title: Physician breastfeeding education leads to practice changes and improved clinical outcomes.
abstract: OBJECTIVE
  Lack of physician knowledge about breastfeeding is associated with decreased initiation and continuation of breastfeeding by patients. We evaluated the effects of a breastfeeding education program on physicians' breastfeeding knowledge, attitudes, and beliefs, measured changes in clinical practice, and examined breastfeeding rates of patients of participating physicians.
  
  
  METHODS
  Six breastfeeding sessions addressed breastfeeding problem-solving and counseling and specific clinical issues including mastitis, perceived insufficient milk, poor infant weight gain, and return to work. We measured physicians' breastfeeding knowledge, attitudes, and beliefs before and after curriculum implementation and also measured changes in practice. We analyzed breastfeeding rates of patients in the practice before, during, and after the intervention.
  
  
  RESULTS
  We studied 24 residents and 15 faculty members at the intervention site; there were 12 residents and nine faculty in a similar control program. Attendance at education sessions improved breastfeeding knowledge (p<0.01) and attitudes/beliefs (p=0.03). Participants identified 15 unique practice changes with a strong commitment to make these changes (4.7 on a 5-point scale) and fulfillment of practice change of 3.6. Participation in education sessions improved patients' rates of any breastfeeding at 4 and 6 months and of full breastfeeding at 4 months.
  
  
  CONCLUSIONS
  A breastfeeding education program at a semirural residency program improved physicians' breastfeeding knowledge. Implementation of practice changes was fair. Two years into the intervention, breastfeeding rates improved for patients of the physicians with high levels of participation in the program.
authors.affiliation: Department of Pediatrics, The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire 03756, USA. alison.v.holmes@hitchcock.org
authors.forename: Alison Volpe
authors.initials: AV
authors.lastname: Holmes
authors.forename: Angela Yerdon
authors.initials: AY
authors.lastname: McLeod
authors.forename: Claire
authors.initials: C
authors.lastname: Thesing
authors.forename: Stephanie
authors.initials: S
authors.lastname: Kramer
authors.forename: Cynthia R
authors.initials: CR
authors.lastname: Howard
mesh_terms: D001942:Breast Feeding; D005194:Family Practice / Q000193:education*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007396:Internship and Residency; D009513:New Hampshire; D010818:Practice Patterns, Physicians'; D011340:Problem Solving; D018794:Problem-Based Learning; D012423:Rural Health