Why FACTS Exists: A Research Study of Medical Trainees

December 18, 2019
By Joi Spaulding

Editor’s Note: This is a review of research[i] published in 2017 in Fertility and Sterility titled, “Low Fertility Awareness in United States reproductive-aged women and medical trainees: creation and validation of the Fertility & Infertility Treatment Knowledge Score (FIT-KS).” Medical student Joi Spaulding conducted this thorough review of the study as part of a two-week online elective taught by FACTS executive director, Dr. Marguerite Duane, at Georgetown University College of Medicine. The results point to the need for specific education about fertility and infertility treatments not only for the general population but also for medical trainees—an important reason why FACTS exists!

Multiple studies have shown that fertility-related knowledge among the general public and medical trainees is quite low. Knowledge gaps have been found to be especially large regarding the effect of age on fertility and the extent to which lifestyle affects one’s fertility. This study by Kudesia et al discusses the development, validation, and implementation of a web-based instrument—the Fertility & Infertility Treatment Knowledge Score (FIT-KS)—to assess the fertility and infertility treatment knowledge of lay and medically-trained women in the United States. 

In this cross-sectional study, the FIT-KS was designed as an online questionnaire. The research team determined which topics to include in the questionnaire based on clinical experience, surveys, and a review of prior literature. The final FIT-KS document consisted of 29 questions (21 questions about natural fertility and 8 questions about interfertility treatment). In addition to the questions, information was recorded about age, marital/parental status, geography, ethnicity, faith, education, income, and occupation for each survey participant.

Once complete, the study was uploaded onto a secure online system and disseminated in two phases. Phase 1 included reproductive age women (18-45 years old) who spoke English and lived in the United States. Phase 2 participants included female medical trainees, both medical students and OB/Gyn resident physicians, from two large urban academic medical centers in the United States. 

A total of 245 women completed the FIT-KS online survey (118 in phase 1 and 127 in phase 2). The majority of women identified as Caucasian in both phases of the study. In phase 1, the median age was 31, and 52 of them had children (44.1%). In phase 2, most women were 30 or younger (median age 25), and only 12 (9.4%) of them reported having children.

The median score of questions answered correctly on the survey was 16/29 among phase 1 participants (55%) and 19/29 among phase 2 participants (65%). The study identified that when all demographic differences were controlled for, only age and category of training were statistically significant predictors of FIT-KS score (r = 0.40, P <.01). For medical trainees, year of training correlated with a higher score.

Overall, the majority of women in both phases were aware of the effect of lifestyle factors such as smoking and caffeine intake on natural fertility. Across both groups, women were most aware of the impact on fertility of weight and obesity, and least aware of the impact of using certain types of sexual lubricants.

Regarding assisted reproductive technologies, most women in both groups knew about the different options that exist, including oocyte cryopreservation, intrauterine insemination, and in vitro fertilization (IVF). Yet, the medical trainees were significantly (p<.001) more likely to know what these procedures entailed. While the majority of women in both phases were aware of these options, both groups overestimated the chances of success and underestimated complication rates.

Based on the demonstrated validity of the survey and the results generated, the FIT-KS proves to be a successful tool to assess fertility knowledge in the general population and among medical trainees in the United States. The results for both phase 1 and 2 participants support what other literature has already stated: the level of fertility and infertility knowledge in the general population and among medical trainees is low.

The results highlight the need for enhanced fertility education not only among reproductive aged women from the general public but also for future medical professionals. If medical trainees lack adequate fertility knowledge, then it is likely they will not be equipped to counsel patients appropriately on topics related to fertility and infertility. This could perpetuate a cycle of misinformation.

Limitations of the study include a small sample size and a lack of demographic diversity. Using women from more diverse backgrounds and more than two medical institutions could help increase generalizability of the study. Given the nature of the subject matter and complexity of the questions, it is possible that high reading comprehension and advanced test-taking ability may have skewed overall scores, especially among phase 2 participants. This possibility cannot be ruled out at this time. While a solution would be to create two separate surveys, one for lay people and one for medical trainees, this would defeat the purpose of developing a tool to assess fertility knowledge in both the general population and medical trainees.

Limitations aside, the FIT-KS has been validated as a reliable and easily accessible tool to assess fertility knowledge among medical trainees and non-medical individuals. This instrument not only indicates what knowledge the participants already have regarding fertility and infertility but also highlights gaps in fertility knowledge that need to be filled.

Editor’s Note: This year, we chose to narrow our Giving Campaign to focus specifically on supporting student education. This review of research involving medical trainees confirms the need for such education. Consider joining our campaign by supporting a student this coming year (learn more below). It is one way you can help us continue to change the culture of medicine. Thank you!

Author Bio: Joi C. Spaulding is a fourth year medical student at Wake Forest School of Medicine. Originally from Stamford, CT, Joi moved to North Carolina almost a decade ago to complete her undergraduate degree at Davidson College. Before beginning the Doctor of Medicine program, Joi received her Masters of Biomedical Science at Wake Forest School of Medicine. She completed the FACTS elective and also had the opportunity to care for patients alongside Dr. Duane. Joi is currently applying to family medicine residency programs and has a special interest in women and children’s health.


[i] Kudesia, Rashmi, et al. “Low Fertility Awareness in United States Reproductive-Aged Women and Medical Trainees: Creation and Validation of the Fertility & Infertility Treatment Knowledge Score (FIT-KS).” Fertility and Sterility, Oct. 2017, www.ncbi.nlm.nih.gov/pubmed/28911930.


GIVE Students the GIFT of Knowledge!

Our Month of Giving campaign focused on giving students The Gift of Knowledge ends this week, and we thank you if you have already given to support the work of FACTS. Your tax-deductible donation will fund our efforts to bring accurate, up-to-date evidence-based information about FABMs to more medical professionals, women, and couples! In 2020, we hope to update and expand our highly successful online elective, offer current and new webinars as well as more CME conferences, and more. Yet, this will ONLY be possible with YOUR SUPPORT.

We need your help! Our goal for this Month of Giving campaign is to raise $10,000, and thus far, we have only raised $3,100. Please consider giving to FACTS through a generous end-of-year gift or by becoming a monthly donor. Your generosity will enable us to continue to change the culture of medicine so students like Joi (who wrote this week’s blog post) have a chance to learn the latest information about FABMs. Thank you!

Our Giving Campaign Ends in 2 Days.

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Your gift of $20 will allow a student to attend a FACTS webinar.
Your gift of $100 will enable a student to attend our educational conference.
You gift of $250 will allow a student to enroll in our online elective.
Your gift of $500 will cover the cost of a speaker to present to students.

We hope every supporter of FACTS will sponsor at least one student.

Your generosity enables the next generation of physicians and other medical professionals to:
Attend FACTS conferences
Enroll in our elective
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Learn through our webinars
Teach their peers and faculty about the science behind FABMs
Give women and couples more choices in family planning
Establish and grow a network of fertility awareness colleagues early in their careers

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