A comparison of medical student competency, attitudes and knowledge of abortion care after a structured clinical curriculum

Abstract

Background: Abortion care is a core educational objective according to the Association of Professors of Gynecology and Obstetrics (APGO), but clinical exposure is variable in medical education. The authors sought to compare professional competency, attitudes, and knowledge regarding abortion between students who attended a structured clinical experience in abortion care to those who chose a less-structured family planning clinical environment.Methods: All medical students participating in the Obstetrics & Gynecology clerkship from 2014-2015 were invited to complete a pre- and post-clerkship survey and grouped based on their attendance to a structured clinical abortion experience at Planned Parenthood (PPCW) versus an alternative Family Planning Clinic (FPC) experience. Self-assessed competency and attitudes about abortion were measured using a 100-mm visual analog scale (VAS). Authors assessed knowledge about abortion with multiple-choice questions.Results: A total of 89 students completed the surveys (PPCW: 74; FPC: 15). Students attending PPCW were more likely to observe counseling about abortion and ultrasound prior to abortion (PPCW: 67/74, 91%; FPC: 4/15, 27%, p=<0.01). More PPWC students observed a surgical abortion (91% versus 7% of FPC students). Self-assessed competency scores improved with composite mean difference in VAS for PPCW of 42.2 mm and FPC of 27.3 mm (p=0.02). Attitude scores were unchanged in those with initial VAS <80 mm. Knowledge improved overall, with greater changes among the PPCW group.Conclusions: A structured clinical abortion experience met APGO educational objectives more than an alternative experience. Future physicians should universally be exposed to clinical abortion care in order to ensure evidence-based education about abortion.

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

“…3,8,18,27,30,32,33,38,48 Twenty-one USA studies assessed clinical students during their third year clerkships. 2,4,5,9,[11][12][13][14][15][16][17]19,[21][22][23]26,28,31,40,49,55 Two studies assessed sexual and reproductive health education from all years in medical school through surveys of faculty with knowledge of the curriculum. 7,53 Six studies assessed fifth and/or sixth year students about sexual and reproductive health education.…”

“…The authors found improved student knowledge after the education but that knowledge decreased after a year. 4,5 Additional studies described improvements in students' selfassessment of knowledge, 2,20 comfort, 8,13 confidence, 18,20,52 and competency 9 after an educational intervention on sexual and reproductive health topics.…”

“…16,17,21 Thirty-one studies reported student responses about their knowledge on, perceptions of, or experiences with, sexual and reproductive health teaching . [2][3][4][5]8,9,[13][14][15]18,19,24,[32][33][34][35][36][38][39][40][41]43,44,[46][47][48][49][51][52][53]55,56 Five studies provided insights from medical educators about their experiences with contraception and abortion education. 7,23,48,49,53 Two qualitative studies explored student perspectives on sexual and reproductive health education.…”

“…1 Abortion Twenty-two studies discussed abortion care in medical education . 3,6,7,9,10,15,19,20,[24][25][26]29,30,[37][38][39]43,45,46,51,55,56 Some studies described specific education teaching approaches 15,38,43 while others assessed student perceptions of abortion education. 30,37,39,55,56 One study described a rotation developed by students to provide abortion education in the preclinical years.…”

“…29 Clinical medical students who participated in a structured clinical curriculum in abortion care reported higher self-assessed measures of competency than those who experienced ad hoc clinical experiences. 9 In a survey of students at one US medical school who spent a half day at an abortion clinic, 82% (119/145) of participants found the experience "highly valuable" and 90% (131/145) would recommend the experience to another student. 6 At another US medical school, clinical students could opt into an additional day of clinical learning about abortion care and 28% (98/350) of students chose to do so.…”