Knowledge and Confidence of Obstetrics and Gynecology Residents in the Evaluation and Management of Heavy Menstrual Bleeding Due to Inherited Bleeding Disorders

Background: Heavy menstrual bleeding (HMB) is common, and 20-30% of patients presenting with HMB are diagnosed with an inherited bleeding disorder (IBD). Despite the frequent association of HMB with bleeding disorders, specific learning objectives on this topic are lacking for Obstetrics and Gynecology (OBGYN) residents.

Objective: We sought to determine the exposure of OBGYN residents to didactics, clinical training, and confidence in evaluation and management of patients with HMB due to IBDs.

Methods: Prospective survey of OBGYN residents through email solicitation. Residents were invited to complete an anonymous 26-item survey, querying residents' confidence in evaluation and management of HMB in patients with and without IBDs.

Results: In total, 239 OBGYN residency programs were invited to participate and 20 programs responded. Among 388 residents, 84 completed the survey (21.6%). The majority reported didactics on HMB evaluation (n = 71, 85.5%) and treatment (n = 77, 92.8%); however, for HMB due to IBDs, only 35 residents (42.4%) reported didactics on evaluation and 28 (33.7%) reported didactics on treatment. Confidence in evaluation and management of HMB was high but decreased significantly with an IBD. Residents who received didactics on IBDs reported more confidence in their evaluation than residents who did not receive didactics (mean Likert scale score of 3.67 vs. 3.23, p = 0.002). Increasing postgraduate year level was associated with more confidence in treatment (p < 0.001) and did not differ based on type of training program (p = 0.825).

Conclusion: OBGYN residents have decreased confidence in evaluation and management of HMB due to IBDs. Resident confidence increases with didactics and training. Residents would benefit from curricula designed to address this deficit in training.