Miller Elizabeth J N, Cookingham Lisa M, Woodruff Teresa K, Ryan Ginny L, Summers Karen M, Kondapalli Laxmi A, Shah Divya K
Department of Obstetrics and Gynecology, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455 USA.
Center for Reproductive Health, Kaiser Permanente Northern California, 1650 Response Road, Sacramento, CA 95815 USA.
Fertil Res Pract. 2017 Jul 4;3:9. doi: 10.1186/s40738-017-0036-y. eCollection 2017.
Despite a large body of data suggesting that delivery of fertility care to cancer patients is inconsistent and frequently insufficient, there is a paucity of literature examining training in fertility preservation for those physicians expected to discuss options or execute therapy. The study objective was to compare fertility preservation training between Reproductive Endocrinology & Infertility (REI) and Gynecologic Oncology (GYN ONC) fellows and assess the need for additional education in this field.
A 38-item survey was administered to REI and GYN ONC fellows in the United states in April 2014. Survey items included 1) Clinical exposure, perceived quality of training, and self-reported knowledge in fertility preservation; 2) an educational needs assessment of desire for additional training in fertility preservation.
Seventy-nine responses were received from 137 REI and 160 GYN ONC fellows (response rate 27%). REI fellows reported seeing significantly more fertility preservation patients and rated their training more favorably than GYN ONC fellows (48% of REI fellows versus 7% of GYN ONC fellows rated training as 'excellent', < 0.001). A majority of all fellows felt discussing fertility preservation was 'very important' but fellows differed in self-reported ability to counsel patients, with 43% of REI fellows and only 4% of GYN ONC fellows able to counsel patients 'all the time' ( = 0.002). Seventy-six percent of all fellows felt more education in fertility preservation was required, and 91% felt it should be a required component of fellowship training.
Significant variability exists in fertility preservation training for REI and GYN ONC fellows, with the greatest gap seen for GYN ONC fellows, both in perceived quality of fertility preservation training and number of fertility preservation patients seen. A majority of fellows in both disciplines support the idea of a standardized multi-disciplinary curriculum in fertility preservation.
尽管大量数据表明，为癌症患者提供的生育护理并不一致，而且常常不足，但针对那些预期要讨论生育选择或实施治疗的医生，关于生育力保存培训的文献却很少。本研究的目的是比较生殖内分泌与不孕症（REI）专科住院医师和妇科肿瘤学（GYN ONC）专科住院医师的生育力保存培训情况，并评估该领域额外教育的必要性。
2014年4月，对美国的REI和GYN ONC专科住院医师进行了一项包含38个条目的调查。调查项目包括：1）临床接触、对培训质量的认知以及生育力保存方面的自我报告知识；2）对生育力保存额外培训需求的教育需求评估。
从137名REI专科住院医师和160名GYN ONC专科住院医师那里收到了79份回复（回复率为27%）。REI专科住院医师报告称，他们见到的生育力保存患者明显更多，并且对培训的评价比GYN ONC专科住院医师更高（48%的REI专科住院医师将培训评为“优秀”，而GYN ONC专科住院医师中这一比例为7%，<0.001）。所有专科住院医师中的大多数人认为讨论生育力保存“非常重要”，但在自我报告的为患者提供咨询的能力方面存在差异，43%的REI专科住院医师能够“一直”为患者提供咨询，而GYN ONC专科住院医师中只有4%能够做到（=0.002）。76%的专科住院医师认为需要在生育力保存方面接受更多教育，91%的人认为这应该是专科培训的必修内容。
REI和GYN ONC专科住院医师的生育力保存培训存在显著差异，GYN ONC专科住院医师在生育力保存培训的认知质量和见到的生育力保存患者数量方面差距最大。两个学科的大多数专科住院医师都支持制定标准化的多学科生育力保存课程的想法。
