Virtual IUD placement training improves physician confidence

“The spring 2020 COVID-19 pandemic prevented most in-person education, with new restrictions on in-person instruction,” said study co-author Suzan Goodman, MD, MPH, national training director for the Bixby Beyond the Pill program at the University of California, San Francisco (UCSF) and Clinical Professor of Family and Community Medicine at UCSF. “There has also been patient demand for more streamlined service delivery models to facilitate contraceptive care, particularly in rural and geographically dispersed areas.”

The relative lack of literature on virtual IUD manikins also inspired the authors to initiate the study and address the growing needs in the field.

The University of New Mexico Long-Acting Reversible Contraceptives Mentoring Program in Albuquerque, New Mexico, and UCSF collaborated to develop the innovative, virtual hands-on IUD training model.

Prior to the virtual training, participants watched a didactic pre-training video on patient eligibility and counseling and received a pelvic model, IUD demonstration kit, instrumentation, and phone camera tripod to aid in the visualization of a cervix and uterus model in the mail.

A total of 34 New Mexico clinicians were trained in a 1.5 hour virtual session from January to June 20211. The virtual session was conducted via 1-to-1 zoom video or small group conference where the trainees demonstrated the loading, placement, and removal of all IUDs approved by the Food and Drug Administration (FDA) and reviewed challenging cases. The pelvic model and instruments were returned after training.

Surveys given to trainees before and immediately after training assessed physician satisfaction and assessed changes in self-assessed comfort levels before and after training using IUD methods.

Of the 32 trainees who took part in the before/after surveys, 48% were nurses and midwives, 28% were physician assistants, 17% were doctors, and 7% were trainee clinicians. Overall, 37% of those surveyed had prior experience placing spirals.

All elements of the training delivery were highly rated by clinicians, with all trainees successfully using the virtual platform. Additionally, 50% said they might choose virtual training over in-person training in the future.

After the training, clinicians reported significantly improved comfort in all aspects of IUD placement and removal (P ≤ 0.01).

In addition, all respondents stated that they would recommend the training to a colleague.

“While virtual training was highly rated and increased clinical convenience when inserting and removing coils, I was surprised that half said they would prefer virtual training to an in-person option going forward,” Goodman said Modern OB/GYN®. “That’s a much higher rate than I would have expected.”

She also found unexpectedly that none of the clinicians reported difficulties using the virtual platform and that the results were consistent regardless of the IUD provider’s experience.

“With increasing regulatory restrictions on reproductive health, it is becoming increasingly important that all providers caring for patients with potential pregnancy offer the full spectrum of contraceptive services rather than further fragmenting patient care,” Goodman said. “However, it can be difficult for a trainer to work with more than three virtual learners at a time to effectively guide participants through hands-on procedures over Zoom.”

The virtual internship is useful during periods of the ongoing COVID-19 public health emergency, as well as in geographically large and rural settings, Goodman said. “Virtual IUD training is also helpful when there are high demands on clinic time to simplify logistics, such as: Easier planning and no travel time, and in settings facing reproductive health bans or surges in patient numbers,” she said.

Relation

  1. Sebastian RA, Robinson J, Rayburn E, et al. The virtual training for the placement of the intrauterine device improves the comfort for the doctor. Family Med. 2022;54(6):456-60.

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