National assessment of physicians' breast-feeding knowledge, attitudes, training, and experience

JAMA. 1995 Feb 8;273(6):472-6. doi: 10.1001/jama.1995.03520300046035.


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.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Breast Feeding*
  • Counseling*
  • Curriculum
  • Family Practice / education
  • Female
  • Gynecology / education
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Internship and Residency / standards
  • Male
  • Obstetrics / education
  • Pediatrics / education
  • Physician's Role*
  • Surveys and Questionnaires
  • United States