Abortion training in obstetrics and gynecology residency training programs has increased since 2004, yet many programs graduate residents without sufficient training to provide abortions for any indication, as well as dilation and evacuation. Professional training standards and support for family planning training have coincided with improved training, but there are still barriers to understand and overcome.
Introduction
Before their clinical rotations, medical students have limited exposure to women's health issues, particularly abortion.
Methods
We piloted a problem-based learning (PBL) module to introduce second-year medical students at the University of Louisville School of Medicine to counseling patients about pregnancy options. Students were divided into groups of 10 and met for two 2-hour sessions. In the first session, learners were presented with a case about a woman diagnosed with Zika virus who was considering pregnancy termination. Students discussed the case and developed learning objectives to research. One week later, students reconvened and shared what they had learned individually. Students were asked to complete pre- and post-PBL surveys. PBL facilitators also completed a survey evaluating the module.
Results
Fifty-eight percent of students felt informed or very informed about abortion after the PBL, compared to 30% before (
p
< .001). Students' mean quiz score increased from 29% on the pretest to 40% on the posttest (
p
< .001). Ninety-three percent of facilitators believed this PBL provided students with tools to better counsel about abortion, but only 56% of faculty felt adequately trained to facilitate this discussion.
Discussion
Students appreciated this PBL as an opportunity to discuss pregnancy options counseling and to clarify their own values surrounding abortion provision. Despite their positive response to the module, students identified barriers that would prevent them from implementing knowledge learned from this module in practice.
BACKGROUND:
The Accreditation Council for Graduate Medical Education (ACGME) requires ob-gyn programs include “access to experience with induced abortion.” Yet in 2004 when last studied, only 51% included routine abortion training.
METHODS:
Directors of 240 ob-gyn residency programs were invited to complete an online survey. Training was considered routine when the director reported abortion training was included in a rotation dedicated to family planning and/or dedicated time for abortion training. We assessed program directors' reports of resident experience by training type using χ2, t tests, and logistic regression.
RESULTS:
One hundred ninety (79%) directors responded. Sixty-one percent reported that training was routine, 32% said it was available or optional for residents, and 7% said it was not available. Routine training, compared with optional training, was correlated with higher mean total numbers of abortion procedures per graduating resident (87.2 versus 48.1, P<.001). Seven directors (4%) reported that their program had been cited for inadequate abortion training.
DISCUSSION:
Abortion training in ob-gyn residency programs has substantially increased from 12% in 1992 to 61% in 2014, and as in other studies, routine training is associated with greater clinical competence (Almeling R, Tews L, Dudley S. Fam Plann Perspect 2000;32:268–71, 320. MacKay HT, MacKay AP. Fam Plann Perspect 1995;27:112–5. Eastwood KL, Kacmar JE, Steinauer J, Weitzen S, Boardman LA. Obstet Gynecol 2006;108:303–8). In a third of programs, residents needed to seek out training themselves, and 7% of programs offered no opportunity for training, falling short of meeting the ACGME requirement.
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