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Gary L. Freed, MD, MPH; Sarah J. Clark, MPH; James Sorenson, PhD; Jacob A. Lohr, MD; Robert Cefalo, MD, PhD; Peter Curtis, MD

JAMA. 1995;273(6):472-476.

Abstract
Objective.
—Previous reports have demonstrated that physician counseling can improve rates of breast-feeding initiation and duration but suggest that physicians are ill-prepared for this role. It is unclear whether residency training for pediatricians, obstetrician/gynecologists, and family physicians provides the knowledge and skills necessary for effective breast-feeding promotion.

Design.
—Survey.

Participants.
—A national random sample of 3115 residents and 1920 practicing physicians in pediatrics, obstetrics/gynecology, and family medicine.

Outcomes.
—Assessment of breast-feeding knowledge, attitudes, training, and experience.

Results.
—Overall response rate was 68%. All groups demonstrated significant deficits in knowledge of breast-feeding benefits and clinical management; for example, less than 50% of residents chose appropriate clinical management for a breast-fed jaundiced infant or a breast abscess. Practicing physicians performed slightly better, but still more than 30% chose incorrect advice for mothers with low milk supply. Residents reported that their breast-feeding instruction consisted mainly of didactic lecture, not patient experience. Only 55% of senior residents recalled even one instance of precepting related to breast-feeding, and less than 20% had demonstrated breast-feeding techniques at least five times during residency. Regarding preparation for breast-feeding counseling, more than 50% of all practicing physicians rated their residency training as inadequate. Overall, physician involvement in breast-feeding promotion was endorsed by 90% of respondents, yet only half rated themselves as effective in counseling breast-feeding patients. The greatest predictor of physician self-confidence was previous personal or spousal breast-feeding experience.

Conclusions.
—In this national sample of residents and practicing physicians in three specialties, physicians were ill-prepared to counsel breast-feeding mothers. Deliberate efforts must be made to incorporate clinically based breast-feeding training into residency programs and continuing education workshops to better prepare physicians for their role in breast-feeding promotion.

(JAMA. 1995;273:472-476)

Author Affiliations
From the Division of Community Pediatrics (Drs Freed and Lohr), Cecil G. Sheps Center for Health Services Research (Dr Freed and Ms Clark), and the Departments of Health Behavior and Health Education (Dr Sorenson), Obstetrics and Gynecology (Dr Cefalo), and Family Medicine (Dr Curtis), University of North Carolina at Chapel Hill.

Footnotes
Reprint requests to Cecil G. Sheps Center for Health Services Research, CB 7590, University of North Carolina, Chapel Hill, NC 27599-7590 (Dr Freed).

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