Although residents scored slightly above our minimum acceptable score of 70% on the knowledge domain of the survey, there is still significant room for improving pediatric residents’ breastfeeding knowledge. Residents’ comfort level with assessing and managing breastfeeding difficulties was suboptimal. Although most residents agree that it is their role to promote and assist with breastfeeding, many have never watched a patient being breastfeed. Our study showed that residents receive very little breastfeeding education. Nearly all residents felt that more breastfeeding education should be incorporated into their residency. This feeling is shared by most program directors, who identified a need for more breastfeeding education in residency.
Our survey identified some specific knowledge gaps among pediatric residents, particularly in the area of latch assessment. Other poorly answered questions related to the pumping and storage of breastmilk, as well as an infant’s tongue position while feeding. This suggests that pediatric residents lack knowledge about some of the practical aspects of breastfeeding. These results are in line with those of other studies worldwide [10, 17,18,19]. In Canada, a recent study also showed that failing to identify aspects of a successful latch was a significant knowledge gap for family physicians and pediatricians .
Given the above results, it is not surprising that very few residents felt comfortable providing parents with assistance in the practical aspects of breastfeeding. Only 8 of our 201 participants felt very comfortable evaluating an infant’s latch at the breast, teaching a parent how to position an infant at the breast, and addressing parents’ questions about breastfeeding issues. This result is quite different from the results of a recent Canadian study , where 75% of physicians in the study reported feeling comfortable addressing breastfeeding difficulties. In that previous study, this number dropped significantly when physicians were asked specifically about their comfort with technical breastfeeding skills, such as latch assessment, milk transfer and teaching mothers how to use a breast pump. This previous study suggested that perhaps physicians overestimated their overall comfort with breastfeeding as they may not be aware of their deficiencies. The residents in our current study reported significantly lower comfort levels with addressing breastfeeding difficulties, indicating that residents may be more aware of their gaps in breastfeeding knowledge and skills, and may therefore be more receptive to educational interventions.
Not surprisingly, having children, personal experience with breastfeeding, and certification in breastfeeding were all associated with greater comfort level with the practical aspects of breastfeeding and counseling. Interestingly, higher year of residency training was also associated with higher self-reported comfort. However, this increase in comfort was not paralleled by an increase in knowledge, which raises the possibility that residents may feel more confident without necessarily being more proficient.
We found that residents had very limited experience observing their patients being breastfed. This may be due to residents’ awareness of their lack of breastfeeding counseling-related knowledge, resulting in residents feeling ill-equipped to help if breastfeeding difficulties arise and therefore avoiding these vulnerable situations. This is particularly concerning since previous studies have established that a lack of physician support negatively impacts breastfeeding duration [20,21,22,23]. Nevertheless, we were encouraged to find that despite their discomfort with assessing and managing some of the practical aspects of breastfeeding, residents have positive perceptions about breastfeeding. Of the pediatric residents who completed our survey, the vast majority agreed that breastfeeding promotion is part of their role as a pediatric resident.
Our results clearly demonstrate that breastfeeding education for pediatric residents in Canada could be greatly improved. The small number of residents who had received breastfeeding education reported that the teaching received was mostly didactic, which corresponds to what the program directors reported. However, when residents were asked about their preferred mode of breastfeeding education, most felt that interactive workshops with breastfeeding mothers or shadowing a lactation consultant would be the best ways to learn. Evidently there is a gap between the breastfeeding education residents are currently receiving and the type of breastfeeding education they perceive would be most beneficial. This shows a significant area for improvement within pediatric residency programs across Canada.
Study limitations include a somewhat low overall response rate, although we expected this for the population surveyed . Given that residents self-selected to complete the survey, this could have resulted in a higher proportion of residents with a breastfeeding interest participating in our study. Such self-selection would be expected to positively skew our results, suggesting that the overall knowledge score of all pediatric residents is actually below the 71% score that we obtained. We specifically designed the survey used in this study and the knowledge items have not been widely used or tested from a psychometric point of view. However, it is important to note that we adapted questions from other studies used to assess physicians’ breastfeeding knowledge, confidence, beliefs, and attitudes and as such, we were able to make comparisons between our results and those of the other studies.
This is the largest survey of pediatric residents in Canada assessing breastfeeding knowledge. Moreover, we obtained information from the majority of program directors, giving us a complete view of the state of breastfeeding education among pediatric residents in Canada.