NATIONAL ASSESSMENT OF PHYSICIANS BREAST-FEEDING KNOWLEDGE, ATTITUDES, TRAINING, AND EXPERIENCE

Objective.-Previous reports have demonstrated that physician counselin g can improve rates of breast-feeding initiation and duration but sugg est that physicians are ill-prepared for this role. It is unclear whet her residency training for pediatricians, obstetrician/gynecologists, and family physicians provides the knowledge and skills necessary for effective breast-feeding promotion. Design.-Survey. Participants.-A na tional random sample of 3115 residents and 1920 practicing physicians in pediatrics, obstetrics/gynecology, and family medicine. Outcomes.-A ssessment of breast-feeding knowledge, attitudes, training, and experi ence. Results.-Overall response rate was 68%. All groups demonstrated significant deficits in knowledge of breast-feeding benefits and clini cal management; for example, less than 50% of residents chose appropri ate clinical management for a breast-fed jaundiced infant or a breast abscess. Practicing physicians performed slightly better, but still mo re than 30% chose incorrect advice for mothers with low milk supply. R esidents reported that their breast-feeding instruction consisted main ly of didactic lecture, not patient experience. Only 55% of senior res idents recalled even one instance of precepting related to breast-feed ing, and less than 20% had demonstrated breast-feeding techniques at l east five times during residency. Regarding preparation for breast-fee ding counseling, more than 50% of all practicing physicians rated thei r 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 patien ts. The greatest predictor of physician self-confidence was previous p ersonal or spousal breast-feeding experience. Conclusions.-In this nat ional sample of residents and practicing physicians in three specialti es, physicians were ill-prepared to counsel breast-feeding mothers. De liberate efforts must be made to incorporate clinically based breast-f eeding training into residency programs and continuing education works hops to better prepare physicians for their role in breast-feeding pro motion.