anonymous 26-item survey. Five-point Likert scales queried residents’ confidence in the evaluation and management of HMB and iron deficiency anemia, in patients with and without suspected IBDs. Additional items surveyed exposure to lectures or other structured education on these topics, year of post-graduate training, gender, and type of training program. Descriptive statistics were used for continuous variables using means and ranges. For tests of association with residency year, we used linear ANOVA, and for all other tests of association, we used independent sample t-tests.
239 U.S. ObGyn residency programs were invited to participate; 83 surveys were collected (34.7% response). Respondents represented academic (54.2%) and community (45.8%) programs with 25.3% PGY-1, 32.5% PGY-2, 31.3% PGY-3 and 10.8% PGY-4. Majority were female (95.2%). Majority reported didactics on the evaluation (n=71, 85.5%) and treatment (n=77, 92.8%) of HMB, but for causes specifically due to an IBD, only 35 residents (42.4%) reported didactics on evaluation and 28 (33.7%) reported didactics on treatment. Confidence in evaluation and management of HMB was high but decreased significantly in the setting of a bleeding disorder (Table 1). Residents who received didactics in both the evaluation and treatment of patients with HMB due to IBDs reported more confidence in their evaluation of those patients than those who did not receive didactics (Table 2, p < 0.001). Increasing level of residency training was associated with more confidence in management of these patients and did not differ based on type of training program.
Exposure to and confidence in evaluation and management of HMB due to bleeding disorders is lacking. Resident confidence increases with didactics and training. Residents would benefit from specific curricula designed to address this deficit in training.
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