Resident Reporters 2017
SASGOG was excited to sponsor five Resident Reporters at the SASGOG Annual Meeting and ACOG Scientific Session in San Diego California in May 2017. These five young resident physicians represent the future of SASGOG as they begin their careers as academic specialists in Obstetrics and Gynecology. Through a generous grant from Hologic, the Resident Reporters attended the full day of the SASGOG Annual Meeting, where they actively participated in many interactive sessions. As part of their commitment to the program, each Reporter wrote a short essay related to the meeting’s theme of Academic Generalists Providing Comprehensive Women’s Health Care. We are pleased to post these essays on the SASGOG website, where they may spark interest in other residents who are considering careers as academic generalists and all that SASGOG has to offer them. Please take a few moments to read the reflections of the 2017 Reporters and share them.
Supported by:
Joy Biessel, MD, Mayo Clinic - Rochester, MN
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Reflections on SASGOG Annual Meeting:
Of course you can do THAT: Promoting comprehensive women’s health” – What I learned during the SASGOG meeting to address this theme, what I would want to share with other residents who could not attend, and how I see this knowledge impacting my planned career and how SASGOG can be supportive in reaching these goals.
During my experience as a resident reporter at the 5th annual Society for Academic Specialists in General Obstetrics and Gynecology (SASGOG) conference in San Diego, it became clear that this society can be a pillar of support during my upcoming transition from resident to academic generalist. This was the first extensive exposure I have had to SASGOG, and I appreciated having this opportunity to better understand its foundation, aims, and roles. The society is comprised of a group of similarly-minded academic generalists who aim to clearly define general OB/GYN as a specialty in and of itself. SASGOG mirrors my own vision of myself of a future specialist in general OB/GYN. In its view, we are not "just" generalists; we are providers who are central to women’s health and a bridge between the subspecialties. We care for patients in the clinic, operating room, and bedside. We are slated with the responsibility of resident education, quality improvement, advocacy, and leadership within our departments, hospitals, and field. This year, the meeting’s theme of “Of course you can do THAT: Promoting comprehensive women’s health” was a fitting description of what the society aims to foster.
My experience as a resident reporter started with the opportunity to attend a round-table breakfast meeting with residents and academic generalists for a question and answer session. We touched on topics ranging from innovative ways to be academically productive to how to refine surgical expertise. After this thought-provoking conversation, we moved to the main session that included several presentations and expert panels about salient aspects in our field. We learned from Dr. Rodriguez about altering one’s teaching style based on generational trends in learning. Small panels tackled techniques and tips to approach vaginal hysterectomy and forceps. These are two areas of our field in which training is not uniform, and the academic generalist has the ability to refine these practices and impart skills to resident learners. During the meeting, we also had time for 1:1 mentorship and networking with academic specialists at different points in their career.
The conference did an excellent job of promoting comprehensive care and simultaneously identifying one's niche. One particularly interesting small panel was entitled “Developing your clinical niche” and included OB/GYNs with specialty interests in healthcare business, education, healthcare quality and safety, and clinical specialization. One speaker who resonated with me was Dr. Patricia Weiss. She is an OB/GYN who specializes in quality improvement in healthcare. She aptly pointed out that QI combines communication, human nature (“to err is human”), the concept of the second victim, and emotional intelligence, all of which have independently interested me in different arenas. She encouraged the audience to say "yes, if" instead of "no, but" and to follow one’s passion. If a need beyond the scope of normal practice is identified, then the next step an individual should take is to ask himself/herself if that is something he/she truly enjoys. If so, this may be an avenue of great opportunity to develop a niche outside of the span of typical practice. Using this straightforward formula, young clinicians like me may be able to identify their niche within a department towards which they can direct energy, attention, and resources. Establishing a niche can make an obstetrician/gynecologist all the more productive, impactful, and effective within an academic department and can be part of a larger aim to promote truly comprehensive healthcare for women.
I feel grateful, and in truth lucky, that I had the opportunity to discover more about SASGOG before graduating from residency. This society offers me a home base, a sounding board, and a launching pad all at the same time. It provides many opportunities for residents and physicians early in their careers to become involved in SASGOG as leaders, authors, educators, and mentors. It provides a model of what an academic generalist is, one that mirrors my own aspirations as a future specialist in general OB/GYN. Academic generalists have overlap with every area of specialization in our field and yet are specialists in their own right—not only in the clinical realm but also in the domains of education, administration, and advocacy. This vision of the comprehensive OB/GYN will propel our field forward. SASGOG as an institution will help mold and propagate the identity of academic generalists as the pillars of OB/GYN, central to the provision of comprehensive healthcare for women.
SASGOG/ACOG Scientific Session: Applying the Evidence:
ACOG subspecialty session for SASGOG scientific presentations, describe the presentation and how this area of research might apply in my future career as an academic generalist:
One presentation that particularly interested me at the SASGOG Scientific Session on Sunday, May 7th was “Prenatal contraceptive counseling and Nexplanon discontinuation after immediate postpartum insertion” by Dr. Jasmine Patel from the University of Connecticut. This caught my attention because of a long-standing personal interest in unique approaches to contraception in the adolescent, medically complex, and socially high risk patient populations. Dr. Patel and her colleagues aimed to decrease short interval pregnancies in at risk women in their institution. Their retrospective cohort study identified 230 women from July 2014 to December 2015 who underwent a postpartum etonogestrel implant (Nexplanon) placement for contraception. All included women qualified for the Ryan Grant, indicating that they were 300% below the poverty line. These women tended to be Hispanic, African American, young (average age 24), and unmarried. During the follow up period through March 2016, 11.4% (n=20) requested removal of the Nexplanon for side effects (most commonly abnormal uterine bleeding) or an expressed desire for pregnancy. Of those without an expressed desire for pregnancy, 10% subsequently had an unintended pregnancy within the follow up period.
Overall, the rate of overall Nexplanon continuation of 89% in the postpartum period was encouraging. It was an acceptable intervention and avoids a significant pitfall of post-placental IUDs—expulsion. The rate of unintended pregnancy after removal for side effects was the finding that most stood out to me. This was 10% even without an extended follow up period. Preventing short interval pregnancies can decrease complications such as intrauterine growth restriction and preterm birth. Perhaps more importantly, it can help advance women economically, educationally, and professionally. This study identifies a potential area of research into additional therapies for common Nexplanon side effects to encourage postpartum continuation. The study highlights and supports the need to increase affordable access to effective long acting reversible contraception for high risk postpartum patients.
Megan Cesta, MD, Summa Health Systems - Akron, OH
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Reflections on SASGOG Annual Meeting:
Of course you can do THAT: Promoting comprehensive women’s health” – What I learned during the SASGOG meeting to address this theme, what I would want to share with other residents who could not attend, and how I see this knowledge impacting my planned career and how SASGOG can be supportive in reaching these goals.
When I chose to pursue a career in medicine I did not realize that I was also choosing to become I career student. With no formal training, I have taken on roles such as tutoring in medical school and being resident clerkship liaison for medical student. As someone who is naturally drawn to academics, I find it very interesting how easy it is to learn from some educators and how difficult it is to learn from others. We are expected to care for sick patients and learn complicated surgical techniques. Our lives revolve around learning, yet our main instructors in medicine usually have no formal education in teaching. Enter here the age-old montage “see one, do one, teach one”. Seems a little outdated, right?
When attending the annual SASGOG meeting, there was a real focus on bridging the generational gap in education. How do students learn today, how is it possible to combine the learning styles of Baby Boomers, Millenials, and Gen Xers? Communication is key. I personally identify with the learning styles of Millenials, I like the implementation of technology, group work, and active learning. But I also identify with some aspects of the Baby Boomer generation – I’m a sucker for a good old red pen and double spaced text when editing an article. I spent the day learning new ways to incorporate teaching styles into my repertoire to capture all learners for any given lesson.
In the hospital we interact with people from all generations. It is often an intimidating task to teach learners older than myself. It is a fine balance between confidence and arrogance. But SASGOG’s lecture series helped to identify strategies for teaching adult learners. For example, flipped classroom sessions can be very helpful for adult learners, but you can also incorporate Millenials into these sessions by adding an interactive feedback platform. Using multiple teaching strategies and integrating them into the same lessons makes the generational gap fade and sets the tone for all learners to succeed.
As I will be assuming a senior role in residency next year, my desire to become a better educator is strong. However, struggles about learning how to teach are innumerable. When giving medical student lectures, I would often try to tailor the lecture to each student, which can be an arduous and inefficient task. I realized that if I was solely focused on trying to teach learners based on if they were a tactile, visual or auditory learner, I forgot to focus on the broader picture. I spent my day at SASGOG making the revelation that any learner can take key points away from any teaching style as long as it is done well. This conference has inspired me to focus on the generational nuances of learners and quality of education moving forward.
SASGOG/ACOG Scientific Session: Applying the Evidence:
ACOG subspecialty session for SASGOG scientific presentations, describe the presentation and how this area of research might apply in my future career as an academic generalist:
With new regulations in my state requiring that all women be offered postpartum long-acting reversible contraception before discharge from the hospital, I was particularly interested in the “Prenatal Contraceptive Counseling and Nexplanon Discontinuation After Immediate Postpartum Insertion” research presentation. Given the immediate state of health care, this was an aptly relevant study. As the popularity of LARCs increase and the benefits continue to prove themselves, I took some time to reflect on my own family planning counseling process.
The study presented a retrospectively identified a cohort of women with immediate postpartum Nexplanon insertion. The main outcome was to see if prenatal counseling had an effect on discontinuation. Outcomes were measure by using Cox proportion hazard ratios to identify reasons why women discontinued Nexplanon. This study highlighted the importance of both early counseling and making sure patients know there are methods of helping to control the abnormal bleeding without complete removal of the device. I usually begin contraceptive counseling with the benefits of LARCs for family planning and patient convenience of administration and removal. However, the irregular bleeding pattern remains difficult for some to accept.
This study demonstrated that themajor risk factors for Nexplanon discontinuation were having regular menses before device placement, non-cohabitating partners, and high clinic utilization. If the patients who still desire a LARC can be identified antepartum, the core element to having higher percentages of device retention could be in the physician counseling. Expectations are key. Patients need to know what options are available to control abnormal bleeding other than device removal.Additionally, they may need to know that perhaps a different LARC is best suited for them based on their contraceptive preferences.
Limitations of the study includedthe small population size and the fact that all paticipants received LARC funding from a grant. The chart review was also limited, as many are, by documentation of the physician. There is no standard method of documenting contraceptive counseling, and certainly no standard method of documenting the breadth of that counseling. One might take from this presentation that a standard office counseling approach to LARCs can be adapted for each clinic. Some patients in the study either received no counseling or had no documentation that it was performed.
As the global healthcare climate changes, effective contraceptive counseling is paramount to the reproductive health and safety of our patients, and it should be included and documented in the prenatal record. Patients desiring LARCs should be made aware of the variety of available contraceptive options as well as therapeutic interventions to help decrease unwanted side effects. Setting expectations appropriately will be key to improve the future of contraceptive counseling.
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Nazaneen Homaifar, MD, University of California San Francisco - San Francisco, CA
Reflections on SASGOG Annual Meeting:
Of course you can do THAT: Promoting comprehensive women’s health” – What I learned during the SASGOG meeting to address this theme, what I would want to share with other residents who could not attend, and how I see this knowledge impacting my planned career and how SASGOG can be supportive in reaching these goals.
While attending my first SASGOG annual meeting, I was struck by the camaraderie of the crowd – academic generalists recognized each other and were quick to make new connections. The crowd was big enough to fit a large room but small enough to ensure walking into the same person later in the day. At the networking lunch, a time when most colleagues like to sit and catch up, the generalists opened their arms to the next generation and offered inquisitive questions and anecdotes. More than anything, this demonstration of camaraderie and mentorship, stayed with me most as SASGOG represents a lifelong community of very talented generalists to engage with and learn from. The mentorship match within the SASGOG resident reporter program and the panel discussion on fostering the relationship between mentors reminded me of the value of lifelong relationships that thrive when there is a balance of openness, shared learning, and time investment.
In “Teaching the Next Generation of Learners” I learned about the importance of diversifying my teaching style to be more effective in reaching various audiences. While PowerPoint has been a mainstay in academic teaching, I am trying to be more proactive in leading discussions that include multimedia –like teaching videos and podcasts—or those that result in mapping out the discussion along the way. “Forceps – The Lost Art” helped reinforce skills needed to teach more procedural skills with a reliance on a checklist and models for practice.
“Tracking in OBGYN” provided a lively discussion that challenged our commonly held beliefs on what it means to be a generalist OB/GYN. Compelling data demonstrated the significant difference in total acute morbidity and transfusion based on surgeon volume (<10 hysterectomies per year). This data aligned with work highlighted by surgeon and public health researcher, Dr. Atul Gawande in 1998. At that time at Shouldice Hospital, a small medical center outside Toronto, twelve surgeons perform 600-800 hernia surgeries annually. The operation took a significantly shorter amount of time and the recurrence rate was 1%. These data highlight that repetition breeds success and an ability to better handle unexpected situations. In that vein, I respect the Kaiser mentality of specializing surgeons. That being said, this year’s SASGOG conference focused on “You can do anything” and, indeed, the appeal of generalist OB/GYN is the wide breadth of clinical and procedural work we are able to do. The knowledge imparted from this discussion and ongoing discussions on further specialization in OB/GYN in the current healthcare environment motivates me to stay well versed in common GYN surgeries through a combination of simulations, resident teaching, paired mentorship with seasoned surgeons and my own surgical practice. The discussion, along with the panel on developing clinical niche, further highlighted the growing body of work in quality improvement that is conducted by academic generalist. In my new role as an academic generalist at UCSF, I look forward to taking on quality improvement projects that improve inpatient L&D care, enhance patient education and counseling, and encourage interprofessional collaboration.
I look forward to the years of mentorship, learning, and community building with SASGOG colleagues in the future and greatly appreciate my first introduction through the resident reporter program.
SASGOG/ACOG Scientific Session: Applying the Evidence:
ACOG subspecialty session for SASGOG scientific presentations, describe the presentation and how this area of research might apply in my future career as an academic generalist:
Dr. Neal Shah highlighted the alarming rate of cesarean sections in the United States at the 2017 ACOG Conference and announced a call to action for OB/GYNs nationwide to think and act more responsibly in managing complexity of patients. At a time where hospital cesarean rates vary in the country from 7-70% percent and the rate of cesarean in the last fifteen years has gone up by 50%, we OB/GYNs must take a critical look within our profession to improve and standardize our care. Dr. Shah reported, “In 2017, the biggest risk factor for the most common surgery performed on earth is not a woman’s preferences or her medical risks, but literally which door she walks through.”
In this vein, I deeply respected the work of Dr. Zishan Hirani and his presentation titled “A Multidisciplinary Collaboration to Decrease the Primary Cesarean Section Rate at a New Academic Medical Center.” Dr. Hirani and his colleagues highlighted the challenges in undertaking quality improvement in OB/GYN –especially when it involves a significant shift in culture, transparency, and practice change. He and his colleagues took a systematic and multidisciplinary approach in educating all team members and creating standards for calling a primary cesarean section, and informing providers about their rates.
As a member of the OB/GYN resident quality improvement team at UCSF these past four years, I have experienced the rewards and challenges of introducing new quality improvement initiatives to the department. We have had many successes and also have experienced our share of “failures”—which often provide the most valuable insight into challenges in implementing quality improvement. In my career as an academic generalist, I intend to advocate for improved quality metrics that better reflect health outcomes and tools to improve patient-provider communication in women’s health.
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Audra Williams, MD, Northwestern University - Fienberg School of Medicine - Chicago, IL
Reflections on SASGOG Annual Meeting:
Of course you can do THAT: Promoting comprehensive women’s health” – What I learned during the SASGOG meeting to address this theme, what I would want to share with other residents who could not attend, and how I see this knowledge impacting my planned career and how SASGOG can be supportive in reaching these goals.
Professional women, particularly those in medicine, have always been faced with challenge of whether they can really have it all. While we continue to find ways to improve work-life balance, our ability to have it all as academic generalist ob/gyn is becoming more and more of a reality. The theme of this year’s SASGOG annual meeting “Of Course You Can Do That” reflects the sentiment that academic generalists really can do it all in the field of obstetrics and gynecology. Through the various sessions, I learned a great deal about all of the ways I can shape my career to be a leader in education, clinical care and advocacy.
To truly be comprehensive women’s health care providers, academic generalists must play a role in advocating for women’s health on the local and national level. ACOG Vice President for Health Policy Barbara Levy focused on this point in her keynote address “The Room Where It Happens: Payment Reform and Comprehensive Healthcare Delivery for Women.” The title of this session draws from a show-stopping number in the hit musical Hamilton. In the song, antagonist Aaron Burr realizes the importance of being present when critical decisions are made. Dr. Levy stressed the need for ob/gyns to be involved and leaders in the conversations in state houses and boardrooms across the country that are shaping health policies that impact women.
One of the strongest points she made was utilizing the experience we have providing comprehensive care to obstetric patients and translating that to creating medical homes for women that improve quality and safety. I believe that generalists can really promote ourselves as experts and lead health policy reforms that can help achieve the triple aim outlined by Dr. Levy – population health, healthcare for individuals and lower cost through quality improvement. This theme of advocacy was also emphasized at the SASGOG scientific session at ACOG where the session leaders warned us “If we don’t tell our story, someone else will tell it for us.” Overall these advocacy sessions inspired me to be a strong voice in the fight to provide excellent care to women across the country.
The SASGOG meeting highlighted the breadth of clinical opportunities available to academic generalists. One of the most interesting sessions for me focused on developing a clinical niche. At first I was confused about how a talk on narrowing clinical focus fit in at a conference based on the idea of doing it all. But it became clear that developing different niches is a way that academic generalists can provide comprehensive women’s care. We often think about subspecialists being the experts in ob/gyn, however there are multiple aspects of the field where generalists can hone their knowledge and expertise. Areas such as menopause, adolescent health and sexual health are common issues for the generalist to encounter in clinic, but often require more time or attention than the problems we are more commonly trained for. The panelists really emphasized how taking the time for additional professional development in a particular area can help you expand your practice and become a “go-to” person for your division and department.
Lastly, I learned a great deal about the large role academic generalists play as educators. Several of the sessions focused on different aspects of teaching – whether it was a specific skill like vaginal hysterectomy or forceps or adapting to target population. Dr. Rochell Rodriguez shared techniques for teaching Millenials and emphasized the need to be clear with expectations, provide rationale for learning and incorporate active learning strategies. Her example of a “flipped” journal club where residents were posed with a clinical question and then had to find literature to answer it really illustrated how building in more active participation can give new life to an old standard.
I learned so much at the SASGOG meeting that I feel I will immediately be able to incorporate into my practice as an academic generalist. More than anything it was wonderful to be surrounded by so many people that are working so hard to advance the field. I truly feel like I am a part of a community truly doing it all to advance women’s health and can’t wait for the next meeting!
SASGOG/ACOG Scientific Session: Applying the Evidence:
ACOG subspecialty session for SASGOG scientific presentations, describe the presentation and how this area of research might apply in my future career as an academic generalist:
“A Multidisciplinary Collaboration to Decrease the Primary Cesarean Section Rate at a New Academic Medical Center” - Zishan Hirani MD, Resident Physician in OB/GYN, University of Texas Rio Grande Valley
This abstract presentation described a quality improvement project to help reduce the primary cesarean section rate at a hospital. While this hospital had a new residency program, they also had many private practice providers that were also part of the target population of the intervention. The development of the intervention was multidisciplinary and involved residents, attendings, nursing and administration. The intervention itself was also multifaceted as it involved a mandatory fetal monitoring course, collection of and distribution of c-section rates and other educational components. After implementation, the hospital had a decrease in primary c-section rate from 35% down to 24%, however the rates quickly rose almost back to baseline after the initial roll-out.
This presentation is very applicable to the generalist practice as we are constantly looking for ways to reduce the c-section rate. The setting of this study is particularly meaningful to me as I have also trained at an institution with a mix of faculty and private practice providers. This is a unique environment where it can at times be difficult to establish a standard of care because there are so many variable ways to practice. The development and design of this intervention really showed how important it is to have investment from all stakeholders whenever undertaking a quality improvement project. It also illustrated that many of the problems we face in ob/gyn are multifactorial and require multi-modal approaches to fix them. Lastly it shows the difficulty in creating quality improvements that are sustainable and the need to build in “maintenance” strategies for any similar interventions.
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Heather Wolfe, MD, Walter Reed National Military Medical Center - Bethesda, MD
Reflections on SASGOG Annual Meeting:
Of course you can do THAT: Promoting comprehensive women’s health” – What I learned during the SASGOG meeting to address this theme, what I would want to share with other residents who could not attend, and how I see this knowledge impacting my planned career and how SASGOG can be supportive in reaching these goals.
Say yes. Of COURSE you can do THAT – just say yes! A seemingly innocuous sentiment but representing the idea that, though something may seem challenging to the point of being insurmountable, there is confidence that you can achieve it. You can do it. Whatever the objective, YOU can surpass it. Just say yes! This sentiment was encountered and echoed all around the 2017 Annual Meeting of the Society for Academic Specialists in Obstetrics and Gynecology (SASGOG). As a first time attendee, I approached the meeting with the goal of finding tips and ideas for my new career as an Academic Specialist. This theme reverberated in all of the sessions and reinforced the importance of saying yes to opportunities, new strategies, and aspects of practice that can seem intimidating or difficult.
I began the day at the resident breakfast in which SASGOG members from around the country gathered to meet and engage with residents. Conversation flowed easily and the environment was relaxed and one of genuine interest and support. Questions commonly returned to how these inspiring men and women achieved success in their careers and what steps led them there. Many reported that they said “yes” to an opportunity that seemed, at the time, to be undesired or not in their primary focus. Only by agreeing to a variety of disparate opportunities were they able to meet new people, experience unique facets of Ob/Gyn, and tailor their careers. If they had refused or held back due to fear of new experiences, these people may not be in the positions they are today. This same concept was further reinforced at the panel later in the day about developing a clinical niche. These physicians discussed their unique experiences as Academic Specialists and how varied this field can be. Aspects such as education, healthcare business, clinical specialization, and quality and safety were reviewed and panelists were given the opportunity to discuss how they created their careers. Many of the panelists reinforced the concept that they did not initially envision their careers as taking these specific trajectories but it was only through agreeing to an unexpected opportunity that they discovered themselves and were able to realize their career aspirations.
Education is an essential part of the career of an Academic Specialist. I imagine that it could be very easy to develop a teaching style and continue to use the same techniques and lectures year after year. In my own experience teaching medical students and junior residents, I know it can be challenging to teach someone with a different learning style than myself or to adapt previously-developed lectures to a different crowd. The SASGOG presenters encouraged educators to “say yes” to trying new teaching strategies. For instance, during the breakout session on “TVH – Teaching What You Can’t See” Dr. Farrell introduced an inexpensive TVH model. She encouraged attendees to try both making this model and practicing the surgical removal of the pool noodle and cling wrap uterus. Dr. Rodriguez encouraged attendees to use technology and social media in reaching millennial learners in her keynote address called “Teaching the Next Generation of Learners”. I feel inspired to try both of these novel approaches with student and resident learners next year.
Advocacy is often one of the aspects of practice that many Academic Specialists find most challenging. Personally, I have felt intimidated and overwhelmed by the magnitude and gravity of policy and the legal aspects of our practice. However, Dr. Levy’s keynote address entitled “The Room Where It Happens: Payment Reform & Comprehensive Healthcare Delivery for Women” made advocacy accessible. She was inspiring. She reinforced the importance of being a part of the discussions that impact our care and our patients. Dr. Leininger and Dr. Jacobson further emphasized this importance during the Scientific Session. They gave several shocking, yet true, scenarios of medical decisions that were made by people not trained in the field. They memorably stated that “if you don’t tell your story, someone else will” and stated that all Academic Specialists need to “say yes” to incorporating advocacy in daily practice.
Perhaps it is because I approached the SASGOG meeting looking for direction in my new career that I seemed to find the theme “Of course you can do THAT” to mean “Say YES”. As a new graduate and natural introvert, I worry that I will stand on the sidelines and wait to get involved in aspects of our field of medicine. This meeting has inspired me and filled me with confidence. I not only know the importance of saying yes to various opportunities, but I also feel empowered to do so. SASGOG truly supports Academic Specialists in all pursuits and with the support of this organization, there is nothing we can’t achieve.
SASGOG/ACOG Scientific Session: Applying the Evidence:
ACOG subspecialty session for SASGOG scientific presentations, describe the presentation and how this area of research might apply in my future career as an academic generalist:
Drs. Joyner and Mullins began their presentation on better breastfeeding counseling by asking the group of attendees how many providers routinely discuss breastfeeding in the prenatal clinic setting. Though many people in the crowd rose their hands to indicate comfort with this topic, the data actually demonstrate that only a startling 16% of patients remember discussing breastfeeding in clinic. Remarkably, even fewer physicians (8%), feel that their breastfeeding counseling is of value. Without a doubt, academic specialists in obstetrics and gynecology are able to recite the importance of breastfeeding and are clearly engaged in providing patient education and support on a variety of topics throughout pregnancy. However, this data suggests that there is room to improve breastfeeding counseling during pregnancy. More needs to be done to equip physicians to have meaningful and memorable breastfeeding discussions in the prenatal clinic setting.
The presentation went on to provide discrete techniques and resources to improve breastfeeding counseling. Specific patient scenarios, common questions, and misconceptions were used to make the session applicable to the providers in attendance. Individual statements taken from real patient encounters including: “I heard [breastfeeding] hurts,” “it would just be easier to give the baby a bottle,” and “I couldn’t breastfeed last time and want to do so this time” were discussed and precise ideas for engagement with these women were reviewed. Detailed resources provided by ACOG were also examined, including patient counseling sheets, physician resources and a list of ICD codes that can make taking the time to have a worthwhile discussion more professionally feasible. The physician toolkit on www.acog.org/breastfeeding is an excellent resource for all providers and yet is one that may people are unaware of.
I used to feel unprepared and anxious about engaging in conversations and counseling about breastfeeding. When faced with questions about breastfeeding, especially earlier in my career, I was absolutely that resident Dr. Joyner joked about as saying “let me grab that lactation consultant for you” while rapidly exiting the patient’s room. After attending this presentation at the SASGOG scientific session, I now have the necessary resources to initiate and continue this conversation. I feel empowered and supported in reviewing breastfeeding questions and concerns. I know where to find specific resources on coding and addressing more difficult questions. Though there are certainly complex situations in which lactation specialists are warranted, this session illustrated that an engaged Academic Specialist can provide many women with the support and education needed. More effective and memorable breastfeeding counseling is a huge area for improvement in our specialty and, with these resources, one that we can change with each daily patient encounter.
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