RESUMEN
BACKGROUND: Breastfeeding education should be incorporated routinely into medical school curricula. Despite strong evidence supporting exclusive breastfeeding of infants, lack of physician education has continued to undermine the practice of breastfeeding. Protecting and supporting breastfeeding should be a public health priority as it has the potential to save billions of dollars in health care and also provide the most benefit to the newborn infant. The purpose of this article was to evaluate how the United States undergraduate medical institution incorporates breastfeeding medicine into its curriculum and to suggest modifications that will improve breastfeeding education at all undergraduate medical institutions. METHODS: The authors performed an in-depth review of the undergraduate medical curriculum at the United States medical institution. Course requirements and lectures were compared with the 12 knowledge-based and 12 skill-based competencies that the authors suggest all medical students should possess. In addition, the authors sent out an electronic survey to 600 medical students at the same institution to assess current students understanding and comfort with basic breastfeeding topics. RESULTS: Students in the preclinical years are only learning 3 of the 12 knowledge-based competencies and 1 of the 12 skill-based competencies. Students in the clinical years are learning 5 of the 12 knowledge-based competencies and 9 of the 12 skill-based competencies. Survey results showed that the majorities of medical students were not comfortable with basic breastfeeding medicine and guidance. DISCUSSION: The authors recommend several curriculum changes to advance breastfeeding education. A more targeted breastfeeding curriculum in medical education will help to improve physician knowledge, practice patterns, and confidence in breastfeeding management.
Asunto(s)
Lactancia Materna , Curriculum , Educación de Pregrado en Medicina/métodos , Estudiantes de Medicina , Competencia Clínica , Humanos , Encuestas y CuestionariosRESUMEN
A model of the neural regulation of maternal behavior in rats proposes that the basolateral amygdala (BLA) provides pup-related sensory inputs to the nucleus accumbens-ventral pallidum (NA-VP) circuit and that medial preoptic area activation of the mesolimbic dopamine system potentiates the ability of BLA neurons to stimulate goal-directed maternal responses, such as pup retrieval behavior. Previous research using electrical lesions has provided some direct support for the importance of BLA. In the current study, we examined the effects of temporary inactivation of neurons within BLA and the adjoining basomedial nucleus of the amygdala (BMA) on maternal behavior in postpartum rats. For an anatomical control, muscimol was injected into the medial amygdala (MeA). Since research has shown that MeA plays an inhibitory role in maternal behavior, it was predicted that muscimol injections restricted to that site would not disrupt maternal behavior. The results showed that muscimol injections into BLA/BMA, at dosage levels between 100 and 200 ng/side, produced major deficits in retrieval behavior and minor deficits in nursing behavior. In contrast, muscimol injections into MeA left maternal behavior relatively unaffected. These results show that neuron-specific inactivation of BLA/BMA causes severe deficits in what can be considered a goal-directed and appetitive maternal response, pup retrieval, while leaving the consummatory aspect of maternal behavior, nursing, relatively unaffected. Since oxytocin is important for maternal behavior, and since both BMA and MeA neurons contain OT-binding sites, perhaps OT stimulates BMA output and suppresses MeA output to influence aspects of maternal behavior.