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

Journal

Clinical obstetrics and gynecology

ISSN: 1532-5520

Titre abrégé: Clin Obstet Gynecol

Pays: United States

ID NLM: 0070014

Informations de publication

Date de publication:
30 May 2024

Historique:

medline: 30 5 2024

pubmed: 30 5 2024

entrez: 30 5 2024

Statut: aheadofprint

Résumé

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.

Identifiants

DOI: 10.1097/GRF.0000000000000874 PMID: 38813914

pubmed: 38813914

doi: 10.1097/GRF.0000000000000874

pii: 00003081-990000000-00160

doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Informations de copyright

Références

Bearak J, Popinchalk A, Ganatra B, et al. Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990-2019. Lancet Glob Health. 2020;8:e1152–e1161.

Jones RK, Kirstein M, Philbin J. Abortion incidence and service availability in the United States, 2020. Perspect Sex Reprod Health. 2022;54:128–141.

International Federation of Gynecology and Obstetrics (FIGO), International Federation of Medical Students Associations (IFMSA), World Association of Trainees in Obstetrics and Gynecology (WATOG). Joint statement of support for the inclusion of contraception and abortion in sexual and reproductive health and wellbeing education for all medical students. 2022. Accessed June 23, 2023. https://www.figo.org/resources/figo-statements/joint-statement-support-inclusion-contraception-abortion-srhr-education

Burns RM, Shaw KA. Standardizing abortion education: what medical schools can learn from residency programs. Curr Opin Obstet Gynecol. 2020;32:387–392.

Dobbs, State Health Officer of the Mississippi Department of Health, et al. v Jackson Women’s Health Organization et al. US 597 (US Supreme Court 2022).

Stephenson-Famy A, Sonn T, Baecher-Lind L, et al. The Dobbs decision and undergraduate medical education: the unintended consequences and strategies to optimize reproductive health and a competent workforce for the future. Acad Med J Assoc Am Med Coll. 2023;98:431–435.

Tillman S, Eagen-Torkko M, Levi A. Ethics, abortion access, and emergency care post-Dobbs: the gray areas. J Midwifery Womens Health. 2023;68:774–779.

Stein RA, Katz A, Chervenak FA. The far-reaching impact of abortion bans: reproductive care and beyond. Eur J Contracept Reprod Health Care Off J Eur Soc Contracept. 2023;28:23–27.

Phillips AM, Rachad S, Flink-Bochacki R. The association between abortion restrictions and patient-centered care for early pregnancy loss at US obstetrics-gynecology residency programs. Am J Obstet Gynecol. 2023;229:41.e1–41.e10.

Feinberg EC, Kawwass JF, Cedars MI. Roe v Wade and the threat to fertility care. Obstet Gynecol. 2022;140:557–559.

Rivlin K, Westhoff CL. Navigating uncertainty: narrative medicine in pregnancy options counseling education. Patient Educ Couns. 2019;102:536–541.

Lupi CS, Runyan A, Schreiber N, et al. An educational workshop and student competency in pregnancy options counseling: a randomized controlled trial. Am J Obstet Gynecol. 2012;207:414.e1–414.e7.

Pace L, Sandahl Y, Backus L, et al. Medical students for choice’s reproductive health externships: impact on medical students’ knowledge, attitudes and intention to provide abortions. Contraception. 2008;78:31–35.

Gardner H, Zimmerman M, Flanigan M, et al. A comparison of medical student competency, attitudes and knowledge of abortion care after a structured clinical curriculum Preprint Version 3. Research Square; 2020. doi: 10.21203/rs.2.22383/v3

Cohen P, Mayhew J, Gishen F, et al. What should medical students be taught about abortion? An evaluation of student attitudes towards their abortion teaching and their future involvement in abortion care. BMC Med Educ. 2021;21:4–10.

French V, Steinauer J. Sexual and reproductive health teaching in undergraduate medical education: A narrative review. Int J Gynaecol Obstet. 2023;163:23–30.

Espey E, Ogburn T, Dorman F. Student attitudes about a clinical experience in abortion care during the obstetrics and gynecology clerkship. Acad Med J Assoc Am Med Coll. 2004;79:96–100.

Espey E, Ogburn T, Chavez A, et al. Abortion education in medical schools: a national survey. Am J Obstet Gynecol. 2005;192:640–643.

Association of American Medical Colleges and American Medical Association. 8.5 Medical Student Feedback. LCME Functions and Structure of a Medical School: Standards for Accreditation of Medical Education Programs Leading to the MD Degree. Association of American Medical Colleges and American Medical Association; 2023. Accessed October 3, 2023. https://lcme.org/publications/

Landy U, Turk JK, Simonson K, et al. Twenty years of the Ryan residency training program in abortion and family planning. Contraception. 2021;103:305–309.

AAMC. Mission & vision. Accessed September 13, 2023. https://www.aamc.org/about-us/strategic-plan/mission-vision

Boston University Medical Group. Mission, vision, and values. Accessed September 13, 2023. https://www.bumc.bu.edu/bumg/about-us-2/mission-vision-values/

Vanderbilt University School of Medicine. About the school. School of Medicine. Accessed September 13, 2023. https://medschool.vanderbilt.edu/about-the-school/

Icahn School of Medicine at Mount Sinai. Mission. Accessed September 13, 2023. https://icahn.mssm.edu/about/faculty-resources/handbook/general/mission

University of California, San Francisco. Mission and values. Accessed September 13, 2023. https://www.ucsf.edu/about/mission-and-values

Northwestern University. About us. Accessed September 13, 2023. https://www.feinberg.northwestern.edu/about/index.html

Medical University of South Carolina. COM mission, vision, values. Accessed September 13, 2023. https://medicine.musc.edu/about/mission

USF Health. College missions, values, & goals. Accessed September 13, 2023. https://health.usf.edu/medicine/com_mission

School of Medicine, University of Utah Health. MD degree information. 2021. Accessed September 13, 2023. https://medicine.utah.edu/programs/md

Association of Professors of Gynecology and Obstetrics (APGO) Undergraduate Medical Education Council. APGO Medical Student Educational Objectives for Students 11th ed. Association of Professors of Gynecology and Obstetrics; 2019.

O’Connor K. How to Grade for Learning: Linking Grades to Standards 4th ed. CORWIN, A SAGE Publishing Company; 2018.

Shepard LA. The role of assessment in a learning culture. Educ Res. 2000;29:4–14.

Federation of State Medical Boards of the United States, National Board of Medical Examiners. United States Medical Licensing Examination (USMLE) Content Outline. Federation of State Medical Boards of the United States and National Board of Medical Examiners; 2022. Accessed May 10, 2024. https://www.usmle.org/sites/default/files/2021-08/USMLE_Content_Outline.pdf

Association of American Medical Colleges and American Medical Association. 8.1 Curricular management. LCME Functions and Structure of a Medical School: Standards for Accreditation of Medical Education Programs Leading to the MD Degree. Association of American Medical Colleges and American Medical Association; 2023. Accessed October 3, 2023. https://lcme.org/publications/

Association of American Medical Colleges and American Medical Association. 6.1 Program and learning objectives. LCME Functions and Structure of a Medical School: Standards for Accreditation of Medical Education Programs Leading to the MD Degree. Association of American Medical Colleges and American Medical Association; 2023. Accessed October 3, 2023. https://lcme.org/publications/

Association of American Medical Colleges and American Medical Association. 2 Use of medical educational program objectives. LCME Functions and Structure of a Medical School: Standards for Accreditation of Medical Education Programs Leading to the MD Degree. Association of American Medical Colleges and American Medical Association; 2023. Accessed October 3, 2023. https://lcme.org/publications/

Englander R, Cameron T, Ballard AJ, et al. Toward a common taxonomy of competency domains for the health professions and competencies for physicians. Acad Med J Assoc Am Med Coll. 2013;88:1088–1094.

Eckstrand KL, Potter J, Bayer CR, et al. Giving context to the physician competency reference set: adapting to the needs of diverse populations. Acad Med J Assoc Am Med Coll. 2016;91:930–935.

The Accreditation Council for Graduate Medical Education (ACGME). Obstetrics and gynecology milestones. 2021. Accessed July 31, 2023. https://www.acgme.org/specialties/obstetrics-and-gynecology/milestones/

Edgar L, McLean S, Hogan SO, et al. The Milestones Guidebook. ACGME; 2020. Accessed May 10, 2024. https://www.acgme.org/globalassets/milestonesguidebook.pdf

Obeso V, Brown D, Aiyer M, et al., ed. Toolkits for the 13 core entrustable professional activities for entering residency. 2017. Accessed September 20, 2023. aamc.org/initiatives/coreepas/publicationsandpresentations

Baden K, Driver J. The State Abortion Policy Landscape One Year Post-Roe. Guttmacher Institute; 2023.

Chen AMH, Brown S, Mark K, et al. An overview of instructional approaches and decision-making strategies to curtail curricular overload. Am J Pharm Educ. 2023;87:100013–100020.

Thornby KA, Brazeau GA, Chen AMH. Reducing student workload through curricular efficiency. Am J Pharm Educ. 2023;87:100015–100021.

Coleman E. Sexual health education in medical school: a comprehensive curriculum. Virtual Mentor VM. 2014;16:903–908.

Bloom BS, Engelhart MD, Furst EJ, et al. Taxonomy of Educational Objectives: The Classification of Educational Goals. David McKay Company; 1956.

Dzara K, Gooding H. A guide to educational pyramids commonly used in medical education programs. Acad Med. 2022;97:313.

Association of American Medical Colleges. Phase (academic level) length and distribution. Accessed July 31, 2023. https://www.aamc.org/data-reports/curriculum-reports/data/phase-academic-level-length-and-distribution

Janiak E, Goldberg AB. Eliminating the phrase “elective abortion”: why language matters. Contraception. 2016;93:89–92.

MedEdPORTAL MedEdPORTAL. 2023. Accessed November 16, 2023. https://www.mededportal.org/

Pomerantz T, Bergin A, Miller KH, et al. A problem-based learning session on pregnancy options, counseling, and abortion care. MedEdPORTAL J Teach Learn Resour. 2019;15:10816.

Steinauer J, Preskill F, Robertson P. Training medical students in intrauterine procedures using papayas. Med Educ. 2007;41:1099–1100.

Lupi CS, Estes CM, Broome MA, et al. Conscientious refusal in reproductive medicine: an educational intervention. Am J Obstet Gynecol. 2009;201:502.e1–502.e7.

Lupi CS, Ward-Peterson M, Castro C. Non-directive pregnancy options counseling: online instructional module, objective structured clinical exam, and rater and standardized patient training materials. MedEdPORTAL J Teach Learn Resour. 2017;13:10566.

Steinauer J, Sufrin C, Hawkins M, et al. Caring for challenging patients workshop. MedEdPORTAL. 2014;10:9701.

Hew KF, Lo CK. Flipped classroom improves student learning in health professions education: a meta-analysis. BMC Med Educ. 2018;18:38–50.

Mody SK, Kiley J, Gawron L, et al. Team-based learning: a novel approach to medical student education in family planning. Contraception. 2013;88:239–242.

Caro-Bruce E, Schoenfeld E, Nothnagle M, et al. Addressing gaps in abortion education: a sexual health elective created by medical students. Med Teach. 2006;28:244–247.

Association of Professors in Gynecology and Obstetrics 2015. Topic 34: pregnancy termination. 2015. Accessed September 13, 2023. https://www.youtube.com/watch?v=dwO0zkBXyLQ

Association of Professors of Gynecology & Obstetrics. Medical student educational objectives for students. Accessed September 13, 2023. https://apgo.org/general/custom.asp?page=msostudent

Innovating Education in Reproductive Health; Bixby Center for Global Reproductive Health. Accessed July 31, 2023. https://www.innovating-education.org/

National Board of Medical Examiners. 2024 NBME customized assessment services. Accessed May 10, 2024. https://www.nbme.org/educators/assess-learn/customized-assessment-services

King LP, Penzias A. Fostering discussion when teaching abortion and other morally and spiritually charged topics. AMA J Ethics. 2018;20:E637–E642.

Mengesha B, Zite N, Steinauer J. Implications of the Dobbs decision for medical education: inadequate training and moral distress. JAMA. 2022;328:1697–1698.

Valley TM, Cowley ES, Farooque A, et al. “We had to put ourselves in their shoes”: experiences of medical students and obgyn residents with a values clarification workshop on abortion. MedRxiv. 2023. Preprint. doi: 10.1101/2023.02.16.23286043

doi: 10.1101/2023.02.16.23286043

Ipas. Abortion attitude transformation: a values clarification toolkit for global audiences. Accessed September 13, 2023. https://www.ipas.org/resource/abortion-attitude-transformation-a-values-clarification-toolkit-for-global-audiences/

Turner KL, Pearson E, George A, et al. Values clarification workshops to improve abortion knowledge, attitudes and intentions: a pre-post assessment in 12 countries. Reprod Health. 2018;15:40–51.

World Health Organization. Abortion Care Guideline. World Health Organization; 2022. Accessed September 13, 2023.

Steinauer J, Adler A, Turk J, et al. Professionalism in family planning care workshop. MedEdPORTAL. 2022;18:11212.

Medical Students for Choice. Curriculum reform. Accessed September 13, 2023. https://msfc.org/medical-students/curriculum-reform/

Medical Students for Choice. Reproductive health externship. Accessed July 31, 2023. https://msfc.org/medical-students/msfc-abortion-training/rhe/

Witt LB, Wolff S, Shih G, et al. Abortion and contraception in medical school curricula: a survey of North American family medicine clinical curriculum directors. Teach Learn Med. 2023;36:174–182.

Shubkin CD, Sieplinga K, Hunter RJ, et al. Transforming pediatric education in response to Dobbs v. Jackson: empowering adolescents to manage their reproductive choices. Acad Pediatr. 2023;24:381–384.

Liaison Committee on Medical Education. LCME Functions and Structure of a Medical School: Standards for Accreditation of Medical Education Programs Leading to the MD Degree. Association of American Medical Colleges and American Medical Association; 2023. Accessed July 31, 2023. https://lcme.org/wp-content/uploads/2023/03/2024-25-Functions-and-Structure_2023-03-21.docx

Martinez RC, Bonnin R, Feld Z, et al. Abortion opt-in experience in third-year clerkship. Primer Leawood Kan. 2021;5:38–46.

Ipas. Training resources. Accessed September 13, 2023. https://www.ipas.org/resource-library/training/

Society of Family Planning. Clinical guidance. Accessed November 16, 2023. https://societyfp.org/clinical-guidance/

Clinical & Professional Archives. National Abortion Federation. Accessed November 16, 2023. https://prochoice.org/product-category/clinical-professional/

American College of Obstetricians and Gynecologists. Clinical guidance: practice bulletin. Accessed November 16, 2023. https://www.acog.org/clinical/clinical-guidance/practice-bulletin

Cason P, Cwiak C, Edelman A, et al. Contraceptive Technology. 22nd ed. Jones & Bartlett Learning; 2023.

Jensen JT, Creinin MD. Speroff & Darney’s Clinical Guide to Contraception. 6th ed. LWW; 2019.

Allen RH, Cwiak CA. Contraception for the Medically Challenging Patient. 2014th ed. Springer; 2014.

Ryan Program. Ryan program didactic curriculum in family planning. Accessed November 16, 2023. https://ryanprogram.org/ryan-program-didactic-curriculum-in-family-planning/

National Resident Matching Program Data Release and Research Committee. Results of the 2022 NRMP Program Director Survey. National Resident Matching Program; 2022.

Veazey K, Nieuwoudt C, Gavito C, et al. Student perceptions of reproductive health education in US medical schools: a qualitative analysis of students taking family planning electives. Med Educ Online. 2015;20:28973–28979.

Association of American Medical Colleges. Visiting student learning opportunities (VSLO). Accessed July 31, 2023. https://students-residents.aamc.org/visiting-student-learning-opportunities/visiting-student-learning-opportunities-vslo

Kirkpatrick JD, Kirkpatrick WK. Kirkpatrick’s Four Levels of Training Evaluation 1st ed. Association for Talent Development; 2016.

Pessar L, Levine R, Bernstein C, et al. Recruiting and rewarding faculty for medical student teaching. Acad Psychiatry J Am Assoc Dir Psychiatr Resid Train Assoc Acad Psychiatry. 2006;30:126–129.

Hanson ER, Gantwerker EA, Chang DA, et al. To teach or not to teach? Assessing medical school faculty motivation to teach in the era of curriculum reform. BMC Med Educ. 2022;22:363.

National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division, Board on Health Care Services, Board on Population Health and Public Health Practice, Committee on Reproductive Health Services: Assessing the Safety and Quality of Abortion Care in the US. The Safety and Quality of Abortion Care in the United States. National Academies Press (US); 2018.

Harris LH. Recognizing conscience in abortion provision. N Engl J Med. 2012;367:981–983.

Society of Family Planning. #WeCount. Accessed October 3, 2023. https://societyfp.org/research/wecount/

Society of Family Planning. #WeCount Report: April 2022 to March 2023. 2023. doi: 10.46621/XBAZ6145.

Keefe-Oates B, Fulcher I, Fortin J, et al. Use of abortion services in Massachusetts after the Dobbs decision among in-state vs out-of-state residents. JAMA Netw Open. 2023;6:e2332400–e2332404.