Fertility preservation training for obstetrics and gynecology fellows: a highly desired but non-standardized experience
Miller et al. Fertility Research and Practice
Fertility preservation training for obstetrics and gynecology fellows: a highly desired but non-standardized experience
Elizabeth J. N. Miller 3
Lisa M. Cookingham 2
Teresa K. Woodruff 1
Ginny L. Ryan 5
Karen M. Summers 5
Laxmi A. Kondapalli 4
Divya K. Shah 0
0 Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Pennsylvania , 3701 Market Street, Suite 800, Philadelphia 19104 , USA
1 Department of Obstetrics and Gynecology, Northwestern University , 303 East Superior Street, Chicago, IL 60611 , USA
2 Center for Reproductive Health, Kaiser Permanente Northern California , 1650 Response Road, Sacramento, CA 95815 , USA
3 Department of Obstetrics and Gynecology, University of Minnesota , 420 Delaware St SE, Minneapolis, MN 55455 , USA
4 Colorado Center for Reproductive Medicine , 10290 RidgeGate Circle, Lone Tree, CO 80124 , USA
5 Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Iowa , 200 Hawkins Drive, Iowa City, IA 52242 , USA
Background: Despite a large body of data suggesting that delivery of fertility care to cancer patients is inconsistent and frequently insufficient, there is a paucity of literature examining training in fertility preservation for those physicians expected to discuss options or execute therapy. The study objective was to compare fertility preservation training between Reproductive Endocrinology & Infertility (REI) and Gynecologic Oncology (GYN ONC) fellows and assess the need for additional education in this field. Methods: A 38-item survey was administered to REI and GYN ONC fellows in the United states in April 2014. Survey items included: 1) Clinical exposure, perceived quality of training, and self-reported knowledge in fertility preservation; 2) an educational needs assessment of desire for additional training in fertility preservation. Results: Seventy-nine responses were received from 137 REI and 160 GYN ONC fellows (response rate 27%). REI fellows reported seeing significantly more fertility preservation patients and rated their training more favorably than GYN ONC fellows (48% of REI fellows versus 7% of GYN ONC fellows rated training as 'excellent', p < 0.001). A majority of all fellows felt discussing fertility preservation was 'very important' but fellows differed in self-reported ability to counsel patients, with 43% of REI fellows and only 4% of GYN ONC fellows able to counsel patients 'all the time' (p = 0.002). Seventy-six percent of all fellows felt more education in fertility preservation was required, and 91% felt it should be a required component of fellowship training. Conclusion: Significant variability exists in fertility preservation training for REI and GYN ONC fellows, with the greatest gap seen for GYN ONC fellows, both in perceived quality of fertility preservation training and number of fertility preservation patients seen. A majority of fellows in both disciplines support the idea of a standardized multi-disciplinary curriculum in fertility preservation.
Fertility preservation; Fellowship training; Medical education
Background
As survival rates among young cancer patients have
continued to rise, the scope of cancer treatment has
expanded to address long term survivorship and quality of
life issues in individuals diagnosed with cancer [
1, 2
].
Young survivors consistently identify desire for future
fertility as among the most significant concerns following a
cancer diagnosis [
1–4
]. Heightened anxiety about fertility
has been shown to negatively correlate with perceived
quality of life among cancer survivors [
5
], whereas
availability and uptake of fertility preservation services prior to
treatment has been shown to increase psychosocial
wellbeing and avoid long-term regret in patients diagnosed
with cancer [
6–10
].
Though many fertility preservation techniques have
existed for decades, it is only recently that the many
medical specialties involved in cancer care have
converged to start providing fertility options to young
cancer patients. The term “oncofertility” was coined in
2006 to describe this integrated discipline that addresses
the complex reproductive needs of cancer survivors by
“balancing life-preserving treatments with
fertilitypreserving options [
11–13
]. Published guidelines on
fertility preservation from the American Society of
Clinical Oncology (ASCO) acknowledge the need for
such a multidisciplinary approach, targeting a diverse array
of specialists including medical oncologists, radiation
oncologists, gynecologic oncologists, urologists, hematologists,
pediatric oncologists, and surgeons [
14
]. Both ASCO as
well as the American Society for Reproductive Medicine
(ASRM) specify that all patients should be informed about
the potential for infertility resulting from cancer and its
treatment and given the opportunity to speak with a fertility
specialist to (...truncated)