Teaching Breastfeeding Medicine in the ER

Background: Breastfeeding education among training physicians in multiple fields has historically been limited, often leading to low rates of physician support for breastfeeding and low adherence to AAP recommendations for exclusive breastfeeding of at least 6 months. While specialties like pediatrics and Ob/Gyn often have lactation curriculum, many other medical specialties encounter breastfeeding mother-infant dyad without the necessary breastfeeding medicine education and clinical training; this is the case most notably in Emergency Medicine and Family Medicine. All too often, lack of knowledge translates into outdated and inaccurate medical advice that is inappropriately conservative and jeopardizes sustained breastfeeding.

Methods: A pilot curriculum was developed and implemented in a tertiary-care pediatric emergency department with interactive, small-groups of rotating Family Medicine, Emergency Medicine, and Pediatrics residents. Pre- and post-test surveys assessed self-reported comfort with lactation medicine and included fact-based questions based on Wellstart quizzes. Trainees used a 1-6 Likert scale (1 being “low comfort” and 6 “very comfortable”) to grade their comfort with the topic. Five fundamental knowledge questions were then completed before and after the lecture; these questions were reviewed systematically with the learners at the end of the session.

Results: Trainees initially had evaluated their prior knowledge and comfort in breastfeeding education with an average initial score of 2.3/6 that increased to 4.3/6 after the educational session. After the didactic session, residents verbalized increased comfort with taking a breastfeeding history and trended towards higher scores on the knowledge based test. Thus, engaging non-pediatric residents within a tertiary-care ER to build their comfort with the assessment and management of breastfeeding dyads can provide relevant, in-the-moment teaching that builds a strong foundational knowledge.

Conclusion: Lactation medicine didactics fill knowledge gaps for physicians who will almost certainly care for breastfed infants and their parents in the future, now armed with greater knowledge and educational resources. Such didactic sessions are also well-received by trainees recognizing their need for further training and building focused skills in an interactive learning environment.

Given the success of this pilot program, we plan to revise the didactic sessions from resident feedback and continue to target trainees on their pediatric ER rotation for breastfeeding medicine education.