Medical Students for Choice's Reproductive Health Externships: impact on medical students' knowledge, attitudes and intention to provide abortions

Abortion Education for Medical Students in an Era of Increased Abortion Restrictions

Following the Supreme Court's decision in Dobbs v Jackson Women's Health in June 2022, many states restricted or banned abortion. Medical educators have focused on how this change impacts abortion training for residents, but schools must also adapt undergraduate medical education. Medical schools provide the foundation for future physicians' knowledge and attitudes on abortion. Comprehensive, high-quality abortion education for all medical students is essential for the future of abortion care. Here, we present how education champions can lead curricular improvements in abortion education in the preclinical, clerkship, and postclerkship phases of undergraduate medical education.

"That is when I understood everything": Ideological trajectories of pro-choice female doctors in Mexico

OBJECTIVES

There is little evidence about how physicians become abortion clinicians or advocates. We describe the ideological trajectories of pro-choice female Mexican doctors and the factors that made them pro-choice.

STUDY DESIGN

In this qualitative study, we conducted semistructured interviews with members of the Mexican Network of Female Pro-choice Physicians. Participants came from eight diverse states. We used a feminist epistemology approach and analyzed data using inductive coding as well as a priori categories (becoming pro-choice, trajectories, and training).

RESULTS

We included 24 female pro-choice physicians. We identified five intersecting factors that influenced becoming pro-choice: feminism, personal experiences, confrontation with the inequalities and violence that women experience, role models, and routine exposure to abortion care. Participants described three ideological trajectories: being pro-choice before studying medicine, not having a specific opinion, and changing from "pro-life" to "pro-choice." Participants described the absence of abortion training in medical schools, stigmatizing training, and the use of alternative training sources.

CONCLUSIONS

In the absence of training on abortion during medical education, a combination of intersecting personal as well as work-related experience may turn doctors into pro-choice abortion clinicians and/or advocates. The findings of this study may be used to develop comprehensive medical curricula as well as strategies directed at doctors who have never received training on abortion care, such as promoting interactions with nonmedical abortion providers, education on inequalities and violence against women, moving beyond public health to a human rights and gender perspective, and exposure to routine safe abortion care.

IMPLICATIONS

Mexican female doctors become pro-choice clinicians who provide abortion care and/or advocates in spite of their medical education.

Abortion and Contraception in Medical School Curricula: A Survey of North American Family Medicine Clinical Curriculum Directors

Phenomenon: Contraception and abortion care are commonly accessed health services, and physicians in training will encounter patients seeking this care. Curricula that teach contraception and abortion provision during medical school equip medical students with valuable skills and may influence their intention to provide these services during their careers. Family planning is nevertheless understood to be underrepresented in most medical curricula, including in North American medical schools where the laws on providing contraception and abortion have been consequentially changing. This study investigated the prevalence and predictors of contraception and abortion education in North American medical curricula in 2021.

Approach: We asked family medicine clerkship directors from Canada and the United States (US) to report about contraception and abortion teaching in their clinical curricula and their school's whole curriculum and to report on associated factors. Survey questions were included in the 2021 Council of Academic Family Medicine's Educational Research Alliance (CERA) survey of Family Medicine Clerkship Directors at accredited North American medical schools. Surveys were distributed between April 29 and May 28, 2021, to the 160 clerkship directors listed in the CERA organization database.

Findings: Seventy-eight directors responded to the survey (78/160, 48%). 47% of responding directors reported no contraception teaching in the family medicine clerkship. 81.7% of responding directors reported no abortion teaching in the clerkship, and 66% indicated abortion was not being taught in their school's whole curriculum. Medical school region correlated with the presence of abortion curricula, and schools with high graduation rates into the family medicine specialty reported abortion teaching more frequently. Fewer than 40% of responding directors had received training on both contraception and abortion care themselves.

Insights: Contraception and abortion are both underrepresented in North American medical curricula. Formal abortion education may be absent from most family medicine clerkships and whole program curricula. To enhance family planning teaching in North American medical schools, we recommend that national curriculum resources be revised to include specific contraception and abortion learning objectives and for increased development and support for clinical curricula directors to universally include family planning teaching in whole program and family medicine clerkship curricula.

International support for abortion education in medical schools: results of a global online survey to explore abortion willingness, intentions, and attitudes among medical students in 85 countries

Introduction

Access to safe abortion has been recognized as a fundamental human right and important public health priority. Medical schools provide a rare opportunity to expose medical students to comprehensive sexual and reproductive health (SRH) topics and normalize abortion care early in a physician's career.

Methods

This cross-sectional descriptive study used an online survey to explore abortion content in medical curricula and medical student intentions, attitudes, and beliefs regarding abortion provision among 1,699 medical students from 85 countries.

Results

Results demonstrate positive attitudes towards abortion provision, with 83% reporting that "access to safe abortion is every woman's right". Students also reported a relatively high willingness to provide abortion professionally despite few opportunities to learn about this care. Only one-third of students surveyed reported having taken a gynecology course (n = 487; 33%); among these, one-third said they had no content on abortion care in their programs thus far (n = 155; 32%), including instruction on postabortion care. Among the two-thirds of students who had some content on abortion care (n = 335), either on induced abortion, postabortion care (PAC), or both, 55% said content was limited to one lecture and only 19% reported having an opportunity to participate in any practical training on abortion provision. Despite most students having no or very limited didactic and practical training on abortion, 42% intended to provide this care after graduation. Three-quarters of student respondents were in favor of mandatory abortion education in medical curricula.

Discussion

The findings of this study offer new evidence about abortion care education in medical curricula around the globe, indicating that there is no lack of demand or interest in increasing medical knowledge on comprehensive abortion care, merely a lack of institutional will to expand course offerings and content.

Barriers to abortion provision: A qualitative study among medical students and gynecologists in Berlin, Germany

OBJECTIVES

While abortion is a common medical procedure in Germany, the number of abortion-providing facilities declined by 46% between 2003 and 2022. As existing data do not paint a complete picture of the factors influencing this decline, an understanding into the perspectives of health care professionals (HCPs) is necessary. We set out to examine attitudes of HCPs in Berlin, Germany toward different aspects of abortion to identify barriers that might prevent them from providing abortions.

STUDY DESIGN

We used a qualitative research design consisting of in-depth semistructured one-on-one interviews with 14 medical students and four gynecologists. We transcribed interviews verbatim and conducted qualitative content analysis.

RESULTS

Many interviewees perceived abortion as a taboo and legally ambiguous intervention. They feared stigmatization when talking about or providing abortions, especially by fellow students or religious family members. Few participants objected to abortion provision on religious grounds. Some medical students underestimated the safety of abortion and overestimated the potential for side effects and complications. Medical students obtained their knowledge about abortion from various sources, such as media, religious school education, or personal experience with abortion; the topic was rarely discussed in their medical education. To decide whether to provide abortions later, many students wished for detailed abortion teaching during medical school and residency.

CONCLUSIONS

Fear of stigmatization, misconceptions on abortion, and religious beliefs reduced HCPs' willingness to perform abortions. Abortion education was widely valued by medical students and could address some of the barriers to abortion provision we found in this study.

IMPLICATIONS

Universities and teaching hospitals should systematically teach about abortion to counteract misinformation and help normalize abortions among HCPs. Moreover, political decision-makers should take measures in order to destigmatize abortion, like an abortion regulation outside the Criminal Code in line with international public health recommendations.

Understanding pre-residency abortion training pathways and career choices in the United States: a qualitative study

BACKGROUND

Many factors contribute to the decision to provide abortion in the United States. We aim to describe pre-residency experiences and decisions that contribute to choosing a career as an abortion provider in the United States.

METHODS

We conducted 60-min semi-structured telephone interviews with 34 current abortion care providers about their career trajectories, decision-making and planning. Interviews were transcribed and coded by three members of the research team using thematic analysis.

RESULTS

A majority of the participants considered (73.5%, n=25) and firmly committed (62.8%, n=22) to providing abortion care prior to entering residency. They described important professional experiences with women's health and reproductive rights, as well as personal experiences with abortion care, all of which inspired them to seek out abortion training during medical school and residency. Participants also described a dearth of mentors or role models until late in training, especially for family physicians.

CONCLUSIONS

Our study suggests that the decision to provide abortion care is often made prior to residency training, before or during medical school, so additional support may be needed to promote exposure to abortion care during undergraduate medical education or even before. Further, there is a need for improved mentorship and role modelling during these periods, especially for family physicians. This may be especially critical after the overturn of Roe v Wade, as medical schools in restrictive states may not be able to provide abortions to patients, depriving students of role models who are abortion providers.

Sexual and reproductive health teaching in undergraduate medical education: A narrative review

OBJECTIVE

Contraception use, undesired pregnancy, and abortion care are common medical experiences that most physicians will encounter for their patients. Future physicians should therefore have some formal education on these topics. In this narrative review, we focused on how medical education approaches these sometimes polarizing yet fundamental topics.

METHODS

We assessed the published literature on sexual and reproductive health education in undergraduate medical education from 2000 to 2021, screening 868 articles and including 52 articles. We included articles that discussed contraception, emergency contraception, pregnancy options counseling, abortion, and ethics related to sexual and reproductive health.

RESULTS

Included studies came from 14 countries and described both preclinical and clinical education. Studies assessed medical student knowledge, the effectiveness of educational interventions and medical school faculty perspectives on sexual and reproductive health curricula. Medical educators have employed a variety of approaches to teach sexual and reproductive health including simulation, objective structured clinical examinations, team-based learning, narrative medicine, online modules, and flipped classrooms.

CONCLUSION

Students generally received sexual and reproductive health education favorably, demonstrating increased knowledge and comfort with these topics after an education session. Studies also identified curricular gaps and deficiencies in student knowledge, which may indicate a need for improved and consistent medical school education on contraception and abortion.

New Gaps and Urgent Needs in Graduate Medical Education and Training in Abortion

Abortion is essential health care, and abortion training and education are essential at all levels of medical education. Among the most common procedures performed in obstetrics and gynecology (OB/GYN), abortion is a core competency for OB/GYN residency programs. For nearly 50 years, the procedure was federally protected by the U.S. Supreme Court's January 22, 1973, Roe v Wade decision. On June 24, 2022, amidst increasing state restrictions limiting abortion access, the Court's decision on Dobbs v Jackson Women's Health Organization effectively reversed Roe . As a result, immediate bans on abortion went into effect across the country, removing access to abortion for millions of people and newly limiting training and education in this core competency for many medical residents. As of June 2022, nearly half of U.S. OB/GYN residency programs and more than 40% of residents are located in states that have banned or are likely to ban abortion. In states where abortion is restricted or illegal, states must adapt quickly to ensure their residents meet training requirements. This adaptation may include developing and leveraging relationships with programs in states where access is protected, depending on simulation, and placing greater emphasis on education and training in pregnancy loss management and postabortion care. None of these is a comprehensive solution and even all together, they are insufficient to train residents and medical students. Ultimately, many future physicians will not receive the training they need to provide full reproductive health care to their pregnant patients. Legal and other systems of support are needed to ensure that current and future physicians can provide compassionate, evidence-based reproductive health care, including essential abortion care.

The ongoing crisis of abortion care education and training in the United States

PURPOSE OF REVIEW

The Dobbs vs Jackson case (Dobbs) decided by the Supreme Court of the United States (SCOTUS) in 2022 rescinded the constitutional right to abortion care, resulting in immediate state bans and severe restrictions on abortion care in almost half of the states at the time of submission. This article reviews the current state of abortion education and training as well as available curricula and programmes to support continued training.

RECENT FINDINGS

Prior to Dobbs, a national residency-level training programme, the Ryan Residency Training Program, has helped expand abortion care training in residency programs nationally, yet there remained many barriers to incorporating this training into practice, including practice and hospital restrictions. New state restrictions now additionally constrain almost half of all the Ob-Gyn residency programmes. Medical students benefit from education on options counselling and values exploration.

SUMMARY

Abortion care education and training is in crisis. Almost half of the Ob-Gyn residents are training in states that have banned or severely restricted abortion care. This threatens to create a workforce without critical early pregnancy management knowledge and skills. Residents are more likely to provide abortion care when they have scheduled routine training. Medical students can apply options counselling and values exploration knowledge broadly. Online education resources provide some patchwork solutions to continue abortion care education and training in this heavily restrictive landscape.

The Status of Medical Student Education in Pregnancy Options Counseling: a Review

BACKGROUND

The Association of Professors of Gynecology and Obstetrics (APGO) has acknowledged the importance of pregnancy options counseling by listing it as a "shows how" skill for all undergraduate medical students. Unfortunately, there is no standard curriculum utilized to teach medical students pregnancy options counseling or to assess skill sustainability over time.

OBJECTIVES

To review and summarize the literature on pregnancy options counseling in undergraduate medical education.

METHODS

We performed a structured literature review searching Google Scholar, PubMed, and EMBASE for articles between 2000 and February 2020. Inclusion criteria were English language studies of M. D. and D.O. programs in North America with a discussion of pregnancy options counseling as it relates to medical student education.

RESULTS

There is a small but growing body of literature on pregnancy options counseling in medical student education. The common themes across the 17 papers reviewed include the status of pregnancy options counseling in undergraduate medical education, barriers to teaching options counseling, the timing of education, utilization of the options counseling Objective Structured Clinical Examination (OSCE), learner challenges, and novel strategies for implementing education in options counseling and subsequent learning outcomes.

CONCLUSIONS

There is no standardized pregnancy options counseling curriculum in undergraduate medical education (UME). The landscape in which this important skill is being taught is one of random, insufficient, and uncoordinated curricular interventions. This is the only review on this subject, making it a unique summary on pregnancy options counseling in UME.

Physician attitudes about abortion and their willingness to consult in abortion care at a Midwestern academic medical center

OBJECTIVE

To assess abortion-related attitudes, practices, and perceptions among physicians of all specialties at a Wisconsin academic medical center.

STUDY DESIGN

We developed and disseminated a cross-sectional web and mail survey to physicians at our academic center using a list generated by Human Resources. We performed descriptive analyses and assessed bivariate relationships between measures of support for abortion, perceived climate of opinion, willingness to consult in abortion-related cases, and sociodemographic and professional characteristics. We used binary logistic regression to model willingness to consult.

RESULTS

We sent the survey to 1357 physicians and received 913 (67%) responses. Participants reported strong support for unrestricted access to abortion and the efforts of abortion providers but estimated relatively lower support among peers. Compared to 556 (62%) who reported "a lot" of support for abortion access, only 183 (21%) estimated the same level of support among peers. Similarly, 615 (69%) participants reported "a lot" of support for abortion providers, compared to only 227 (25%) who estimated the same level of support among peers. Participants most commonly estimated that peers "somewhat" support abortion access (381; 43%) and abortion providers (344; 39%). Across specialties, 799 (90%) physicians said they were at least "somewhat" willing to consult in abortion-related cases. Compared to obstetrician-gynecologists and family physicians, other specialists were less likely to be willing to consult (aOR = 0.43, 95% CI 0.29-0.65), though majorities of both groups were willing. Physicians who perceived equal or higher support for abortion among peers were more likely to be willing to consult (aOR = 2.17, 95% CI 1.60-2.95).

CONCLUSION

Most physicians at our center reported support for abortion; however, those who perceived less support among peers reported less willingness to consult in abortion-related care, regardless of specialty.

IMPLICATIONS

Even among physicians who supported abortion, the perception that peers were less supportive deterred participation in abortion-related care at our institution. Where abortion care is isolated or stigmatized, physicians may be unaware of colleagues' true attitudes about abortion. Efforts to normalize communication about abortion care could improve access and quality.

Access to abortion training

The changing political landscape has had a significant impact on abortion training in the United States. Access to training in medical and surgical abortion has been improving over the past several decades, though significant barriers exist in training providers adequately. We sought to evaluate access to abortion training to providers, including obstetrician-gynecologists, family practice physicians, and advanced practice providers. Training in contraception, miscarriage management, medication abortion and surgical abortion procedures is a requirement for Obstetrics and Gynecology residents. Limited information exists about the details of residency training, though larger percentages of graduating residents are reporting access to comprehensive family planning training. Initiatives by groups such as Medical Students for Choice and the Kenneth J. Ryan Program have greatly improved access to abortion training by increasing opportunities for resident involvement. Abortion training opportunities exist for Family Medicine residents and advanced practice clinicians, though this training is not mandated and as such, often not standardized. In light of increasingly restrictive legislation and decreasing numbers of abortion providers, concerns exist about the sustainability of abortion training access. Other noteworthy barriers to provider training include hospital policy, lack of expert faculty, and state laws. Ensuring integrated evidence-based and standardized abortion training is important in maintaining access to a full range of family planning services.

Abortion attitudes, training, and experience among medical students in Jamaica, West Indies

Objective

To define abortion attitudes, training and experience among medical students in Jamaica, a restricted environment for legal abortion.

Method

From September to November 2017 we conducted an anonymous online cross-sectional survey among medical students enrolled at the University of West Indies (UWI) in Jamaica. An abortion attitudes sum score was used for analysis. Multivariate regression was applied to evaluate the impact of characteristics and experiences on abortion attitudes.

Results

The primary outcome was a validated composite abortion attitudes sum score, ranging from zero to forty-five. 1404 students completed the survey for a response rate of 88%. 64% had a positive attitude towards abortion. In multivariate analysis, medical students’ attitudes were favorably impacted by a prior personal or family experience with abortion, identifying as non-religious, being older in age and mixed raced. 1321 (94%) agreed that abortion training should be included in the medical school curriculum. 78.8% reported no abortion training and only 17.9% reported miscarriage management training.

Conclusion

Medical students at UWI had favorable attitudes towards abortion, despite their limited training in a restrictive environment. Prior personal experience with abortion and being non-religious were the strongest predictor of favorable attitudes. Increased training and clinical exposure may prove to be crucial in improving access of safe abortion.

"Without any indication": stigma and a hidden curriculum within medical students' discussion of elective abortion

Pregnancy termination is a common, beneficial medical procedure, but abortion care in the United States is stigmatized. Language, including categorization of some abortions as elective, may both reflect and convey stigma. We present a history of the term "elective" in reference to abortion, followed by data demonstrating its use by a sample of contemporary medical trainees and an analysis of the term's relationship to abortion stigma, medical training, and patient access to abortion care. We analyzed interviews with 41 U.S. medical students who had applied to residency programs in obstetrics and gynecology. Participants discussed experiences with, and attitudes toward, abortion before and during medical school, and plans to perform abortions in future practice. We inductively coded participants' use of "elective" in reference to abortion and analyzed their meanings. Participants did not use "elective" according to its medical definition, which conveys an absence of urgency for surgery. Instead, "elective" identified a subset of abortions that lacked maternal or fetal medical indications. "Elective" negatively marked and isolated some abortions, and participants used the term to convey judgment about patients' social and reproductive histories. Participants saw medical and psychosocial indications as mutually exclusive, and became confused when interrelated factors influenced patients' abortion decisions. They ignored the voluntary nature of abortion in the setting of medical illness, sexual violence, or fetal complications, and accepted discrimination against women seeking abortion for psychosocial indications as normal and ethical. The term "elective" enables the creation and perpetuation of abortion stigma, and contributes to a hidden curriculum for abortion training in medical education that distracts from core content, incorporates social judgment of patients into medical practice, and promotes normative gender concepts. Our findings support calls to improve the language of abortion care to ensure policies and training environments are consistent with professional standards.

Values clarification workshops to improve abortion knowledge, attitudes and intentions: a pre-post assessment in 12 countries

Background

Women’s access to abortion care is often denied or hampered due to a range of barriers, many of which are rooted in abortion stigma. Abortion values clarification and attitude transformation (VCAT) workshops are conducted with abortion providers, trainers, and policymakers and other stakeholders to mitigate the effects of abortion stigma and increase provision of and access to abortion care. This study assesses changes in knowledge, attitudes, and behavioral intentions of VCAT workshop participants.

Methods

Pre- and post-workshop surveys from 43 VCAT workshops conducted in 12 countries in Asia, Africa, and Latin America between 2006 and 2011 were analyzed to assess changes in three domains: knowledge, attitudes and behavioral intentions related to abortion care. A score was created for each domain (range: 0-100), and paired t-tests or Wilcoxon matched-pairs signed-ranks tests were used to test for significant differences between the pre- and post-workshop scores overall and by region and participant type (providers, trainers, and policymakers/other stakeholders). We also assessed changes in pre- and post-workshop scores for participants with the lowest knowledge and negative attitudes on the pre-workshop survey.

Results

Overall, the mean knowledge score increased significantly from 49.0 to 67.1 (p < 0.001) out of a total possible score of 100. Attitudes and behavioral intentions showed more modest, but still statistically significant improvements between the pre- and post-workshop surveys. The mean attitudes score increased from 78.2 to 80.9 (p < 0.001), and the mean behavioral intentions score rose from 82.2 to 85.4 (p = 0.03). Among participants with negative attitudes pre-workshop, most shifted to positive attitudes on the post-workshop survey, ranging from 35.2% who switched to supporting unrestricted access to second-trimester abortion to 90.9% who switched to feeling comfortable working to increase access to contraceptive services in their country. Participants who began the workshop with the lowest level of knowledge experienced the greatest increase in mean knowledge score from 20.0 to 55.0 between pre- and post-workshop surveys (p < 0.001).

Conclusions

VCAT workshop participants demonstrated improvements in knowledge, attitudes, and behavioral intentions related to abortion care. Participants who entered the workshops with the lowest levels of knowledge and negative attitudes had the greatest gains in these domains.

The unmet need for safe abortion in Turkey: a role for medical abortion and training of medical students

Abortion has been legal and safe in Turkey since 1983, but the unmet need for safe abortion services remains high. Many medical practitioners believe that the introduction of medical abortion would address this. However, since 2012 there has been political opposition to the provision of abortion services. The government has been threatening to restrict the law, and following an administrative change in booking of appointments, some hospital clinics that provided family planning and abortion services had to stop providing abortions. Thus, the availability of safe abortion depends not only on permissive legislation but also political support and the ability of health professionals to provide it. We conducted a study among university medical school students in three provinces on their knowledge of abortion and abortion methods, to try to understand their future practice intentions. Pre-tested, structured, self-administered questionnaires were answered by 209 final-year medical students. The students' level of knowledge of abortion and abortion methods was very low. More than three-quarters had heard of surgical abortion, but only 56% mentioned medical abortion. Although nearly 90% supported making abortion services available in Turkey, their willingness to provide surgical abortion (16%) or medical abortion (15%) was low, due to lack of knowledge. Abortion care, including medical abortion, needs to be included in the medical school curriculum in order to safeguard this women's health service.

Assessing abortion coverage in nurse practitioner programs in Canada: a national survey of program directors

OBJECTIVES

Although nurse practitioners (NPs) play a critical role in the delivery of reproductive health services in Canada, there is a paucity of published information regarding the reproductive health education provided in their training programs. Our study aimed to understand better the didactic and curricular coverage of abortion in Canadian NP programs.

STUDY DESIGN

In 2014, we conducted a 3-contact, bilingual (English-French) mailed survey to assess the coverage of, time dedicated to and barriers to inclusion of 17 different areas of reproductive health, including abortion. We also asked respondents to speculate on whether or not mifepristone would be incorporated into the curriculum if approved by Health Canada for early abortion. We analyzed our results with descriptive statistics and used inductive techniques to analyze the open-ended questions for content and themes.

RESULTS

Sixteen of 23 (70%) program directors or their designees returned our survey. In general, abortion-related topics received less coverage than contraception, ectopic pregnancy management and miscarriage management. Fifty-six percent of respondents reported that their program did not offer information about first-trimester abortion procedures and/or post-abortion care in the didactic curriculum. Respondents expressed interest in incorporating mifepristone/misoprostol into NP education and training.

CONCLUSION

Reproductive health issues receive uneven and often inadequate curricular coverage in Canadian NP programs. Identifying avenues to expand education and training on abortion appears warranted. Embarking on curricular reform efforts is especially important given the upcoming introduction of mifepristone into the Canadian health system for early abortion.

IMPLICATIONS

Our findings draw attention to the need to integrate abortion-related content into NP education and training programs. The approval of Mifegymiso® may provide a window of opportunity to engage in curriculum reform efforts across the health professions in Canada.

Ethics teaching on 'Beginning of Life' issues in UK medical schools

Medical ethics forms an essential component of an undergraduate medical programme. In the UK the Institute of Medical Ethics has released a consensus statement detailing its recommendations for a minimum curriculum for ethics. One important issue it highlights for inclusion is 'Beginning of Life', which includes a wide range of themes. This paper presents an evaluation of the current teaching and assessment of these important issues in UK medical schools, complemented by a specific analysis of students' reaction to the teaching they received at the University of Edinburgh as part of their Obstetrics and Gynaecology rotation. Schools which responded to the survey reported a wide range of teaching and assessment methods. While there was a good overall coverage of topics, only one of them was covered by every institution and the religious/cultural elements of those topics were often neglected. The medical schools viewed better clinical integration of ethics teaching as the best route to improvement, but the students reported a desire for more ethics teaching in the form of specific tutorials, lectures or discussions. It is likely that a combination of these approaches will lead to significant improvements in the delivery of ethics teaching in this area and in others.

University students' attitudes towards Voluntary Interruption of Pregnancy

An evaluation of the future professional trends was performed by analyzing the attitudes of university students to the Voluntary Interruption of Pregnancy (VIP). An anonymous questionnaire was distributed to 300 students (Medicine, Nursing and Law) of the University of Santiago de Compostela, with questions on their personal beliefs, opinion on the law and intention to participate in VIP. Of the 245 respondents (response rate 82%), 66.5% were pro-abortion and their attitudes towards VIP were consistent with their opinion on the beginning of life and with the ethical arguments related to the fetus and the mother. No differences were found with age, sex or degree. The students showed to be well informed on the VIP law, and the majority of them considered unsuitable termination of pregnancy in minors without parental consent. Students' intentions to take part in abortion provision were influenced by their views on abortion, level of participation and circumstances of pregnancy. Although the majority of participants would be willing to perform VIP in situations that affect fetus and mother's life or health (87-66%), their intentions clearly diminished in other situations, such as abortion on demand (17%). These data suggest that conscientious objection of health professionals can even increase with the new policy, a fact that might affect VIP availability. It is important to stress the need of ethical training to help in the solution of conflicts between patient and health professional values.

Perceptions of family planning and abortion education at a faith-based medical school

BACKGROUND

Because of religious beliefs against contraception and abortion, family planning education is limited at faith-based institutions. The purpose of this study was to assess medical students' satisfaction with family planning education at a faith-based medical school.

STUDY DESIGN

A self-administered anonymous questionnaire was designed and distributed to all second- and fourth-year students (n=273) at a faith-based medical school during the 2008-2009 academic year. The questionnaire included items on adequacy of and preference for amount and content of family planning preclinical education and clinical training.

RESULTS

A total of 220 students completed the questionnaire for a response rate of 80.6%. The majority of respondents described the preclinical education as inadequate and preferred increased content on contraception (73.9%), sterilization (68.6%) and abortion (65.2%). The majority of fourth-year students reported appropriate contraceptive clinical training (69.0%), but inadequate sterilization training (54.8%) and abortion training (71.4%) during their third-year OB/GYN clerkship. Approximately half of fourth-year students (51.8%) desired clinical abortion training.

CONCLUSION

The majority of students enrolled at a faith-based medical school rated their current family planning education as inadequate and desired additional opportunities.

Care closer to home

In 2008, in total there were 202 158 abortions performed in England and Wales and 13 817 in Scotland, unfortunately one of the most common gynaecological procedures. 'Care closer to home' applied to this service, as part of a holistic integrated care pathway, can improve access and choice and reduce cost whilst continuing to focus on clinical quality and safety and work towards reducing the number of primary and repeat abortions. Whilst constraints remain within Law, there are ways to change services to help reduce barriers to access not just to abortion but also the essential allied interventions of contraception, sexual health and counselling and support. The first will be reflected in the number of women able to have their abortions earlier, therefore more safely and at lesser cost. It would build on service changes to date, which has allowed women more choice of the method of abortion. The integration of contraceptive services should impact positively on the currently high level of repeat abortions. Bringing care closer to home, into the communities within which women spend their lives, is an important strategy in addressing the quality agenda in abortion care.

First impressions: what are preclinical medical students in the US and Canada learning about sexual and reproductive health?

BACKGROUND

This study evaluates the inclusion of sexual and reproductive health (SRH) topics in preclinical US and Canadian medical education.

STUDY DESIGN

Between 2002 and 2005, we sent surveys to the student coordinators of active Medical Students for Choice chapters at 122 US and Canadian medical schools. Students reported on the preclinical curricular inclusion of 50 specific SRH topics in the broad categories of pregnancy, contraception, infertility, elective abortion, ethical and social issues, and other topics.

RESULTS

We received 77 completed surveys, for an overall response rate of 63%. Coverage of pregnancy physiology and STIs/HIV was uniformly high. In contrast, inclusion of contraceptive methods and elective abortion procedures greatly varied by subtopic and geographic region. Thirty-three percent of respondents reported no coverage of elective abortion-related topics.

CONCLUSIONS

Inclusion of contraception and elective abortion in preclinical medical school courses varies widely. As critical components of women's lives and health, we recommend that medical schools work to integrate comprehensive family planning content into their standard curricula.