National assessment of physicians' breast-feeding knowledge, attitudes, training, and experience.
OBJECTIVE
Previous reports have demonstrated that physician counseling can improve rates of breast-feeding initiation and duration but suggest that physicians are ill-prepared for this role. It is unclear whether residency training for pediatricians, obstetrician/gynecologists, and family physicians provides the knowledge and skills necessary for effective breast-feeding promotion.


METHODS
Survey.


METHODS
A national random sample of 3115 residents and 1920 practicing physicians in pediatrics, obstetrics/gynecology, and family medicine.


RESULTS
Assessment of breast-feeding knowledge, attitudes, training, and experience.


RESULTS
Overall response rate was 68%. All groups demonstrated significant deficits in knowledge of breast-feeding benefits and clinical management; for example, less than 50% of residents chose appropriate clinical management for a breast-fed jaundiced infant or a breast abscess. Practicing physicians performed slightly better, but still more than 30% chose incorrect advice for mothers with low milk supply. Residents reported that their breast-feeding instruction consisted mainly of didactic lecture, not patient experience. Only 55% of senior residents recalled even one instance of precepting related to breast-feeding, and less than 20% had demonstrated breast-feeding techniques at least five times during residency. Regarding preparation for breast-feeding counseling, more than 50% of all practicing physicians rated their residency training as inadequate. Overall, physician involvement in breast-feeding promotion was endorsed by 90% of respondents, yet only half rated themselves as effective in counseling breast-feeding patients. The greatest predictor of physician self-confidence was previous personal or spousal breast-feeding experience.


CONCLUSIONS
In this national sample of residents and practicing physicians in three specialties, physicians were ill-prepared to counsel breast-feeding mothers. Deliberate efforts must be made to incorporate clinically based breast-feeding training into residency programs and continuing education workshops to better prepare physicians for their role in breast-feeding promotion.
Division of Community Pediatrics, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, NC 27599-7590.
G L
GL
Freed
S J
SJ
Clark
J
J
Sorenson
J A
JA
Lohr
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Cefalo
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Curtis
D001942:Breast Feeding; D003376:Counseling; D003479:Curriculum; D005194:Family Practice / Q000193:education; D005260:Female; D006176:Gynecology / Q000193:education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007396:Internship and Residency / Q000592:standards; D008297:Male; D009774:Obstetrics / Q000193:education; D010372:Pediatrics / Q000193:education; D010819:Physician's Role; D011795:Surveys and Questionnaires; D014481:United States