Bleeding Disorder Education in Obstetrics and Gynecology Residency Training: A National Survey

Dietrich, Jennifer E.; Tran, Xuan G.; Giardino, Angelo P.

doi:10.1016/j.jpag.2010.11.005

Cited by 9 publications

(6 citation statements)

References 11 publications

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“…Research in the United States has shown that residents in obstetrics and gynaecology average 9.1 hours of training in bleeding disorders in their first year of residency and 11.1 hours in total in the subsequent 4 years of residency. 15 Trainees in obstetrics and gynaecology appeared to have strong skills in appropriate history taking, but lacked the knowledge to manage heavy menstrual bleeding in this patient population. Currently, there is no research exploring how the diagnosis and management of bleeding disorders in women and girls are addressed in Canadian medical training.…”

Section: Development Of Competencies Related To Diagnosis and Managemmentioning

confidence: 99%

Development of competencies related to diagnosis and management of bleeding disorders in women and girls for use in residency training

et al. 2019

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Section: Development Of Competencies Related To Diagnosis and Managemmentioning

confidence: 99%

Development of competencies related to diagnosis and management of bleeding disorders in women and girls for use in residency training

et al. 2019

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“…14 A study assessing obstetrician-gynecologist residency training in the evaluation of menorrhagia demonstrated that chief residents were less likely to ask questions about common bleeding risk factors; for example, 66.1% of respondents would ask about excessive postsurgical bleeding either less than half of the time or never. 15 Additional medical education may be needed to increase awareness of risk factors suggestive of bleeding disorders.…”

Section: Commentmentioning

confidence: 99%

Evaluation of bleeding disorders in women with menorrhagia: a survey of obstetrician-gynecologists

Byams

Anderson

Grant

et al. 2012

American Journal of Obstetrics and Gynecology

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OBJECTIVE-To better understand the current evaluation of unexplained menorrhagia by obstetrician-gynecologists and the extent to which a bleeding disorder diagnosis is being considered in this population. STUDY DESIGN-A total of 1200 Fellows and Junior Fellows of the American College of Obstetricians and Gynecologists were invited to participate in a survey on blood disorders. Respondents completed a questionnaire regarding their patient population and their evaluation of patients with unexplained menorrhagia. RESULTS-The overall response rate was 42.4%. Eighty-two percent of respondents reported having seen patients with menorrhagia caused by a bleeding disorder. Seventy-seven percent of physicians reported they would be likely or very likely to consider a bleeding disorder as causing menorrhagia in adolescent patients; however, only 38.8% would consider bleeding disorders in reproductive age women. CONCLUSION-The current data demonstrate that obstetrician-gynecologists seem to have a relatively high awareness of bleeding disorders as a potential underlying cause of menorrhagia. Keywords bleeding disorder; menorrhagia; physician survey; practice patterns; von Willebrand disease Menorrhagia is a common clinical problem that affects approximately 30% of reproductiveage women. 1 Menorrhagia may result from various clinical conditions, including uterine fibroids, endometriosis, and cancer; however, a cause for menorrhagia is never identified in approximately 50% of cases. 2 Underlying bleeding disorders, including von Willebrand disease (VWD), other coagulation factor deficiencies, and platelet disorders, are prevalent among women with menorrhagia. VWD is caused by a quantitative or qualitative defect in

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“…1,9 Undergraduate and graduate medical curricula generally do not prepare physicians well enough to care for patients afflicted with a bleeding disorder. 10 In addition, anecdotal evidence suggests that educational efforts to improve practicing physicians' knowledge and skills in the diagnosis and management of bleeding disorders tend to primarily target hematologists and experts in hemostasis. In Scott et al's conceptual framework, the Models of Pathways to Treatment, physicians' education and knowledge is one of the many factors that can explain delays in diagnosis and management and one that could be subject for interventions to improve early recognition, diagnosis and treatment of illness.…”

Section: Introductionmentioning

confidence: 99%

“…Empirical evidence examining knowledge gaps in bleeding disorders remains limited to self-reported surveys. 10,13 The purpose of this study was to test the hypothesis that IM residents, irrespective of stage of training, are inadequately prepared to evaluate and manage PBD.…”

Section: Introductionmentioning

confidence: 99%

“…Knowledge gaps in bleeding disorders are often cited as a leading cause for such delays with calls to improve physicians’ education on the matter 1,9 . Undergraduate and graduate medical curricula generally do not prepare physicians well enough to care for patients afflicted with a bleeding disorder 10 . In addition, anecdotal evidence suggests that educational efforts to improve practicing physicians’ knowledge and skills in the diagnosis and management of bleeding disorders tend to primarily target hematologists and experts in hemostasis.…”

Section: Introductionmentioning

confidence: 99%

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Knowledge gaps in bleeding disorders: Results from an objective structured oral examination in internal medicine residency training

Khalife

Tinmouth

Duffett

et al. 2022

Journal of Thrombosis and Haemostasis

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Background Empirical evidence for physicians’ knowledge gaps in bleeding disorders is limited to self‐reported surveys, yet often cited as a leading cause of diagnostic and management delays. Objectives Our aim was to assess internal medicine (IM) residents’ competence, based on their training level, in evaluating a patient with a bleeding disorder, and knowledge gaps in their clinical approach. Methods Content experts developed patient case presenting with abnormal bleeding, bruising, and an isolated prolonged PTT. We administered the hemostasis case as part of an objective structured clinical examination (OSCE). We performed a descriptive analysis. One‐way anova was conducted to compare the effect of training level on performance. Item difficulty level for the hemostasis case was also determined. Results Sixty‐seven IM residents participated in the OSCE. The hemostasis case had the highest failure rate at 41.8% with a mean score for the station of 57.96% (SD 13.04). Senior residents scored significantly higher than junior residents on this case (F(2,64) = 4.604, p = .014, ηp2 = 0.126). The item difficulty analysis demonstrated challenges in in eliciting a history of bleeding provoked by challenges, examining the bleeding site, interpreting the mixing study, requesting appropriate follow‐up tests, making the diagnosis and providing acute management for a bleeding patient. Only 49.3% of residents requested a hematology consultation. Conclusions We demonstrated important knowledge gaps in IM residents’ approach to the bleeding patient. Innovative strategies for hemostasis education should be a priority to address physician‐related factors in the diagnostic and management delays of patients with bleeding disorders.

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Bleeding Disorder Education in Obstetrics and Gynecology Residency Training: A National Survey

Cited by 9 publications

References 11 publications

Development of competencies related to diagnosis and management of bleeding disorders in women and girls for use in residency training

Development of competencies related to diagnosis and management of bleeding disorders in women and girls for use in residency training

Evaluation of bleeding disorders in women with menorrhagia: a survey of obstetrician-gynecologists

Knowledge gaps in bleeding disorders: Results from an objective structured oral examination in internal medicine residency training

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