Reproductive Endocrinology and Infertility Case-Based Learning Curriculum Improves Residents and Medical Students'...

Demand for reproductive endocrinology and infertility (REI) specialists has increased with rising utilization of assisted reproductive technology. As a reflection of societal trends, the military medical system has noted increased call for infertility services and specialty-trained expertise. Recent Department of Defense Amendments to the Assisted Reproductive Services Policy reflect an increased utilization of fertility care within our active duty population. Obstetrics and gynecology (OB/GYN) resident physicians are required to complete training in REI, but many report a lack of formalized education while on their REI rotations, and medical students have endorsed decreased interest in the subspecialty with a smaller proportion of represented research. We aimed to develop a case-based REI curriculum for resident physicians and medical students that fulfills national, standardized objectives and assess if the curriculum increases confidence in managing REI conditions.

After receiving exemption from our institution's IRB (protocol number DBS.2023.598, reference 964364), we developed a curriculum using a needs assessment completed by OB/GYN residents in March 2023 who had previously rotated on REI at our institution. A panel of experts wrote the curriculum, which used clinical cases to convey national recommendations and fulfilled learning objectives per the Council on Resident Education. We implemented the curriculum from July 2023 to July 2024 and compared learners' confidence in diagnosing and managing commonly tested REI conditions using the Wilcoxon signed-rank test. We compared needs assessment responses to post-curriculum responses using the Mann-Whitney U test.

Fourteen prior learners completed the needs assessment (response rate 73.6%), all 15 new learners completed the pre-curriculum survey, and 13 of the 15 completed the post-curriculum survey (response rate 86.7%). The curriculum improved the reliability of weekly structured didactics (28.5%-100%) and increased interest in REI grew (28.5%-53.8%). Following curriculum implementation, participants who felt "fairly confident" diagnosing and treating every tested REI condition increased, including amenorrhea (13.3%-84.6%, P < .01), androgen excess (0.0%-69.2%, P < .01), recurrent pregnancy loss (6.67%-76.9%, P < .01), infertility (13.3%-69.2%, P < .01), premenstrual dysphoric disorder (20.0%-53.8%, P = .03), primary ovarian insufficiency (6.67%-53.8%, P < .01), and Mullerian anomalies (6.67%-23.1%, P = .01).

A case-based curriculum improved learners' confidence in diagnosing and managing REI conditions. This curriculum fulfills national learning objectives and can be implemented at medical programs without an REI division. Meeting the rising demand for REIs starts with robust education.