Internal Medicine Resident, University of Chicago Medicine.
Associate Professor, Department of Medicine, University of Chicago Medicine; Associate Program Director, Internal Medicine Residency Program, University of Chicago Medicine; Associate Medical Director, Resident Clinic, Primary Care Group, University of Chicago Medicine.
MedEdPORTAL. 2020 Dec 4;16:11046. doi: 10.15766/mep_2374-8265.11046.
Many women of reproductive age with complex medical conditions receive primary care through an internal medicine (IM) physician rather than an obstetrician/gynecologist. Long-acting reversible contraception methods are the most effective form of contraception; however, IM residents are not routinely trained in them. Infrequent training in, inadequate knowledge of, and discomfort with contraception counseling limit the counseling performed by IM residents. Shared decision-making (SDM) is a method of patient-centered communication that can improve communication about patient preferences and increase patient satisfaction with and adherence to contraception. We developed a curriculum to teach contraception counseling under the framework of SDM for IM residents.
The curriculum focused on contraception counseling through the lens of SDM designed for IM and medicine/pediatrics residents (PGY 2-PGY 4). We adapted an existing seven-step model of SDM to fit elements of contraception counseling. The curriculum consisted of a didactic teaching session with integration of an instructional video and structured interactive discussion. The session lasted 60 minutes.
Fifty-eight residents participated in the curriculum. On pre- and postcurriculum surveys, residents reported improvement in contraception knowledge (overall mean precurriculum = 57%, postcurriculum = 70%, < .001) and comfort with contraception counseling (overall mean precurriculum = 3.2, postcurriculum = 3.6, < .01). Residents expressed strong support for SDM before and after the curriculum.
Based on the survey results, the curriculum successfully addressed gaps in residents' comfort with contraception counseling and knowledge of contraception side effects and efficacy.
许多处于生育年龄的患有复杂疾病的女性通过内科医生（IM）而不是妇产科医生接受初级保健。长效可逆避孕方法是最有效的避孕方法；然而，内科住院医师并未对此进行常规培训。对避孕咨询的培训频率低、知识不足以及对避孕咨询的不适，限制了内科住院医师的咨询能力。共同决策（SDM）是一种以患者为中心的沟通方法，可以改善关于患者偏好的沟通，并提高患者对避孕的满意度和依从性。我们开发了一个课程，在 SDM 框架下为 IM 住院医师教授避孕咨询。
该课程通过 SDM 的视角关注避孕咨询，专为 IM 和内科/儿科住院医师（PGY 2-PGY 4）设计。我们改编了现有的 SDM 七步模型，以适应避孕咨询的要素。该课程包括一个带教学视频和结构化互动讨论的讲座。课程持续 60 分钟。
58 名住院医师参加了该课程。在课程前后的调查中，住院医师报告避孕知识（总体平均预课程=57%，课程后=70%，<0.001）和避孕咨询舒适度（总体平均预课程=3.2，课程后=3.6，<0.01）有所提高。住院医师在课程前后都对 SDM 表示强烈支持。
根据调查结果，该课程成功地解决了住院医师对避孕咨询的舒适度以及对避孕副作用和效果的知识方面的差距。
