Mock clinical exams boost pediatric residents' comfort in addressing breastfeeding

A simulated clinical experience guiding future pediatricians through interactions with breastfeeding moms appears to put the doctors at ease with the sensitive and important health topic, researchers say.

"We showed that their confidence and comfort increased with the OSCE (Objective Structured Clinical Examination) interventions," said Dr. Kathryn McLeod, a pediatrician and educator at the Medical College of Georgia at Georgia Health Sciences University who developed the three simulated patient exams.

Breastfeeding education typically falls to pediatricians who often see mothers and babies several times before a baby is six months old. "Our residents have book knowledge about breastfeeding but they do not have hands-on knowledge on how to help mom's breastfeed," she said. "It's an embarrassing examination for a lot of residents, especially males, watching moms breastfeed infants." It can be embarrassing for moms to ask for help as well, McLeod said.

In the OSCEs, pediatric residents interacted with moms who'd been taught to model three common breastfeeding obstacles: sore nipples, a perception of a poor milk supply and a jaundiced baby. The moms gave residents immediate, face-to-face feedback on their history-taking, style, skill and professionalism. Training was first given in the second year then repeated in the third year.

The experience increased residents' self-reported confidence in helping mothers breastfeed, going from 18.1 to 22 points out of a possible 25 Breastfeeding Attitudes and Behavior assessment score. While their comfort level dipped in the interim, the second course in their third and final year of residency re-boosted the score to 22.2. A second group of residents receiving the more traditional lecture and video in their first and second year experienced a smaller confidence boost.

The findings were reported in a poster presentation at the American Academy of Pediatrics National Conference in New Orleans, Oct. 20-23.

Breastfeeding is considered a win-win for mother and baby. It enhances a baby's protection from infection and reduces the risk of obesity, Sudden Infant Death Syndrome, childhood leukemia and type 1 and 2 diabetes. Additionally, breast milk is easily digestible, reducing the incidence of colic and enhancing food tolerance, since whatever the mother eats flavors the milk. For mothers, it decreases the risk of type 2 diabetes, breast and ovarian cancer and postpartum depression. Still breastfeeding can be technically challenging for already exhausted moms trying to fit it into their hectic schedules, which is why optimal physician support is so important, McLeod said. She is now finalizing videos that mimic the OSCE scenarios, which will be shown to first-year residents, in the hopes of getting them off on the right foot.

Third-year resident Dr. Shannon Myers agrees that the first year is a great place to start. Myers was a second-year resident on maternity leave and breastfeeding her firstborn, Christian Alexander, when McLeod offered the OSCEs. Myers opted to take them anyway. "We as physicians must be comfortable discussing breastfeeding. It is so important to the child's initial development and growth," Myers said. "If pediatricians aren't going to do it, who is?"