ABSTRACT
PURPOSE: Our study aimed to evaluate the acceptability, adverse effects and continuation rates among adolescents who accepted the etonogestrel (ENG) subdermal implant and compared to adolescents who chose other methods during the immediate postpartum period before hospital discharge, with one year follow-up up. MATERIALS AND METHODS: We conducted a cohort non-randomised study at the Women's Hospital, University of Campinas. All women up to 19 years of age, who gave birth at the hospital between July 2019 and April 2020, were invited to participate and were offered the ENG-implant or the routine contraceptive methods. They were followed for one year postpartum. RESULTS: We included 100 teenagers and 72 accepted the ENG-implant. Students are more likely to accept the ENG-implant than non-students (PR: 1.25 [95%CI 0.99-1.59]). Up to one year of follow-up, survival analysis showed that the time of adherence to the method was longer for the ENG-implant users (p = 0.0049). More than 90% of the adolescents were satisfied with the implant; however, five requested early removal due to menstrual irregularity and local discomfort. CONCLUSION: Provision ENG-implant for adolescents in the immediate postpartum demonstrated high acceptance and ensured effective contraception. After one year, most of them were satisfied, with a high continuation rate and without unplanned pregnancies.
ABSTRACT
Objectives: The COVID-19 pandemic necessitated a shift from traditional face-to-face instruction for new technical skills to virtual delivery of medical education training. Our objectives were to develop and validate a virtual simulation training program for Canadian healthcare professionals (HCPs) on the insertion, localization, and removal of the etonogestrel subdermal contraceptive implant. Methods: A scientific committee of Canadian family planning experts developed a two-part virtual training program during the COVID-19 pandemic. In Part 1, core educational content was provided in an asynchronous, self-directed, on-line format. Part 2 consisted of synchronous, simulation-based training using web conferencing. HCPs were provided with model arms and training placebo applicators, trainers demonstrated implant insertion/removal techniques, and trainees received individual feedback on technical performance. All trainees were asked to complete an on-line evaluation upon program completion. Results: Between March 2020 and June 30, 2021, 2130 Canadian HCPs had completed Parts 1 and 2 of the training program and 1275 participants completed the program evaluation (response rate 60%). Participants reported high levels of satisfaction with virtual simulation-based training. Ninety-seven percent (1229/1275) of participants agreed the virtual format was effective. Four percent (51/1275) requested additional training prior to inserting the implant in clinical practice. Conclusions: Virtual simulation-based learning provides effective education and technique training for etonogestrel implant insertion and removal. Online delivery of implant training can be scaled to use as needed to reach professionals in remote or underserved locations and for training provision of other technical or surgical procedures. Keywords: simulation-based training;contraceptives;virtual learning
ABSTRACT
SETTING AND PARTICIPANTS: The COVID 19 pandemic has reshaped how we approach medical education. A need to care for the surge of hospitalized patients and abide by social distancing guidelines to protect our workforce have both limited the time and ability to hold traditional in person teaching sessions. In addition, a focus on caring for these critical sick patients has taken the focus away from chronic disease management and primary care in general. In the setting of the above stressors, increasing physician and resident burnout have affected mental wellbeing and limited our band-width to partake in nonrequired learning. Our internal medicine program had our inaugural primary care workshop in March of 2021. We had to modify our curriculum significantly in order to fit within institutional social distancing policies and ensure the safety of all participants. The workshop was designed for eleven internal medicine resident in our primary care track at a mid-sized IM program. DESCRIPTION: Using a combination of virtual and in-person sessions, we were able to cover a variety of primary care topics and provide an opportunity for comradery and reflection for our primary care track residents during this single day event. The morning was a completely virtual session over the Webex platform that included an initial icebreaker/narrative medicine exercise. This was followed by an advocacy panel discussion and an update on the state of immigrant health in Oregon. The afternoon was an in-person event in a large room that allowed for adequate social distancing. It included an outpatient injection and ultrasound practice session followed by a two hour introduction to Medical Improve. We concluded the day with a Nexplanon training and certification session. EVALUATION: On a post-course survey using Likert scales ranging from 1 to 5 (1=not well at all and 5=extremely well) residents reported the workshop increased the sense of a primary care community within the residency program (mean 4.7, SD 0.45), expanded general knowledge in primary care (mean 4.6, SD 0.48), and increased understanding of varied career paths with in the field (mean 4.3 SD 0.75). All residents reported the workshop made them feel more excited about primary care. DISCUSSION / REFLECTION / LESSONS LEARNED: We believe the ingredients that led to a successful workshop included time for reflection and sharing of experiences, hands-on skills practice, mini-lectures in areas in which our residents had requested further training, and team building through a Medical Improv course. Through organizing the workshop, we have identified the importance of obtaining program support early on in the process and finding the right mix between virtual and face-to-face sessions. We believe surveying current residents and alumni was crucial to determining our agenda and invited speakers. In addition to specific lectures, it is imperative to include activities that foster engagement and community building during workshops, especially during a time in which it has been challenging to build relationships.
ABSTRACT
INTRODUCTION: At the onset of the COVID-19 pandemic, providers were encouraged to counsel patients interested in longacting reversible contraception (LARC) about immediate postpartum placement to decrease in-person postpartum visits. We assessed the impact of this COVID-related hospital policy on postpartum LARC uptake. METHODS: In this retrospective cohort study, we compared patients who delivered a live born infant(s) during two periods, one immediately prior to the COVID pandemic (“pre-COVID cohort” (December 16, 2019 to March 1, 2020)), and one at the onset of the pandemic (“COVID cohort” (March 16-May 31, 2020)). We collected electronic medical record data, including sociodemographic characteristics and contraception choices, in the antenatal and postpartum periods for 649 patients. Odds ratios were adjusted for age and race. RESULTS: We found an increase in immediate postpartum LARC use during COVID (13% vs. 9%, P=.12, aOR 1.44, CI 0.87-2.39). The etonogestrel implant was the most placed form of immediate postpartum LARC in both cohorts (67% and 71% in pre- and during COVID cohorts, respectively). In general, contraceptive choices at discharge differed between the cohorts (P=.01), with fewer patients desiring LARC placement at the postpartum visit during COVID (13% vs. 6% in pre- and during COVID cohorts). There was no difference between the average number of postpartum visits attended in each cohort (OR 0.93, CI 0.68-1.28). CONCLUSION: Changes in contraceptive counseling during COVID were accompanied by differences in postpartum contraceptive choices at discharge. Targeted contraceptive counseling can influence patient choices in the setting of expected barriers to routine postpartum care.