484 - Breastfeeding Education for Resident Trainees: An Innovative Skills-Based Approach Implemented at Two Academic Institutions

Publication Number: 484.4203

Elizabeth Masotti, Golisano Children's Hospital at The University of Rochester Medical Center, Pittsford, NY, United States; Rita Dadiz, Golisano Children's Hospital at The University of Rochester Medical Center, Rochester, NY, United States; Taryn A. Hill, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, United States; John Morrison, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, United States; Shannon Mooney, Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States; Isabel Hendrickson, Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States

Background: Resident training in breastfeeding (BF) and lactation medicine is essential as healthcare providers play a critical role in counselling BF families. Utilizing a skills-based educational approach allows for active learning and deliberate practice to enhance clinical competence and educational outcomes.

Objective: To assess resident knowledge and self-efficacy after participation in a BF curriculum at two academic institutions.

Design/Methods: Since 2021, we created, implemented and iteratively revised a BF curriculum annually for pediatric residents at Johns Hopkins All Children’s Hospital (JHACH). In 2024, we adapted and piloted the curriculum with pediatric residents at the University of Rochester (UR). Trainees participated in a workshop with 4 stations: 1) BF position/latch, 2) breastmilk production/supply, 3) breastmilk hand expression and engorgement, and 4) BF on-the-go. Stations incorporated didactic and skills-based learning with low-fidelity task trainers (including the wearable Laerdal MamaBreast®). Resident self-efficacy of BF skills was assessed pre- and post-curriculum from 10-multiple-choice knowledge questions and 7 survey questions using 5-point Likert scales. We analyzed 2023-2024 data using the Wilcoxon signed-rank and Mann Whitney U tests for paired and unpaired samples, respectively.

Results: Forty residents participated in the curriculum at JHACH (n=16) and at UR (n=24). While the curriculum was new at UR, approximately 25% of JHACH residents participated the prior year. The percentage of residents who answered the knowledge questions correctly improved after participation (Table 1, pre- vs. post-curriculum: JHACH, 79% vs. 86%, P< 0.05; UR, 68% vs. 89%, P< 0.05). Residents showed most improvement in questions on BF latch/position and the most need for additional education on hand expression and breast pumping. There was also a significant improvement in resident self-efficacy of all BF skills in the survey (Table 2). JHACH residents had higher baseline knowledge scores and self-efficacy ratings than UR residents. All residents recommended or highly recommended the curriculum to future residents.

Conclusion(s): A single-day BF curriculum that combines didactics and skills-based learning improved resident knowledge and self-efficacy at two institutions. Results of the knowledge assessment and survey highlight similar areas that instructors should provide additional education in future sessions at both institutions. Future studies could include longitudinal assessment of resident knowledge and skills in parental guidance and support.

Table 1: Percentage of Residents from Two Institutions who Answered Questions on the Knowledge Assessment Correctly Before and After Participation in the Breastfeeding Curriculum
*P value was calculated using the Wilcoxon signed-rank test with continuity correction for paired data representing the percentage of residents who answered each question correctly.
+P value was calculated using the Mann Whitney U test for unpaired data representing the percentage of residents who answered each question correctly.

Table 2: Resident Self-Efficacy in Counseling and Supporting Parents on Breastfeeding Skills Before and After Participation in Curriculum based on a Five-Point Likert Scale at Two Institutions
Likert scale: 1 to 5, “not at all confident” to “very confident.”
All data are expressed as median (Q1, Q3).
*P values calculated using the Wilcoxon signed-rank test.
+P value was calculated using the Mann-Whitney U test.
--Data were not collected from JHACH.