Unintended pregnancy rates remain a world wide public health concern. Healthy People 2030 has designated unintended pregnancies a key initiative, stating that increasing the use of contraception and decreasing unintended pregnancy is an important public health goal. According to the American Academy of Family Physicians, approximately one-half of the 6.6 million pregnancies each year in the United States are unintended. Family medicine physicians have an ideal position to provide contraception counseling in our communities. Unfortunately when surveyed, although 95% of medicine faculty and residents responded that contraceptive counseling is important, only one-quarter of providers reported providing contraceptive counseling “routinely” (defined as ≥ 80% of the time) to reproductive aged women during prevention-focused visits. Several studies have attempted to understand why primary care physicians are not routinely providing preconception and contraception counseling with multiple factors identified including inadequate knowledge of contraception methods (especially in regards to long-acting reversible contraceptives or LARCs), lack of time, lack of routine sexually history taking, and provider misconception regarding contraception. This study was completed as a quality improvement project among ETSU Health Family Medicine Kingsport residents. The aim of the quality improvement project was to determine if increasing awareness of gaps in contraception counseling and providing contraception counseling education would increase the rates of contraception counseling during yearly visits (well child checks, annual physicals, and annual wellness visits) for women of reproductive age (defined as ages 14-45). Clinic charts were reviewed in a 3 month time period pre and post an educational intervention. The educational intervention included a 1 hour lecture on current contraception methods and recommendations. A survey was also collected pre and post educational intervention to identify self-reported rates of contraception counseling and other perceived barriers to contraception counseling in our clinic. The rates of contraception were determined by either the presence or absence of the billing ICD-10 code Z30.09 (Encounter for contraceptive management). Pre-intervention chart review revealed a documented contraceptive counseling rate of 13% at annual preventative visits. Despite these low rates, 71% of residents surveyed pre-intervention strongly agreed that contraceptive counseling was important at annual exams for women of reproductive age. Post-intervention chart review revealed a contraceptive counseling rate of 31% at annual preventative visits, an 18% increase in contraceptive counseling. The results showed that while residents did not self-identify inadequate knowledge of contraceptive methods as a barrier to providing counseling, raising awareness of the importance of contraception counseling and providing an educational intervention did increase rates of contraception counseling. The major barrier identified by providers was a perceived lack of time. One limitation of this study was measuring contraceptive counseling rates by the use of the billing ICD-10 code of Z30.09. By only using this ICD code, visits that documented sexually activity, current contraceptive use, and/or history of prior hysterectomy but did not properly bill for Z30.09 were not included.

BACKGROUND: Nationally, 85% of general surgery graduates pursue fellowships reducing the incoming general surgical workforce with a predicted shortage of 41,000 general surgeons by 2025. In recent studies, the lack of confidence appears to be a major factor contributing to resident decision to pursue fellowship. The aim of the study was to determine if a hybrid academic/community program contributes to early autonomy and the decision to pursue fellowship in general surgery graduates. METHODS: We evaluated the level of confidence, level of autonomy, and decision to pursue fellowship at a hybrid academic/community program that historically graduates 70% of their residents into general surgery practice through an anonymous survey. Participants responded using Likert scales along with simple polar questions. RESULTS: Most current residents (90%) reported, upon graduation, that they feel very confident (45%) or fairly confident (45%) performing major cases independently. Most attendings (64%) reported that during their third year of residency, they began performing the majority (more than 75%) of their major cases as surgeon junior while current residents (55%) reported they were performing the majority as a second-year resident. Fifty-five percent of residents felt that confidence played a role in the decision to pursue fellowship. Thirty-three percent of our current chief residents and only 34% of the total general surgery residents plan to pursue fellowships. Conclusions: Our study showed that our residents appear to have earlier levels of autonomy than that experienced by our practicing surgeons when they were residents. Confidence continues to play a role in the decision to pursue fellowship and overall our residents are confident in technical skills at graduation. Our unique program continues to graduate the majority of our surgical residents into successful general surgery practice.

Despite a mandated 1-month rotation in developmental-behavioral pediatrics (DBP), pediatric residents report inadequate training in behavioral health care. As a first step in much needed curriculum development in this area, this study sought to assess learner experiences regarding the management of behavioral health problems during residency. Four focus groups were conducted for residents in years 1-3 of training in 2 residency programs in a northeastern state. Transcripts were analyzed and coded by researchers through qualitative classical content analysis. The exploratory analysis revealed 9 key themes: time requirements, rapport building, resources and referrals for behavioral health, psychiatric medications, diagnosis vs. treatment, working with families, the importance of behavioral health, fears of working with a pediatric population, and training issues. These qualitative data further identify gaps in the behavioral health training of pediatric residents and may inform future innovations in training curricula.

This paper describes an empirical approach to assessing pediatric residents' attitudes, knowledge and skills in primary care behavioral health. Outcomes from that assessment approach are presented from two pediatric residency training programs in the northeastern United States. Thirty-six pediatric residents completed attitudes, knowledge and skills surveys. The survey was developed to align with the American Academy of Pediatrics’ Policy Statement in 2009 citing aspirational competencies for pediatricians in primary care behavioral health. This alignment addressed both learner variables (attitudes, knowledge, and skills) as well as clinical presentations (ADHD, anxiety, depression, and suicide) highlighted in the policy statement. The survey specifically inquired about self-reported confidence and comfort in managing behavioral health concerns using evidence-based practice parameters (attitudes and knowledge) and their measured ability to deliver evidence-based care in response to clinical vignettes (skills). Findings largely revealed no statistically significant differences in attitudes, knowledge or skills between interns and upper-level residents. Training programs can use the approach described in this paper and the assessment instrument with some possible modifications to monitor annual progress and evaluate any changes in didactic and clinical training.