1
|
Feltman RN, Lewis SR, Thompson NE. Family planning competency following medical school Ob/Gyn clerkships at faith-based and secular sites. Sci Rep 2024; 14:3667. [PMID: 38351035 PMCID: PMC10864354 DOI: 10.1038/s41598-024-54304-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 02/11/2024] [Indexed: 02/16/2024] Open
Abstract
Contraception and abortion topics are variably, but often poorly, addressed in medical school curricula. Restrictions on contraceptive and abortion care at faith-based hospitals may hinder comprehensive family planning training for medical students during Ob/Gyn clerkships. Here we investigated whether medical students at faith-based and non-faith-based clerkships experienced different observations during their Ob/Gyn clerkship and/or differences in self-perceived competency in patient counseling, objective knowledge, and perceived adequacy of training in contraception and abortion topics post-clerkship. A survey was distributed to third- and fourth-year medical students at New York Institute of Technology, College of Osteopathic Medicine. Across all clerkship sites (n = 102 students), observations of, and competency in, contraceptive care was higher than in abortion care. Students at non-faith-based clerkship sites (n = 54) reported the highest levels of observation of contraceptive and abortion care (19.6-90.7%), while those at Catholic sites (n = 26) typically reported the lowest (7.7-34.6%). Students at non-faith-based sites reported significantly higher competency in contraceptive care and some aspects of abortion care, than those at Catholic, and some other faith-based sites (n = 48). Clerkship training at faith-based sites, specifically Catholic sites, resulted in poorer Ob/Gyn training, particularly in contraceptive care. Training outcomes in abortion care were poor at all Ob/Gyn clerkship sites.
Collapse
Affiliation(s)
- Rachel N Feltman
- NYIT College of Osteopathic Medicine, Old Westbury, NY, 11568, USA
| | - Steven R Lewis
- Department of Clinical Medicine, NYIT College of Osteopathic Medicine, Jonesboro, AR, 72401, USA
| | - Nathan E Thompson
- Department of Anatomy, NYIT College of Osteopathic Medicine, 100 Northern Boulevard, Riland 330, Old Westbury, NY, 11568, USA.
| |
Collapse
|
2
|
Gyuras HJ, Field MP, Thornton O, Bessett D, McGowan ML. The double-edged sword of abortion regulations: Decreasing training opportunities while increasing knowledge requirements. MEDICAL EDUCATION ONLINE 2023; 28:2145104. [PMID: 36373897 PMCID: PMC9668273 DOI: 10.1080/10872981.2022.2145104] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/25/2022] [Accepted: 11/03/2022] [Indexed: 05/21/2023]
Abstract
PURPOSE The authors explore how abortion regulations in Ohio, an abortion-restrictive state in the USA, impact obstetrician-gynecologists' (OB/GYNs) training in reproductive healthcare and describe what OB/GYNs believe to be the broader impact of Ohio's regulations on skill-building, skills maintenance, and professional retention of reproductive healthcare providers in the state. Authors discuss how their findings foreshadow abortion training limitations in Ohio and other abortion-restrictive states now that abortion regulations have returned to the states. METHODS The authors conducted four semi-structured focus groups and five in-depth interviews between April 2019 and March 2020. Participants included OB/GYNs practicing obstetrics and gynecology in Ohio between 2010 and 2020. Thematic analysis was conducted using Atlas.ti. RESULTS Twenty attending physicians and 15 fellows and residents participated in the study. Participants discussed the impact of Ohio's written transfer agreement, gestational-limit, and abortion method and facility bans on training and skill-building opportunities. Participants felt that Ohio's strict abortion regulations 1) limit opportunities to observe and perform abortion procedures during training; 2) require learning the ever-changing legality of abortion provision; 3) limit the number of abortions OB/GYNs can provide, leading to the atrophy of their skills over time; and 4) may prevent prospective medical students and residents from choosing to study in Ohio and may lead to physician attrition from the state. CONCLUSION Prior to the reversal of federal protections for abortion in 2022, OB/GYNs in Ohio and other abortion-hostile states experienced barriers to training in abortion care. In returning abortion regulation to the states, access to training is likely to be increasingly restricted. This research demonstrates how abortion-restrictions hamper physicians' skills needed to care for patients, particularly in emergent situations. This puts patients at risk and places physicians in precarious ethical positions. Expanding protections and reducing restrictions on abortion will ensure OB/GYNs and trainees have the skills necessary to care for patients presenting for reproductive healthcare.
Collapse
Affiliation(s)
- Hillary J. Gyuras
- Gyuras Is a Research Associate, College of Public Health, the Ohio State University, Ohio, USA
- CONTACT Hillary J. Gyuras 60 Townshend Hall, 1885 Neil Ave. Mall, The Ohio State University, Columbus, OH 43212
| | - Meredith P. Field
- Division of Social Sciences, Alfred University, Alfred, New York, USA
| | - Olivia Thornton
- Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Massachusetts, USA
| | - Danielle Bessett
- Department of Sociology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Michelle L. McGowan
- Biomedical Ethics Research Program, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
3
|
French V, Steinauer J. Sexual and reproductive health teaching in undergraduate medical education: A narrative review. Int J Gynaecol Obstet 2023; 163:23-30. [PMID: 36951645 DOI: 10.1002/ijgo.14759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 02/25/2023] [Accepted: 03/07/2023] [Indexed: 03/24/2023]
Abstract
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.
Collapse
Affiliation(s)
- Valerie French
- Department of Obstetrics and Gynecology, University of Kansas, Kansas City, Kansas, USA
| | - Jody Steinauer
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| |
Collapse
|
4
|
Merner B, Haining CM, Willmott L, Savulescu J, Keogh LA. Institutional objection to abortion: A mixed-methods narrative review. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231152373. [PMID: 36785871 PMCID: PMC10071095 DOI: 10.1177/17455057231152373] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Institutional objection (IO) occurs when institutions providing health care claim objector status and refuse to provide legally permissible health services such as abortion. IO may be regulated by sources including law, ethical codes and policies (including State and local/institutional policies). We conducted a mixed-methods narrative review of the empirical evidence exploring IO to abortion provision globally, to inform areas for further research. MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), Global Health (CAB Abstracts), ScienceDirect and Scopus were searched in August 2021 using keywords including 'conscientious objection', 'faith-based organizations', 'religious hospitals' and 'abortion'. Eligible research focused on clinicians' attitudes and experiences of IO to abortion. The 28 studies included in the review were from nine countries: United States (19), Chile (2), Turkey (1), Argentina (1), Australia (1), Colombia (1), Ghana (1), Poland (1) and South Africa (1). The analysis demonstrated that IO was claimed in a range of countries, despite different legislative and policy frameworks. There was strong evidence from the United States that clinicians in religious healthcare institutions were less likely to provide abortions and abortion referrals, and that training of future abortion providers was negatively affected by IO. Qualitative evidence from other countries showed that IO was claimed by secular as well as religious institutions, and individual conscientious objection could be used as a mechanism for imposing IO. Further research is needed to explore whether IO is morally justified, how decisions are made to claim IO, and on what grounds. Finally, appropriate models for regulating IO are needed to ensure the protection of women's access to abortion. Such models could be informed by those used to regulate IO in other contexts, such as voluntary assisted dying.
Collapse
Affiliation(s)
- Bronwen Merner
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Casey M Haining
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Lindy Willmott
- Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology, Brisbane, QLD, Australia
| | - Julian Savulescu
- The Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK.,Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Murdoch Children's Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia
| | - Louise A Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| |
Collapse
|
5
|
Bringley J, Zu V, Javlekar A, Daoud Yilmaz F, Flink-Bochacki R. Effects of rotating at a Catholic hospital on medical student contraceptive objective structured clinical exam scores. Contraception 2021; 106:64-67. [PMID: 34506800 DOI: 10.1016/j.contraception.2021.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/27/2021] [Accepted: 09/01/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the impact of rotating at a Catholic vs non-religious institution for the inpatient portion of the third-year medical school obstetrics and gynecology clerkship on medical students' contraceptive competency. STUDY DESIGN We assigned all medical students completing an obstetrics and gynecology clerkship during the 2017-2019 academic years to a Catholic or non-religious hospital for their inpatient teaching site, where they gain much of their contraceptive counseling experience. All students attended the same didactic sessions on contraception. We compared Objective Structured Clinical Exam (OSCE) scores and clerkship grades between the two clinical sites for all medical students. We set significance at p < 0.05. RESULTS Of 281 medical students, the 127 (45.2%) who had rotated at a Catholic hospital performed lower on the data-gathering component of the contraceptive OSCE compared with students at the non-religious hospitals (Catholic: 62.4 ± 16.5 vs non-religious: 70.2 ± 15.9, p < 0.01) and had lower total contraceptive OSCE scores (Catholic: 69.4 ± 9.3 vs non-religious: 72.0 ± 8.5, p < 0.01). Clinical reasoning and communication scores for the contraceptive OSCE, data-gathering and total scores for other OSCE scenarios, overall OSCE and clerkship grades were not different. CONCLUSION Rotation at a Catholic hospital, with fewer opportunities for medical students to experience contraceptive counseling, was associated with poorer data-gathering skills for gynecologic and sexual history. While contraceptive knowledge can be imparted didactically, hands-on history-taking and counseling experiences are needed to build competency in contraceptive care. IMPLICATIONS There is a disparity in medical student family planning training at a Catholic hospital compared with non-religious hospitals. Contraceptive knowledge can be attained through didactic sessions, however additional hands-on practice is needed in gynecologic and sexual history taking if clinical opportunities are limited.
Collapse
Affiliation(s)
- Johanna Bringley
- Albany Medical Center, Department of Obstetrics & Gynecology, Albany, NY, United States.
| | - Virginia Zu
- Albany Medical Center, Department of Obstetrics & Gynecology, Albany, NY, United States
| | - Ashwini Javlekar
- Albany Medical Center, Department of Obstetrics & Gynecology, Albany, NY, United States
| | - Fatima Daoud Yilmaz
- Albany Medical Center, Department of Obstetrics & Gynecology, Albany, NY, United States
| | - Rachel Flink-Bochacki
- Albany Medical Center, Department of Obstetrics & Gynecology, Albany, NY, United States
| |
Collapse
|
6
|
Martinez RC, Bonnin R, Feld Z, Minor S. Abortion Opt-in Experience in Third-Year Clerkship. PRIMER (LEAWOOD, KAN.) 2021; 5:38. [PMID: 34841213 PMCID: PMC8612582 DOI: 10.22454/primer.2021.201254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Despite the public health imperative that all medical practitioners serving reproductive-aged women know the components of abortion care and attain competency in nondirective pregnancy options counseling, exposure to abortion care in US medical school education remains significantly limited. METHODS Florida International University Herbert Wertheim College of Medicine offers an opt-in clinical exposure to abortion care during the obstetrics and gynecology clerkship. During clerkship orientation, students watched a recorded presentation reviewing components of abortion care and emphasizing that participating students may increase or decrease involvement at any time without explanation. Students opting in completed a form specifying their desired level of involvement for each component as "yes," "no," or "not sure." RESULTS Of 350 clerkship students over 23 6-week rotations, 98 (28%) chose to opt in, with opt-in form data available for 90 students. Ninety students chose to observe counseling for first- and second-trimester surgical abortion and medical abortion. Seven students used the option "no" for history taking and examine second trimester fetal parts. Twenty-four students marked "not sure" for participating in evacuation of first-trimester pregnancy. DISCUSSION This educational intervention proved feasible and offers an opportunity for students to have experiential learning about abortion care in an inclusive, respectful manner. This experience may be incorporated into undergraduate and graduate medical education. Providing learners the opportunity for exposure to abortion care improves their overall medical education and will impact the care they provide as future clinicians.
Collapse
Affiliation(s)
- Rebeca C Martinez
- Florida International University Herbert Wertheim College of Medicine, Miami, FL
| | - Rodolfo Bonnin
- Florida International University Herbert Wertheim College of Medicine, Miami, FL
| | - Zoe Feld
- Department of Obstetrics and Gynecology, University of California Davis, Sacramento, CA, Miami, FL
| | - Suzanne Minor
- Florida International University Herbert Wertheim College of Medicine, Office of Medical Education, Miami, FL
| |
Collapse
|
7
|
Standardizing abortion education: what medical schools can learn from residency programs. Curr Opin Obstet Gynecol 2020; 32:387-392. [PMID: 32969850 DOI: 10.1097/gco.0000000000000663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW With over 50 million abortions annually and 25% of pregnancies ending in abortion worldwide, abortion is one of the most common medical procedures. Yet abortion-related topics are glaringly absent from medical school curricula in the USA with half of medical schools including no formal training or only a single lecture. We explore abortion education in US medical schools and Obstetrics and Gynecology (Ob/Gyn) residency programs. Specifically, we review efforts to improve and standardize this training. RECENT FINDINGS Despite documented interest in both learning and in the benefits of early exposure, medical students face a lack of educational opportunities in abortion care. Meanwhile, Ob/Gyn residency has standardized requirements for abortion care, greatly improving training and education, despite persistent challenges in universal compliance with these standards. SUMMARY Education in abortion care is crucially important in fostering and training future abortion providers, thereby ensuring and expanding access to safe abortion. The improvements made by standardizing abortion education in Ob/Gyn residency should encourage similar efforts in medical school in order to increase earlier and wider exposure to future physicians of all specialties. On a national level, standardizing exams for medical students by which to evaluate their understanding of abortion care would hold schools accountable for medical student education.
Collapse
|
8
|
Dianat S, Silverstein IA, Holt K, Steinauer J, Dehlendorf C. Breaking the silence in the primary care office: patients' attitudes toward discussing abortion during contraceptive counseling. Contracept X 2020; 2:100029. [PMID: 32671336 PMCID: PMC7338626 DOI: 10.1016/j.conx.2020.100029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 05/23/2020] [Accepted: 06/07/2020] [Indexed: 11/15/2022] Open
Abstract
Objectives Abortions are common health experiences in the United States, yet they are siloed from mainstream health care. To provide guidance on how clinicians could break down these silos, normalize conversations about abortion, and potentially improve patient experience and contraceptive decision-making, we sought to understand patient attitudes regarding discussing abortion during contraceptive counseling. Study design In 2018, we completed in-depth semi-structured interviews with reproductive-aged women recruited from primary care clinics of two politically disparate regions within California. We elicited acceptability, preferences, and implications of clinicians mentioning abortion during contraceptive counseling. Using directed content analysis, we coded transcripts for inductive and deductive themes. Results We achieved thematic saturation after 49 interviews. Interviewees were diverse in reproductive history, race/ethnicity, religiosity, and abortion attitudes. Participants with diverse attitudes about abortion reported that having abortion mentioned during contraceptive counseling was generally viewed as acceptable, and even helpful, when delivered in a non-directive manner focused on information provision. For some patients, mentioning abortion may reduce abortion stigma and help contraceptive decision-making. Careful attention to a non-judgmental communication style is critical to safeguard against potential contraceptive coercion. Conclusions Discussing abortion during contraceptive counseling was acceptable among this diverse population, and our findings suggest ways to best structure such counseling. Coupled with research on clinician perspectives, our findings can inform development of patient-centered contraceptive counseling approaches that integrate abortion in an attempt to facilitate patient care and reduce stigma. Implications Mentioning abortion during contraceptive counseling can be acceptable, and even helpful, to patients when delivered in a non-directive manner focused on information provision, even among patients who believed abortion should be illegal in all or most cases. For some patients, mentioning abortion may reduce abortion stigma and help contraceptive decision-making.
Collapse
Affiliation(s)
- Shokoufeh Dianat
- University of California, San Francisco, Departments of Family & Community Medicine and Obstetrics, Gynecology & Reproductive Sciences. Address: 1001 Potrero Ave, Ward 22, San Francisco, CA 94110
| | - Ilana A Silverstein
- University of California, San Francisco, Department of Family & Community Medicine, 1001 Potrero Ave, Ward 22, San Francisco, CA 94110
| | - Kelsey Holt
- University of California, San Francisco, Department of Family & Community Medicine, 1001 Potrero Ave, Ward 22, San Francisco, CA 94110
| | - Jody Steinauer
- University of California, San Francisco, Department of Obstetrics, Gynecology & Reproductive Sciences, 1001 Potrero Ave, Ward 6D, San Francisco, CA 94110
| | - Christine Dehlendorf
- University of California, San Francisco, Departments of Family & Community Medicine, Obstetrics, Gynecology & Reproductive Sciences, and Epidemiology & Biostatistics, 1001 Potrero Ave, Ward 22, San Francisco, CA 94110
| |
Collapse
|
9
|
Steinauer J. Institutional Religious Policies That Follow Obstetricians and Gynecologists Into Practice. J Grad Med Educ 2017; 9:447-450. [PMID: 28824756 PMCID: PMC5559238 DOI: 10.4300/jgme-d-17-00376.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
10
|
Abstract
Access to safe abortion hinges upon the availability of trained abortion providers. The American College of Obstetricians and Gynecologists supports education for students in health care fields as well as clinical training for residents and advanced practice clinicians in abortion care in order to increase the availability of trained abortion providers. The American College of Obstetricians and Gynecologists supports the expansion of abortion education and an increase in the number and types of trained abortion providers in order to ensure women's access to safe abortions. Integrated medical education and universal opt-out training policies help to lessen the stigma of abortion provision and improve access by increasing the number of abortion providers. This Committee Opinion reviews the current status of abortion education, describes initiatives to ensure the availability of appropriate and up-to-date abortion training, and recommends efforts for integrating and improving abortion education in medical schools, residency programs, and advanced practice clinician training programs.
Collapse
|
11
|
Fitzgerald JM, Krause KE, Yermak D, Dunne S, Hannigan A, Cullen W, Meagher D, McGrath D, Finucane P, Coffey C, Dunne C. The first survey of attitudes of medical students in Ireland towards termination of pregnancy. JOURNAL OF MEDICAL ETHICS 2014; 40:710-713. [PMID: 23963257 DOI: 10.1136/medethics-2013-101608] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Since the UK Abortion Act (1967), women have travelled from Ireland to the UK for legal abortion. In 2011 >4000 women did so. Knowledge and attitudes of medical students towards abortion have been published, however, this is the first such report from Ireland. OBJECTIVE To investigate medical students' attitudes towards abortion in Ireland. METHODS All medical students at the University of Limerick, and physicians who graduated from the university within the previous 12 months, were invited via email to complete an anonymous online survey. The questionnaire comprised 17 questions. Quantitative and qualitative analyses were performed. RESULTS Response rate was 45% (n=169; 55% women; 88.2% <30 years of age; 66.7% Irish; 29.2% North American). Outcomes were: abortion should not be legally available (7.1%), abortion should be allowed in limited circumstances only (35.5%), abortion should be legally available upon request (55%). 72.8% of respondents were moderately/strongly prochoice (74% of women/71% of men/72% and 76% of Irish and North American respondents, respectively). Students aged >30 years were less likely to be prochoice (55%). While 95.2% believed that education on abortion should be offered within medical school curricula, 28.8% stated that they would decline to terminate pregnancies even if legally permitted. While 58.8% indicated that they might perform legal abortions once qualified, 25.7% would do so under limited circumstances only. CONCLUSIONS The majority of participants wanted education regarding abortion. Despite being predominantly prochoice, considerably fewer students, irrespective of nationality, indicated that they would perform abortions.
Collapse
Affiliation(s)
- James M Fitzgerald
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Katherine E Krause
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Darya Yermak
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Suzanne Dunne
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Ailish Hannigan
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Walter Cullen
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - David Meagher
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Deirdre McGrath
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Paul Finucane
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Calvin Coffey
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Colum Dunne
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| |
Collapse
|