NEONATAL CIRCUMCISION AND PAIN RELIEF - CURRENT TRAINING PRACTICES

Objective. We conducted a national survey of pediatric, family practic e, and obstetrics and gynecology residency program directors to determ ine the curriculum content and predominant practices in US training pr ograms with regard to neonatal circumcision and anesthesia/analgesia f or the procedure. Methods. Residency directors of accredited programs were surveyed in two mailings of a forced response and short answer su rvey (response rate: 680/914, 74%; pediatrics 83%; family practice 72% ; obstetrics 71%). Results. Pediatric residents were less likely than family practice [odds ratio (OR), 0.04; 95% confidence interval (CI), 0.02-0.08] or obstetrical (OR, 0.14; 95% CI, 0.08-0.23) residents to b e taught circumcision. Training and local custom were rated as importa nt determinants of medical responsibility for neonatal circumcision. P ediatric residents training in programs in which community pediatricia ns perform circumcisions were more likely to learn circumcision (OR, 3 9.0; 95% CI, 14.3-110.6) as were obstetric residents (OR, 79.0; 95% CI , 22.4-306.4) training in programs in which community obstetricians pe rform circumcision. In programs that teach circumcision, pediatric (84 %; OR, 3.4; 95% CI, 1.7-7.1) and family practice (80%; OR, 2.7; 95% CI , 1.7-4.2) programs were more likely than obstetric programs (60%) to teach analgesia/anesthesia techniques to relieve procedural pain. Over all, 26% of programs that taught circumcision failed to provide instru ction in anesthesia/analgesia for the procedure. Significant regional variations in training in circumcision and analgesia/anesthesia techni ques were noted within and across medical specialties. Conclusions. Re sidency training standards are not consistent for pediatric, family pr actice, and obstetrical residents with regard to neonatal circumcision or instruction in analgesia/anesthesia for the procedure. Training wi th regard to pain relief is clearly inadequate for what remains a comm on surgical procedure in the United States. Given the overwhelming evi dence that neonatal circumcision is painful and the existence of safe and effective anesthesia/analgesia methods, residency training in neon atal circumcision should include instruction in pain relief techniques .