Obstetrics-Gynecology Resident Attitudes and Perceptions About Chronic Pelvic Pain: A Targeted Needs Assessment to Aid Curriculum Development

Abstract

Background Chronic pelvic pain (CPP) accounts for 10% of gynecologic visits and is a common complaint in university-based and community resident clinics. Resident education about CPP has been inconsistent, and review of the limited literature shows predominantly negative perceptions of patients with CPP. Current literature lacks information regarding obstetrics-gynecology residents' attitudes and acquired knowledge regarding CPP. Objective This targeted needs assessment aims to identify regional obstetrics-gynecology resident attitudes and self-perceived knowledge regarding chronic pelvic pain in order to better address potential educational barriers and look toward placing a greater emphasis on this area in resident training. Methods We conducted a focus group of obstetrics-gynecology residents to identify major themes regarding attitudes about CPP. This informed the development of a survey administered to university-based and community-based obstetrics-gynecology residents (N = 57) in the Colorado part of the Western Mountain Region. Cronbach α was calculated to determine reliability for each theme, and descriptive statistics were calculated for each theme. Independent samples t tests assessed differences between training levels and between university and community training sites. Results Survey response rate was 72% (41 of 57). Residents consistently reported feeling overwhelmed by CPP patients, perceived a lack of time to see these patients, and indicated a desire to learn more in this area, but they varied in chosen learning methods. No significant differences were found between levels of training or training sites. Conclusions Most obstetrics-gynecology residents surveyed believe they are inadequately prepared to address the needs of women presenting with CPP.

Biomechanical changes in women with chronic pelvic pain: a case-control study

“…A possible explanation of that is related to the instability of the pelvis: the change of the uterine position causes an imbalance in hormone levels; oxytocin and prostaglandin, which change the contractile activity of the uterus, can lead to blood flow and hormone alternation [4]. The pelvic instability might be caused by chronic inflammation in the genitourinary system or by anatomical disorders in venous return [15,16].…”

“…The noncyclic CPP occurs not in accordance with menstruation and is represented in the bottom abdomen or pelvis as persistent or chronic pain [3]. It has also an economic burden, being the cause of about 10-25% of all gynaecological consultations [4]. Cyclic CPP is traditionally considered a CPP type following the menstrual cycle, and it is characteristic of fertile age women [3].…”

Effects of Patient-Provider Interactions on Diagnosis and Care for Women With Chronic Pelvic Pain: A Qualitative Study

“…Research suggests chronic pelvic pain (CPP) affects about a quarter of women 1 and results in almost a third of gynecological visits. 2,3 Unfortunately, diagnosis and treatment of this condition is poorly understood. 1,[3][4][5][6] In the United States, a correct diagnosis for CPP conditions may be delayed by 10 or more years.…”

“…Ideally, PPIs should contribute to quality health care and positive health outcomes, 5,[8][9][10][11][12][13][14][15][16][17][18] but women with CPP frequently experience negative PPIs. 2,[6][7][8][9]12,[19][20][21][22][23] Studies have investigated patient perspectives of PPIs from women with CPP, but many were conducted 25 years ago. 7,[21][22][23][24] Since then, the benefits of patientcentered care and the influence of PPIs on patient experiences and health outcomes have been investigated for other conditions, such as chronic pain, gastrointestinal disorders, diabetes, and chronic obstructive pulmonary disease.…”

The characteristics of women recommended a laparoscopy for chronic pelvic pain at a tertiary institution

“…Despite its prevalence, CPP remains under‐researched with pathways for optimal care poorly defined. Affected women frequently have their symptoms disregarded or perceived negatively by health professionals . This results in years of inaccurate diagnosis and poor management …”