Vasectomy Training in Family Medicine Residency Programs: A National Survey of Residency Program Directors
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
ORIGINAL
ARTICLES
Vasectomy Training in Family Medicine
Residency Programs: A National Survey
of Residency Program Directors
Jasmine Patel, MD, MSc; Brian T. Nguyen, MD, MSc; Grace Shih, MD, MAS; Maya Or, MD;
Diane M. Harper, MD, MPH
BACKGROUND AND OBJECTIVES: Vasectomy is considered a permanent con- A US survey in 2002 reported that
traceptive method with fewer associated harms than bilateral tubal ligation. urologists perform the majority of
However, the number of vasectomy-trained providers may not be meeting the vasectomies (79%) followed by family
demand for vasectomy in the United States. We describe the vasectomy train- physicians (13%), and general sur-
ing landscape in family medicine residencies and factors related to increased geons (8%).4 Considering that fam-
procedural training. ily physicians comprise the second
METHODS: Program-specific data were collected from the Council of Academic largest number of vasectomy-pro-
Family Medicine Educational Research Alliance (CERA) national survey of family viding surgeons and are positioned
medicine program directors in 2019. Program characteristics, vasectomy train- to discuss pregnancy planning and
ing (eg, time spent, procedural numbers), as well as direct and specific faculty prevention with patients and cou-
support are described, with bivariate analyses for factors related to procedur- ples, vasectomy procedural training
al competency, defined as more than five vasectomy procedures per resident. should be consistently included in
their residency training. However, a
RESULTS: We received responses from 250 program directors (response 1989 survey of family medicine res-
rate=39.8%), with representation across all US regions, and program types. idency program directors on vasec-
Nearly half (47.5%) offered less than 1 day of vasectomy didactics and/or pro- tomy training found that only 44%
cedural training; 38.9% of programs reported having a family medicine faculty
of programs had vasectomy train-
champion for vasectomy. Only 16 programs (6.8%) reported that their average
ing, 54% of them with both lecture
graduating residents performed more than five vasectomies. Programs with a
and surgery, and the remaining with
faculty champion (OR 28.1, CI 3.6-216.4) or family medicine faculty as primary
trainer (OR 17.6, CI 2.2-138.2) were more likely to graduate residents who had
solely surgical training.5 Additionally,
performed more than five vasectomies. of programs with training available,
only 22% of graduated residents re-
CONCLUSIONS: Fewer than 10% of surveyed family medicine residency pro- ported performing more than 10
grams offer adequate vasectomy procedural training. Family medicine faculty vasectomies during their residen-
who serve as primary trainers and act as faculty champions can increase va- cy.5 A 2003 national survey of fam-
sectomy training opportunities for residents, and thereby increase the supply ily medicine chief residents showed
of vasectomy providers in the United States. that vasectomy was one of the least
(Fam Med. 2022;54(6):438-43.)
doi: 10.22454/FamMed.2022.649054
From the Division of Family Planning,
Department of Obstetrics and Gynecology,
F
amily physicians, urologists, for 22%.2 According to a survey of University of California Irvine (Dr Patel);
Section of Family Planning, Department
and obstetricians/gynecolo- key US health care administrators of Obstetrics and Gynecology, Keck School
gists agree that vasectomy is and providers conducted in 2001 by of Medicine of the University of Southern
more effective, safer, and less cost- the global women’s health nonprof- California, Los Angeles, CA (Drs Patel and
Nguyen); Department of Family Medicine,
ly than bilateral tubal ligation.1 De- it organization, EngenderHealth, University of Washington School of Medicine,
spite these benefits, vasectomy is one of the most frequent barriers Seattle, WA (Dr Shih); Department of Obstetrics
used by 7% of contraceptive users to vasectomy services was a lack of and Gynecology, George Washington University
Hospital, Washington, DC (Dr Or); and
in the United States compared to fe- trained providers.3 Department of Family Medicine and Obstetrics
male sterilization, which accounts & Gynecology, University of Michigan, Ann
Arbor, MI (Dr Harper).
438 JUNE 2022 • VOL. 54, NO. 6 FAMILY MEDICINEORIGINAL ARTICLES likely office procedures learned by in September 2019. Six follow-up analyses were conducted using Stata residents, with only 17% reporting emails were sent to encourage par- Statistical Software, release 16 (Stat- feeling somewhat competent at per- ticipation. Data collection closed af- Corp., College Station, TX). forming vasectomies and 54% re- ter November 2019. porting never having performed a The baseline CERA questionnaire Results vasectomy.6 In a 2011 national sur- covered individual demographics (eg, Of 628 surveyed residency program vey of family medicine program di- gender, ethnicity, amount of time directors, we received 250 responses rectors (n=220), 75.3% of program spent as program director at current (response rate=39.8%). Respondents directors reported that their program program) and program demograph- represented programs across all re- offered vasectomy didactic training ics (eg, location, size of the program, gions of the country, serving the full and 72.1% provided hands-on proce- approximate size of the communi- range of community sizes, with the dural training,7 though the training ty served). Vasectomy items in the majority serving populations of less volume was not assessed. questionnaire included time spent than 500,000 (71.9%). Almost half of The primary objective of this by residents learning about vasec- the programs had between 19-31 res- study was to characterize the cur- tomy, number of vasectomies per- idents (47.8%) total (Table 1). rent state of vasectomy procedural formed during residency, program Table 2 shows the amount of training across family medicine res- director views on vasectomy train- time spent by residents on average idency programs. As the establish- ing, other specialties interest and/ over their entire residency learning ment and maintenance of vasectomy or involvement in training family about vasectomy care, which may training opportunities need to be pri- medicine residents in vasectomies. have included didactics on preop- oritized, we surveyed family medi- Time spent learning about vasecto- erative counseling and evaluation, cine program directors about the my was approximated by summing vasectomy procedure, postopera- vasectomy training that their resi- the number of hours spent in didac- tive care, and complications. Nearly dents receive. The minimum volume tics and receiving clinical experi- three-quarters (73.1%) of programs of vasectomy experience for proce- ence, such that a resident with two offered vasectomy didactics and/or dural competence was set at five pro- 1-hour didactic/simulation sessions procedural training. Approximate- cedures in the Council of Academic plus one-half day in vasectomy clin- ly half (47.5%) of programs had less Family Medicine (CAFM) Consensus ic would sum to 6 hours or
ORIGINAL ARTICLES
Table 1: Family Medicine Program and Program Director Characteristics
Characteristics n (%)
University based 42 (16.9)
Program Type Community based, university affiliated 155 (62.3)
N=249 Community based, nonaffiliated 48 (19.3)
Military 4 (1.6)
Northeast 48 (19.2)
Program Location Midwest 74 (29.6)
N=250 South 67 (26.8)
West 61 (24.4)
Town 5 Vasectomies*** No, ≤5 221 (93.3)
N=237 Yes, >5 16 (6.8)
* “Does your department have one or more faculty champions (ie, someone who demonstrates commitment, advocacy, or advance skills in the area
of vasectomy)?”
** “Time spent learning about vasectomy was approximated by summing the number of hours spent in didactics and clinic experience, such that
a resident with two 1-hour didactic/simulation sessions plus one-half day in vasectomy clinic would sum to 6 hours orORIGINAL ARTICLES
Table 3: Vasectomy Trainers by Physician Specialty champion committed to vasectomy
for Family Medicine Residency Programs provision and training. We found
Physician Specialty Primary Trainer* Secondary champions across 38.9% of pro-
N=236 Trainer** grams, noting as well that programs
N=235 containing champions were signifi-
Family medicine 76 (32.2) 33 (14.0) cantly more likely to graduate res-
Urology 85 (36.0) 36 (15.3)
idents performing more than five
vasectomies per year. This finding
Other physician (ie, general 3 (1.3) 8 (3.4) is not particularly surprising, as a
surgeon, OB/GYN)
2017 study evaluating an interven-
None 72 (30.5) 158 (67.2) tion designed to increase residents’
experience in reproductive health
* Primary trainer is the person who does most of the resident training on vasectomy.
training through faculty advocates
** Secondary trainer is the person who provides supplemental vasectomy training. led to an increase in residents’ ex-
perience in procedures such as IUD
three-quarters (75.6%) of program Discussion insertion (from 85% to 99%) and con-
directors report difficulty providing While the CAFM 2009 Consensus traceptive implant insertion (60%
interested residents with enough Guidelines for procedural training to 85%).13 Likewise, we found that
training opportunities. Nearly a expect all residents to be exposed to when a program’s primary vasec-
quarter (22.8%) of program direc- and have the opportunity to train for tomy trainer was a family physi-
tors reported meeting resistance independent performance in vasecto- cian, the program’s residents were
with other specialties when trying my,10 vasectomy training opportuni- more likely than those with vasec-
to form partnerships to expand va- ties have continued to decline across tomy trainers from other specialties
sectomy training for their residents. family medicine residency programs to graduate residents with more va-
Table 4 examines factors asso- since 2011. Our data show that only sectomy procedural experience.
ciated with programs graduating 6.8% of programs surveyed have res- Furthermore, the lack of vasec-
residents with more than five vasec- idents who, on average, graduates tomy training in residency may re-
tomies performed on average. Fac- having performed more than five flect program directors’ belief that
tors significantly associated with vasectomies during their residency, residents are not interested in the
this outcome included (P1 week OR 194.2, CI 23.7-1,591.9) less than 1 day on vasectomy train- as a reason for their discomfort
were the variables that significant- ing. Given family physicians serve with vasectomy as an in-office pro-
ly increased the odds of graduating as an access point for men to discuss cedure.14 Given urologists also need
residents who performed more than their reproductive goals and how to to provide training opportunities for
five vasectomies on average. We were achieve them,12 adequate training on urology residents, it is not surprising
unable to perform adjusted multi- vasectomy is integral to their facili- that 22.8% of responding program
variate logistic regression due to the tating comprehensive men’s health. directors have met resistance from
small cell sample sizes. Programs with the highest suc- other specialties when trying to form
cess in graduating residents with partnerships to expand vasectomy
vasectomy experience had a faculty training.
FAMILY MEDICINE VOL. 54, NO. 6 • JUNE 2022 441ORIGINAL ARTICLES
Table 4: Association of Family Medicine Program Factors by Vasectomy Training Experience
Residents Graduate
With >5 Vasectomies? P*
No, ≤5 Yes, >5
University-based 37 (16.7) 4 (25)
Community-based, university-affiliated 138 (62.4) 8 (50)
Program Type Community based, non-affiliated 45 (20.4) 1 (6.3)ORIGINAL ARTICLES
Table 5: Factors Linked to Family Medicine Residency References
Training Programs Reporting Residents Who Perform 1. Shih G, Turok DK, Parker WJ. Vasectomy: the
at Least Five Vasectomies Upon Graduating other (better) form of sterilization. Contracep-
tion. 2011;83(4):310-315. Accessed June 28,
Residents Graduate Having 2019. doi:10.1016/j.contraception.2010.08.019
Factors Performed >5 Vasectomies 2. Contraceptive Use in the United States. Gutt-
Odds Ratio 95% CI P macher Institute. https://www.guttmacher.org/
fact-sheet/contraceptive-use-united-states#
Program Type 3. Ross JA. Engender Health. Male sterilization.
University based Reference In: Contraceptive Sterilisation: Global Issues
and Trends. New York: EngenderHealth; 2002.
Community based, University p. 24–32.
0.5 0.2 – 1.9You can also read
