Improving Emergency Physician Confidence in Contraception Initiation and Early Pregnancy Loss Counseling Through Education

Background: Sexual and reproductive health (SRH) concerns such as contraception initiation and early pregnancy loss (EPL) management are frequently encountered in the emergency department (ED). Despite this, there is limited formal training in contraception initiation and EPL options and treatment counseling for emergency medicine physicians. Prior studies suggest that ED-based reproductive health care is feasible and can improve patient access to care. Additionally, standardized pathways can empower ED teams to manage routine EPL and contraception care independently, reserving OBGYN consultation for complex cases. We developed an educational intervention for ED-specific clinical pathways to improve physician confidence for contraception counseling and EPL management.

Objective: Through a partnership between emergency medicine and OBGYN, we aimed to develop ED-specific clinical pathways and formal training that standardize SRH care and enhance physician confidence in contraception counseling and EPL management.

Methods: First, an interdisciplinary team of emergency medicine and OBGYN physicians established a standardized institutional protocol for EPL and contraception initiation at a single-center urban academic ED. Emergency medicine attendings and residents participated in a 30-minute structured educational session introducing the evidence-based protocols, with content including contraceptive counseling and method selection, diagnostic criteria for definitive EPL, and EPL management options including expectant, medical, and procedural. Participants completed anonymous pre- and post-intervention surveys composed of 5-point Likert-scale and multiple-choice knowledge questions at three timepoints: pre-intervention (n=39), immediate post-intervention (n=30), and 5-month follow-up (n=34). Questions assessed contraception counseling frequency, comfort with EPL counseling, and knowledge of evidence-based management. Responses were analyzed using independent-samples Welch t-tests and chi-square analyses.

Results: At baseline, only 3% of providers reported high confidence (Likert ≥4) in familiarity with the EPL pathway; this rose to 90-100% immediately post-intervention and was maintained at 5 months. Comfort with EPL counseling improved significantly (mean 2.71 to 3.64 at 5 months, p < 0.001). EPL diagnostic knowledge improved from 71% pre-intervention to 100% post-intervention, with 88% retention at 5 months (p=0.004). Knowledge of EPL management also improved, though with partial retention: procedural management rose from 2.34 to 4.40 post-intervention (3.15 at 5 months) and medical management from 2.66 to 4.63 (3.55 at 5 months). Contraception counseling showed the least durable effect with 3% of providers reported frequently discussing contraception at baseline, rising to 80% intent immediately post-intervention but falling to 21% actual frequent discussion at 5 months (p=0.05). At follow-up, female providers scored significantly higher than males on three of six confidence domains (p=0.001-0.025), suggesting differential retention by gender.

Conclusion: A collaborative EM/OBGYN intervention pairing education with standardized clinical pathways significantly improved emergency physician confidence and preparedness to provide sexual and reproductive health services in the ED. Gains in EPL knowledge and counseling were largely sustained at 5 months, while improvements in contraception counseling were less durable, suggesting periodic reinforcement may be needed to maintain practice change. This model demonstrates how OBGYN and emergency medicine can partner to extend SRH education and contraceptive and EPL care across an institution, with the potential to improve access to care, support patient centered counseling, and reduce unnecessary consults and transfers.