P3.039: Resident Breastfeeding and Lactation Education: A National Study of Pediatric Residents

Background: Pediatricians play a crucial role in supporting the breastfeeding goals of families. Pediatric residents in the U.S. receive limited training on lactation and there are no national breastfeeding related requirements for residency training. The objective of this study was to assess the current state of breastfeeding and lactation related training of pediatric residents in the U.S. to inform residency programs, national organizations, and accrediting bodies of current needs and encourage the implementation of interventions to improve education.

Methods: Pediatric residency programs participating in the Association of Pediatric Program Directors (APPD) Longitudinal Educational Assessment Research Network (LEARN) were invited to enroll in the study. Following enrollment, an online survey was distributed to all residents in participating programs. The study was deemed exempt from IRB review. The survey assessed six domains pertaining to breastfeeding and lactation education including demographics, perceived importance, current experience and education, confidence, knowledge, and interest in additional training. Knowledge was assessed with questions adapted from the AAP Breastfeeding Curriculum, used with permission.

Results: 21 residency programs enrolled in the study. Overall response rate was 40.8%, with responses from 489 residents. Nearly all respondents agreed that pediatricians play an important role in supporting patient breastfeeding goals (98.8%) and that breastfeeding knowledge is important to clinical practice as a resident (97.8%) and their future careers (85.1%). 74.8% had received breastfeeding education during residency, however only 49.5% were satisfied with that education. The majority (85.5%) agreed that families expect residents to address their breastfeeding related questions/concerns, yet less than half (44.8%) reported that residency training had prepared them to do so. 47.6% felt confident in providing breastfeeding care, with the lowest reported confidence in assessing latch and positioning (32.9%), evaluating milk supply concerns (51.9%), and counseling on medication safety (55.0%). The mean score on knowledge questions was 64.5% (standard deviation 15.3). The majority of residents were interested in additional training (87.9%) and agreed that this would improve patient care (94.5%). Topics of highest interest were assessing latch (87.7%), troubleshooting supply (83.2%), and medication safety (66.5%). Preferred forms of education delivery were hands-on training (82.6%), continuity clinic teaching (62.2%), and conference teaching (58.9%).

Conclusion: Pediatric residents recognize the importance of breastfeeding knowledge and are interested in additional education. Most are expected to manage breastfeeding related concerns, but do not feel adequately prepared to do so, and objective knowledge scores identify significant gaps. Our project provides a framework and novel insights into the current gaps, pertinent domains, and preferred education delivery methods for pediatric residency programs and national organizations to implement targeted interventions to improve education nationally.