YouTube used for IUD training

Doctors are turning to YouTube for training to insert long-acting reversible contraceptives such as the Mirena, top women’s health expert and GP Dr Orna McGinn says.

There is no competency-based training scheme for primary care clinicians to insert subsidised intra-uterine devices, despite being 20 times more effective than the most common form of contraceptive in New Zealand – the birth control pill, which has to be taken daily.

‘‘It is absolutely mandatory that if you are doing an invasive surgery ... you should have been trained,’’ said McGinn, an Auckland GP who is the clinical director of primary care at Auckland DHB women’s health. ‘‘You wouldn’t let a dentist extract a tooth who wasn’t fully trained.’’

There was a competency-based training programme in the UK where clinicians had to complete 12 procedures to be deemed competent, she said.

A competency standard was in development, led by the Ministry of Health, but in its absence GPs have ‘‘had to do their best and were ... doing training over YouTube videos’’, she said.

Family Planning also performed the procedure as well as providing training, but it was ‘‘disrespectful’’ to those seeking the procedure that there wasn’t a formal training scheme. There were also long waits for GPs to access Family Planning training, McGinn said.

‘‘My colleagues want to be trained, it has just not been easy to get,’’ she said. ‘‘If you haven’t gone through a rigorous training programme you will get complications.’’

Dr Jane MacDonald, senior research fellow at Victoria University’s

centre for women’s health research, said the sector had ‘‘no idea how GPs are getting their training in this area. It is very adhoc’’.

She called for a formal training system and more funding so GPs could perform the procedure.

The free contraceptives are inserted into the uterus and release the hormone levonorgestrel, but there is a cost for insertion and removal of about $150 at general practices, which acts as a barrier for patients.

Funding models for contraception in primary care differ between and even within regions, and can depend on patient age, ethnicity or address, or the primary health organisation to which the GP practice belongs.

A Wellington nurse who had

Monday, April 12, 2021 her second IUD inserted after the first fell out was left in excruciating pain for six weeks before she was able to get a $280 ultrasound to prove it had moved and to have it taken out.

The 24-year-old’s copper IUD was inserted by a GP who was learning how to do the procedure in November.

She was initially told she didn’t meet District Health Board criteria for free insertion because she wasn’t at risk of unplanned pregnancy but convinced her doctor it was needed.

The procedure usually takes less than five minutes, but she said it took an hour and a half and was ‘‘intensely painful’’.

The Ministry of Health and Family Planning were approached for comment.

‘‘You wouldn’t let a dentist extract a tooth who wasn’t fully trained.’’

Dr Orna McGinn women’s health expert