We found that medical student self-perceived level of competence in providing accurate information regarding abortion procedures and effectively counseling future patients about all options related to terminating a pregnancy improved for all students after a comprehensive abortion curriculum, regardless of their participation in clinical abortion. However, composite measures of self-perceived competence increased significantly more for those who participated in a structured clinical abortion experience, compared to ad hoc clinical abortion experience, regardless whether they observed an abortion.
We had expected at least a 30 mm improvement in the composite competence measure to be meaningfully different. While the mean difference was statistically significant, we only observed a 15 mm difference in increase of self-reported composite competence between the two groups and a 9 mm absolute difference, which was not statistically different. This may be explained by the relatively higher baseline competence in “explaining all options to a patient who has an unintended pregnancy” reported by the FPC group.
Despite consistently large changes in self-reported competency, there were minimal changes to group attitudes about abortion. Our findings lead us to conclude that it is possible to provide medical student education about abortion may result in increased competence without impacting strong moral beliefs that oppose abortion. Varying levels of participation in a clinical environment focused on abortion care may increase a future medical provider’s ability to administer medically accurate information to their patients.
The limitations of this study include a small sample size, and the selection bias inherent in a study dependent on self-reported surveys and self-selection into educational experiences. Most importantly, because we relied on self-evaluation of competence to be able to explain procedures and options, we did not evaluate the quality of the counseling that would occur from these future physicians. Students who self-selected into a non-structured clinical abortion experience (FPC) due to wanting to avoid exposure to abortion may have inflated views of their ability to provide non-directive medically accurate counseling and expectations about options. As a group, they scored lower on knowledge questions, particularly regarding aspects of the procedure that would be important components of their counseling. A strength of this study is that we grouped students based on the educational environment that they attended and separately assessed the educational exposures that occurred.
Both the Association of Professors of Gynecology and Obstetrics (APGO) and the American College of Obstetricians and Gynecologists (ACOG) recommend that all medical school curricula include training in family planning, including contraception and abortion care.17 Learning about abortion is a core educational objective according to APGO, which sets national standards for medical student education.18 The four objectives related to abortion that students are expected to learn are: (A) Provide non-directive counseling to patients surrounding pregnancy including unintended pregnancy; (B) List surgical and non-surgical methods of pregnancy termination; (C) Identify potential complications of pregnancy termination; and (D) Describe the public health impact of the legal status of abortion. However, medical students are frequently not provided with education to meet these objectives.9,10,19
A 2009 study of medical schools in the US and Canada reported that 67% included an abortion lecture in the preclinical curricula.9 The remaining 33% did not include any discussion of abortion procedures, pregnancy options counseling, post-abortion care, or abortion law/policy/availability in their curriculum. A survey of Ob/Gyn medical student clerkship directors showed that 17% of programs had no formal abortion education and 55% did not offer clinical training or exposure.10 Students receive inconsistent abortion education. In 2009, only 24% of medical students at the University of Colorado reported clinical exposure to abortion and 57% did not have any formal didactic training in abortion.19
Family planning educational curricula is well received by medical students.20-22 After the University of New Mexico School of Medicine instituted a preclinical and clinical abortion curriculum with an optional clinical training opportunity, 96% of students surveyed reported that abortion was an appropriate topic for medical school education and 84% of the students who participated in the clinical training experience reported it was very important to their education.21
Ob/Gyn residents who morally object to performing abortions can undergo partial participation in abortion training up to their level of comfort at many institutions, a practice shown to improve knowledge, capability, and the improved ability to care for patients with miscarriage.11,23
We found that when a partial participation format is applied to undergraduate medical education with structured access to clinical abortion, a larger proportion of students are exposed to abortion education, regardless of chosen specialty training, potentially increasing knowledge and professionalism among future healthcare providers.