(428) Interactive lecture improves resident knowledge and comfort with periviable delivery counseling

Counseling patients at risk for periviable delivery (PVD) is a challenging part of obstetrics. Available resources for PVD counseling (PVDC) include previously published best practices and the National Institute for Child Health and Human Development (NICHD) Calculator for Extremely Preterm Birth Outcomes. Given the necessary nuanced provider knowledge, ethical complexity, and emotional environment of a PVD, we assessed ObGyn resident PVD knowledge and comfort with counseling before and after an educational intervention.

Study Design:

ObGyn residents at a large urban center were given a pre-survey to assess experience, knowledge, and comfort with PVDC. An interactive lecture was given, with case review and group discussion. Those unable to attend lecture were given a reading for comparison. A post-survey was distributed. Paired t-test was used for statistical analysis.

Results:

39 residents participated, and 32 (82.1%) completed the pre-survey. Collectively, residents reported counseling 100 patients a year on PVD, and receiving 1.6 hours of PVD education a year. A majority (87.5%) felt that patients poorly understood after counseling. 21 residents completed the post-survey: 18/26 post-lecture and 3/13 post-reading. Post-lecture, comfort with PVDC significantly improved for all residents (mean 1.9 vs 3.6 on a 5-point Likert Scale; p< 0.01) and PGY1s (mean 1.5 vs 3.2; p=0.01). Knowledge also improved as 50% of residents named all 5 NICHD calculator factors post-lecture, versus 12.5% pre-survey. 100% of residents felt the lecture was very or extremely valuable, and 94.4% plan to implement changes in their practice. Residents post-reading had minimal improvement in PVDC comfort, felt it was slightly or moderately valuable, and none would implement changes.

Conclusion:

At centers with a high incidence of PVD, resident education is crucial to counseling and patient care. Interactive lectures with an opportunity to practice counseling significantly improved comfort and knowledge. These findings highlight a need for high-quality resident education and resources to improve care for patients at risk for PVD.