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The Effect of a Breastfeeding OSCE Curriculum On Resident Confidence and Comfort

Monday, October 22, 2012
Room 346-347 (Morial Convention Center)
Kathryn S. McLeod, MD1, Rachel Elam2, Christie Palladino3 and Andria Thomas, PhD2, (1)Pediatrics, Georgia Health Sciences University, Augusta, GA, (2)Educational Discovery Institute, Georgia Health Sciences University, Augusta, GA, (3)OB/Gyn, Georgia Health Sciences University, Augusta, GA


The literature shows that curricula incorporating simulated clinical scenarios increase resident confidence in counseling breastfeeding mothers. We designed and implemented a breastfeeding curriculum emphasizing experience with live breastfeeding dyads within a clinical context. This project assesses the curriculum’s impact on resident confidence and comfort in addressing breastfeeding issues.


This study involved two cohorts of pediatric residents at Georgia Health Sciences University. The first cohort completed our standardized patient (SP) curriculum during their PGY-2 year (AY 2010) and repeated the curriculum in PGY-3 (AY 2011). The second cohort completed a breastfeeding curriculum involving didactic and video instruction in their PGY-1 year (AY 2010) and the SP curriculum in PGY-2 (AY 2011). In the SP curriculum, each resident completed three Objective Structured Clinical Examination (OSCE) cases modeling common breastfeeding problems that pediatricians encounter: sore nipples, jaundice, and perceived poor milk supply.

The breastfeeding mother standardized patient rated each resident according to history-taking skill, style, and professionalism, and provided immediate face-to-face feedback. We also assessed residents with the Breastfeeding Attitudes and Behavior Assessment (BABA) pre-intervention and again one-week post-intervention, quantifying residents’ self-perceived confidence and comfort with assisting breastfeeding mothers.

We employed nonparametric tests to evaluate the curriculum’s effect on residents’ confidence and comfort. A p-value of <.05 was considered statistically significant.


The first and second cohorts consisted of 10 and 12 residents, respectively. The mean BABA score increased significantly from 18.1 pre-intervention to 22.0 (out of 25) post-intervention in the first cohort’s PGY-2 (effect size η=0.84). In PGY-3, their mean pre-intervention BABA score was 18.9, a significant decrease from their PGY-2 post-intervention mean; however, the mean BABA score increased significantly to 22.2 after repeating the SP curriculum in PGY-3 (η=0.76).

 The mean BABA score in the second cohort increased from 20.2 pre-intervention to 21.8 post-intervention, but the increase was not significant. However, the BABA cumulative confidence score increased significantly from 11.8 pre-intervention to 12.9 (out of 15) post-intervention (η=0.61).

Across cohorts, the mean PGY-2 BABA score increased significantly from 19.2 pre-intervention to 21.9 post-intervention (η=0.67).

The mean standardized patient rating was ≥12.6 (out of 14) for every OSCE performed. Among first cohort residents, standardized patient ratings on the sore nipples case significantly improved (μPGY-2=12.6; μPGY-3=13.8; η=0.85).


The SP curriculum increased residents’ self-reported confidence in helping mothers breastfeed. With repeat administration, residents additionally reported feeling more comfortable. Improvements in confidence and comfort from the first administration declined one year post-intervention, but significant improvement was observed with repeat administration. This may suggest the need for more reinforcement of curricular content. Our high standardized patient ratings may represent a leniency effect. Future directions include developing a reliable instrument capturing explicit resident behaviors as well as producing a video implementation of these cases.