Division of General Internal Medicine, Penn State Health Milton S. Hershey Medical Center, Academic Support Building, 90 Hope Drive, Suite 3200, Mail Code A320, Hershey, PA, USA.
Section of General Internal Medicine, Boston University Medical Center, Boston, MA, USA.
J Gen Intern Med. 2021 Nov;36(11):3346-3352. doi: 10.1007/s11606-021-06832-3. Epub 2021 May 6.
Long-acting reversible contraceptives (LARCs) such as intrauterine devices (IUDs) and implants are highly effective and increasingly popular. Internal Medicine (IM) clinics and residency curricula do not routinely include LARCs, which can limit patient access to these methods. In response, internists are integrating LARCs into IM practices and residency training.
This study examines the approaches, facilitators, and barriers reported by IM faculty to incorporating LARCs into IM clinics and resident education.
We interviewed faculty who were prior or current LARC providers and/or teachers in 15 IM departments nationally. Each had implemented or attempted to implement LARC training for residents in their IM practice. Semi-structured interviews were used.
Eligible participants were a convenience sample of clinicians identified as key informants at each institution.
We used inductive thematic coding analysis to identify themes in the transcribed interviews.
Fourteen respondents currently offered LARCs in their clinic and 12 were teaching these procedures to residents. LARC integration into IM clinics occurred in 3 models: (1) a dedicated procedure or women's health clinic, (2) integration into existing IM clinical sessions, or (3) an interdisciplinary IM and family medicine or gynecology clinic. Balancing clinical and educational priorities was a common theme, with chosen LARC model(s) reflecting the desired priority balance at a given institution. Most programs incorporated a mix of educational modalities, with opportunities based upon resident interest and desired educational goals. Facilitators and barriers related to clinical (equipment, workflow), educational (curriculum, outcomes), or process considerations (procedural volume, credentialing). Participants reported that support from multiple stakeholders including patients, residents, leadership, and other departments was necessary for success.
The model for integration of LARCs into IM clinics and resident education depends upon the clinical resources, patient needs, stakeholder support, and educational goals of the program.
长效可逆避孕措施（LARC），如宫内节育器（IUD）和植入物，具有高度有效性，并且越来越受欢迎。内科（IM）诊所和住院医师课程通常不包括 LARC，这可能限制患者获得这些方法的机会。因此，内科医生正在将 LARC 纳入 IM 实践和住院医师培训中。
本研究考察了内科教员报告的将 LARC 纳入 IM 诊所和住院医师教育的方法、促进因素和障碍。
我们采访了全国 15 个内科部门的前或现任 LARC 提供者和/或教师。他们每个人都在自己的内科实践中为住院医师实施或试图实施 LARC 培训。使用半结构化访谈。
合格的参与者是每个机构确定的作为主要信息提供者的临床医生的便利样本。
我们使用归纳主题编码分析来识别转录访谈中的主题。
14 名受访者目前在他们的诊所提供 LARC，12 名受访者正在向住院医师教授这些程序。LARC 整合到 IM 诊所中有 3 种模式：（1）专门的程序或妇女健康诊所，（2）整合到现有的 IM 临床会议中，或（3）内科和家庭医学或妇科的跨学科诊所。平衡临床和教育优先事项是一个常见主题，选择的 LARC 模式反映了特定机构的期望优先级平衡。大多数项目都结合了多种教育模式，根据住院医师的兴趣和期望的教育目标提供机会。促进者和障碍与临床（设备、工作流程）、教育（课程、结果）或过程考虑因素（程序量、认证）有关。参与者报告说，需要来自多个利益相关者的支持，包括患者、住院医师、领导和其他部门，才能取得成功。
将 LARC 整合到 IM 诊所和住院医师教育中的模式取决于计划的临床资源、患者需求、利益相关者支持和教育目标。
