Medical Students for Choice's Reproductive Health Externships: impact on medical students' knowledge, attitudes and intention to provide abortions

BACKGROUND: The number of abortion providers in the United States has declined dramatically in the past 15 years, threatening women's already limited access to abortion services. Improving medical students' training in abortion could help abate this public health crisis. STUDY DESIGN: From 2004 to 2006, we surveyed students before and after their participation in Medical Students for Choice's Reproductive Health Externship (RHE) program to assess their knowledge about abortion and unintended pregnancy, attitudes about performing abortions, intentions to provide abortions in the future and (in 2006) counseling patients. RESULTS: Following participation in an RHE, 15% more students answered at least 75% of questions about unintended pregnancy and abortion correctly (p=.006) than prior to participation. RHE participants were more supportive of abortion provision (p<.001) and more inclined to provide abortions in the future (p=.008). In 2006, the RHE participants were twice as likely to feel comfortable counseling patients about abortion (p<.001). CONCLUSIONS: Early clinical experiences with abortion and family planning can impact medical students' knowledge, attitudes, intentions to provide abortions and ability to counsel patients, potentially improving women's access to comprehensive reproductive health care in the future.     

Abortion education in the medical curriculum: a survey of student attitudes

BACKGROUND: The purpose of this study was to evaluate student attitudes toward the inclusion of abortion education in the preclinical and clinical medical school curriculum. STUDY DESIGN: All students completing the OB-GYN rotation from May 2004 through January 2005 (n=118) were asked to complete a 21-item survey. Survey questions focused on students' attitudes about the appropriateness of abortion education, reasons for participation or nonparticipation in the abortion care experiences in the clinical curricula and the value of abortion education. RESULTS: One hundred students completed the survey for a response rate of 85%. Nearly all respondents indicated that abortion education was appropriate in the preclinical and clinical curricula (96%). Fifty-three percent of students participated in a clinical abortion care experience. The majority of these students rated it as valuable (84%) and would recommend it to a friend (73%). Most students who planned a career in Family Medicine and OB-GYN preferred the integration of abortion training into the residency curriculum (74%). CONCLUSIONS: Abortion education is acceptable and valued by medical students and should be integrated into the curricula of all medical schools.     

Patient attitudes toward early abortion services in the family medicine clinic.

PURPOSE: To examine urban, inner-city female patients' acceptability of the provision of early abortion services by their family physician in the family medicine clinic (FMC). METHODS: We administered a survey with open- and closed-ended questions to a convenience sample of English- or Spanish-speaking female patients aged 18 to 45 recruited from a FMC in the Bronx, New York. Responses were analyzed using quantitative and qualitative methods. RESULTS: One hundred forty-eight women completed the survey. The majority of respondents stated the FMC should offer abortion services. Seventy percent agreed their clinic should provide medication abortion, and 47% agreed their clinic should provide suction abortion. Of those who would personally consider an abortion, 73% responded that they would prefer to have it done by their family physician in the FMC, whereas 22% would prefer it at a freestanding, high-volume abortion clinic, and 5% had no preference. CONCLUSIONS: The majority of patients surveyed accepted the integration of abortion services into our FMC setting, and would choose to have an early abortion at their FMC. Increasing options for abortion provision within our FMC was acceptable to the majority of our sample.     

Interest in Medication and Aspiration Abortion Training among Colorado Nurse Practitioners,Nurse Midwives,and Physician Assistants

ObjectivesWe examined advanced practice clinicians’ (APCs: nurse practitioners [NPs], certified nurse midwives [CNMs], physician assistants) interest in training to provide medication and aspiration abortion in Colorado, where abortion provision by APCs is legal.MethodsWe surveyed a stratified random sample of APCs, oversampling women's health (CNMs/women's health nurse practitioners [WHNPs]) and rural APCs. We examined prevalence and predictors of interest in abortion training using weighted χ² tests.ResultsOf 512 participants (21% response), the weighted sample is 50% NPs, 41% physician assistants, and 9% CNMs/WHNPs; 55% provide primary care. Only 12% are aware they can legally provide abortion. A minority of participants disagree that medication abortion (15%) or aspiration abortion (25%) should be in APC scope of practice. Almost one-third (29%) are interested in medication abortion training and 16% are possibly interested; interest is highest among CNMs/WHNPs (52%) (p < .01). Interest in aspiration abortion training is 15% with another 11% who are possibly interested; interest is highest among CNMs/WHNPs (34%) (p < .01). There are no significant differences in abortion training interest by rural practice location or by receipt of abortion education in graduate school. Participants not interested in medication and aspiration abortion training cited abortion being outside their specialty practice scope (44% and 38%, respectively) and religious or personal objections (42% and 34%). Among clinicians interested in medication abortion training, 33% believe their clinical facility is likely to allow them to provide this service, compared with 16% for aspiration abortion.ConclusionsInterest in abortion training among Colorado APCs is substantial. However, facility barriers to abortion provision must be addressed to increase abortion access with APCs.     

Community Health Worker Employer Survey: Perspectives on CHW Workforce Development in the Midwest

A statewide Community Health Worker Employer Survey was administered to various clinical, community, and faith-based organizations (n?=?240) across a range of rural and urban settings in the Midwest. At least 80% of participants agreed or strongly agreed that items characterized as supervisory support were present in their work environment. Thirty-six percent of respondents currently employed CHWs, over half (51%) of survey respondents reported seeing the need to hire/work with more CHWs, and 44% saw the need for CHWs increasing in the future. Regarding CHW support, a majority of respondents indicated networking opportunities (63%), paid time for networking (80%), adequate time for supervision (75%), orientation training (78%), mandatory training (78%), ongoing training (79%), and paid time for training (82%). Open-ended responses to the question "In your organization, what needs could CHWs meet?" resulted in the largest number of respondents reporting mental health issues as a priority, followed by connecting people with services or resources, educating the public on preventive health, family support, and home care/visitations. Our findings suggest that respondents, who largely have supervisory or managerial roles, view workplace environments in Nebraska favorably, despite the fact that nearly two-thirds of respondents typically work well over 40 h per week. In addition, CHWs could help address mental and physical health needs in a variety of community and clinical settings through primary and secondary prevention activities, such as provision of health screenings, health and nutrition education, connecting people to resources and empowering community members through these activities and more.     

Medical students' attitudes toward abortion and other reproductive health services

This paper investigated the attitude toward abortion and other reproductive health services of first- and second-year medical students at the Seattle campus of the University of Washington, a large regional primary care-oriented medical school, in 1996-97. A total of 219 (76.6%) students responded. The majority of the students support the availability of a broad range of reproductive health services including abortion; 58.1% felt that first-trimester abortions should be available to patients under most circumstances. Of the 43.4% of students who anticipated a career in family practice, most expected to provide abortions in their future practices. Moreover, older students and women were more likely to support the provision of abortion services. This study concludes that despite the continuing pressure on abortion providers, most first- and second-year medical students at a fairly state-supported medical school intend to incorporate this procedure into their future practices.     

Twenty Years of the Ryan Residency Training Program in Abortion and Family Planning

ObjectiveTo summarize the effects of routine, opt-out abortion and family planning residency training on obstetrics and gynecology (ob-gyn) residents’ clinical skills in uterine evacuation and intentions to provide abortion care after residency.MethodsData from ob-gyn residency programs supported during the first 20 years of the Kenneth J. Ryan Residency Training Program in Abortion and Family Planning were analyzed. Postrotation surveys assessed residents’ training experiences and acquisition of abortion care skills. Residency program director surveys assessed benefits of the training to residents and the academic department from the educators’ perspectives.ResultsA total of 2775 residents in 89 ob-gyn programs completed postrotation surveys for a response rate of 72%. During the rotation, residents – including those who only partially participated – gained exposure to and skills in first- and second-trimester abortion care. Sixty-one percent intended to provide abortion care in their postresidency practice. More than 90% of residency program directors (97.5% response rate) reported that training improved resident competence in abortion and contraception care and 81.3% reported that the training increased their own program's appeal to residency applicants.ConclusionOver 20 years, the Ryan Program has supported programs to integrate abortion training to give ob-gyn residents the skills and inspiration to provide comprehensive reproductive health care, including uterine evacuation and abortion care, in future practice. Residency program directors noted that this integrated training meets resident applicants’ expectations.ImplicationsRyan Program residents are trained to competence and are prepared, both clinically and in their professional attitudes, to care for women's reproductive health.     

Refugees and medical student training: results of a programme in primary care

CONTEXT: Medical schools have responded to the increasing diversity of the population of the USA by incorporating cultural competency training into their curricula. This paper presents results from pre- and post-programme surveys of medical students who participated in a training programme that included evening clinical sessions for refugee patients and related educational workshops. METHODS: A self-assessment survey was administered at the beginning and end of the academic year to measure the cultural awareness of participating medical students. RESULTS: Over the 3 years of the programme, over 133 students participated and 95 (73%) completed pre- and post-programme surveys. Participants rated themselves significantly higher in all 3 domains of the cultural awareness survey after completion of the programme. CONCLUSIONS: The opportunity for medical students to work with refugees in the provision of health care presents many opportunities for students, including lessons in communication, and scope to learn about other cultures and practise basic health care skills. An important issue to consider is the power differential between those working in medicine and patients who are refugees. To avoid reinforcing stereotypes, medical programmes and medical school curricula can incorporate efforts to promote reflection on provider attitudes, beliefs and biases.     

Willing and able? Provision of medication for abortion by future internists.

INTRODUCTION AND BACKGROUND: The development of medications such as mifepristone (RU486) has created the opportunity to introduce medication abortion as a component of office practice. METHODS: Two hundred twelve residents training in internal medicine, family practice, and gynecology at 11 residency programs completed anonymous surveys assessing willingness to provide medication for abortion and perceived barriers to future provision of mifepristone. RESULTS: Residents training in internal medicine knew less about mifepristone and preabortion screening than other primary care trainees. Forty-two percent of internists, 84% of family practitioners, and 83% of gynecologists were willing to prescribe mifepristone (p < .001). Many internists were concerned about lacking adequate "backup" access to vacuum aspiration services (84% of internists, 74% of family practitioners, 35% of gynecologists; p < .001). In multivariable analysis, the training-related factors most predictive of whether an internist was willing to provide medication for abortion were feeling that mifepristone is very safe, abortion services are needed by the patients served, knowing to check an ultrasound before inducing abortion, and having no concern of how to manage bleeding or of lacking adequate backup should vacuum aspiration be needed. CONCLUSIONS AND DISCUSSION: Many (42%) future internists are willing to provide mifepristone, but most lack adequate knowledge of mifepristone and preabortion screening. As access to abortion services is limited in many U.S. counties, internists who are willing to provide mifepristone should be offered the necessary training to do so safely.     

Complementary and alternative medical practices: training,experience, and attitudes of a primary care medical school faculty

BACKGROUND: Interest in alternative and complementary medical practices has grown considerably in recent years. Previous surveys have examined attitudes of the general public and practicing physicians. This study examined the training, experience, and attitudes of medical school faculty, who have the primary responsibility for the education of future family physicians. METHODS: A 24-item, self-administered questionnaire was distributed to all 200 faculty at a medical school with a mission of training primary care physicians. RESULTS: Of 30 therapies listed, 5 were considered legitimate medical practices by more than 70% of the faculty. Eighty-five percent of the respondents reported some training in alternative medical therapies, and 62% were interested in additional training. Eighty-three percent of the faculty reported personal experience with alternative therapies and most rated these as effective. Eighty-five percent of the respondents indicated that their general attitude toward alternative medicine is positive. CONCLUSIONS: The results indicate that respondents have had substantial exposure to complementary therapies, are interested in learning more about these therapies, and have generally positive attitudes toward alternative medical practices and their use. Because of the role of these therapies in prevention, the positive attitudes might reflect the mission of this medical school to train primary care physicians.     

The effects of a community-based intervention on women’s knowledge and attitudes about safe abortion in intervention and comparison towns in Oromia,Ethiopia

The aim of this post-intervention assessment was to measure the effects of community intervention on the knowledge and attitudes of women regarding safe abortion in Ethiopia. In 2014, following implementation of an educational intervention on sexual and reproductive health from December 2012 to December 2013, 800 women were interviewed about their knowledge, attitudes, and practices regarding abortion. Multivariate regression analyses of respondents’ demographics, sources of abortion information, knowledge, and attitudes about safe abortion were conducted. More women in the intervention community knew safe abortion was available in the community (76 percent vs. 57 percent; p < 0.001). Women in the intervention community had greater odds of feeling that women should have access to safe abortion services (adjusted odds ratio [aOR]: 1.55, 95 percent confidence interval [CI]: 1.06, 2.28) after adjusting for socio-demographic characteristics. They had significantly greater odds of feeling comfortable and confident talking to a healthcare provider (aOR: 2.44, 95 percent CI: 1.55, 3.84) and/or her partner (aOR: 2.47, 95 percent CI: 1.58, 3.85) about abortion. Increased mobilization of community networks in disseminating sexual health and abortion information was followed by increased knowledge of abortion services in the intervention community and improved reproductive choices for women.     

Cooperation or conflict over child health surveillance? Views of key actors.

OBJECTIVE--To describe the views of general practitioners, health visitors, and clinical medical officers on child health surveillance, recent changes, perceptions of each other's roles, and attitudes to audit. DESIGN--Postal questionnaire survey. SETTING--Three health districts in North West Thames health region. SUBJECTS--All 602 general practitioners, 272 health visitors, and 42 clinical medical officers in these districts. MAIN MEASURES--Attitudes to and perceptions of child health surveillance and audit. Questionnaires were completed by 440 general practitioners (response rate 73%), 164 health visitors (60%), and 39 clinical medical officers (93%). RESULTS--Attitudes to child health surveillance were less positive among general practitioners than health visitors or clinical medical officers. Few respondents agreed that child health surveillance was a cost effective use of general practitioners' time (general practitioners 28%, 113/407; health visitors 28%, 40/145; clinical medical officers 39%, 15/39) and most thought that health visitors should carry out more of the doctors' examinations (68%, 262/387; 65%, 89/136; 66%, 25/38). General practitioners thought that clinical medical officers were less supportive than other relevant groups of their doing more child health surveillance. Most (72%, 105/146) health visitors thought that the 1990 contract had reduced parental choice of where to attend for child health surveillance. General practitioners were less enthusiastic than health visitors about most forms of clinical audit. CONCLUSIONS--Despite reservations about the impact of recent changes all groups were willing to explore innovative ways of delivering child health surveillance. IMPLICATIONS--There is scope for health visitors to increase their responsibilities and for more varied relationships between general practitioners and community child health doctors.     

Primary Care Professionals’ Feedback on Smiles for Life Curriculum

To assess the value of Smiles for Life: A National Oral Health Curriculum (SFL) in influencing oral health practices of primary care professionals (PCPs). The National Maternal and Child Oral Health Resource Center’s Partnership for Integrating Oral Health Care into Primary Care (PIOHCPC) project is working with five project teams in Georgia, Illinois, Maryland, Michigan, and Rhode Island that are integrating interprofessional oral health core clinical competencies into primary care practice. The competencies were developed to facilitate change in the clinical practice of PCPs working with vulnerable or underserved populations that lack or have limited access to oral health care. An initial PIOHCPC project requirement was for PCPs (physicians, nurse practitioners, nurse midwives, nurses) to complete at least two SFL courses based on their project population of focus (eg, pregnant women, children, adolescents). The curriculum consists of the following courses: Course 1: Relationship of Oral and Systemic Health; Course 2: Child Oral Health; Course 3: Adult Oral Health; Course 4: Acute Dental Problems; Course 5: Oral Health for Women: Pregnancy and Across the Lifespan; Course 6: Caries Risk Assessment, Fluoride Varnish, and Counseling; Course 7: The Oral Exam; and Course 8: Geriatric Oral Health. Three months after completion of the SFL courses, a 10-question feedback form was sent to PCPs. PCPs working in primary care settings (community health centers, local health department, medical center women’s health clinic) serving pregnant women, children, and adolescents who completed at least two SFL courses as part of the PIOHCPC project. Thirteen PCPs (three physicians, three nurse practitioners, three nurse midwives, four nurses) completed the feedback form. One hundred percent of respondents strongly agreed/agreed that SFL courses (1) reinforced the importance of oral health to a patient’s overall health and well-being, (2) increased their awareness of and familiarity with oral health issues in their patients, and (3) increased their confidence in integrating oral health care into primary care. Seventy-seven percent of respondents strongly agreed/agreed that SFL courses helped reduce barriers to incorporating oral health care into primary care. Sixty-two percent of respondents strongly agreed/agreed that integrating oral health care into primary care improved their patients’ oral health outcomes. The majority (ranging from 85 to 100 percent) of PCPs strongly agreed/agreed that SFL courses helped them integrate the interprofessional oral health core clinical competencies into primary care. Three months after completing SFL courses, PCPs indicated that the curriculum had a positive influence on oral health practices in the primary care setting. These findings are consistent with a 2017 study that examined SFL influence on clinical practice and found that the curriculum positively influenced oral health practices in the primary care setting. Additional feedback could be gathered 1 year post-training to assess retention of PCPs’ practices related to integrating oral health care into primary care. Oral health training is essential for enhancing PCPs’ knowledge and practices related to integrating oral health care into primary care. To respond to the need to integrate oral health care into primary care, SFL should be considered as a training for PCPs. Health Resources and Services Administration.     

A longitudinal integrated placement and medical students' intentions to practise rurally

Medical Education 2012: 46 : 179–191 Context Integrated longitudinal rural placements are designed to promote favourable student attitudes towards and facilitate return to rural practice upon graduation. We explored the impact of an integrated placement on medical students’ attitudes towards rural practice. Methods Data were available from interviews with 10 medical students, 15 clinical supervisors and teachers, three community health staff, and focus groups made up of medical students. Socio‐cognitive career theory gave insight into the personal, contextual and experiential factors, as well as the career barriers, that influence students’ rural practice intentions. Framework analysis was used to develop a thematic framework illustrating the key findings. Results The longitudinal placement enabled students to achieve personal goals, and enhanced self‐efficacy beliefs and orientation towards the complex personal and professional demands of rural practice. The informal curriculum, including multifaceted interactions with patients and their families, clinical teachers and other health care staff, was a vital experiential component. Students assimilated these rich experiences into their practice and evolving notions of professional identity as rural practitioners. Some students had little intention of practising rurally, partly as a result of contextual barriers such as geographic isolation, family and relationship needs, restricted postgraduate training opportunities and limited opportunities for specialist practice. Conclusions The richness of the informal curriculum in a longitudinal rural placement powerfully influenced students’ intentions to practise rurally. It provided an important context for learning and evolving notions of professionalism and rural professional identity. This richness could be reinforced by developing formal curricula using educational activities based around service‐led and interprofessional learning. To overcome the contextual barriers, the rural workforce development model needs to focus on socialising medical students into rural and remote medicine. More generic issues include student selection, further expansion of structured vocational training pathways that vertically integrate with longitudinal rural placements and the maintenance of rurally focused support throughout postgraduate training.     

Nutrition knowledge,attitudes and practices among senior medical students in Taiwan.

Nutrition is an important issue in medical training, but the nutritional knowledge, attitudes and practices of medical students in Taiwan have not been elucidated.

This investigation was a need assessment that examined knowledge, attitude and practices of medical students in selected areas of nutrition. A national sample of 528 senior medical students from nine medical colleges in Taiwan participated in this study by completing a questionnaire.

On a 10-point scale, the average score of students on general and clinical nutritional knowledge was 5.99 +/? 1.51 and 5.15 +/? 1.77, respectively. The percentage of correct answers from questionnaires in both areas was 60% and 52%, respectively. Seventy-seven percent or more of the students reported that they either agreed or strongly agreed with four positive-attitude statements and either disagreed or strongly disagreed with two out of three negative-attitude statements. Between 30% and 61% of the students reported that they practice on nutrition-related individual behaviors.

The knowledge, attitudes and practices of senior medical students in Taiwan suggest the need for education strategies to improve competence in the area of nutrition.     

Associations Between Abortion Services and Acceptance of Postabortion Contraception in Six Indian States

Women receiving induced abortions or postabortion care are at high risk of subsequent unintended pregnancy, and intervals of less than six months between abortion and subsequent pregnancy may be associated with adverse outcomes. This study highlights the prevalence and attributes of postabortion contraceptive acceptance from 2,456 health facilities in six major Indian states, among 292,508 women who received abortion care services from July 2011 through June 2014. Eighty‐one percent of the women accepted postabortion contraceptive methods: 53 percent short‐term, 11 percent intrauterine devices, and 16 percent sterilization. Postabortion contraceptive acceptance was highest among women who were aged 25 years and older, received first‐trimester services, received induced abortion, attended primary‐level health facilities, and had medical abortions. Doctors receiving post‐training support were more likely to offer contraceptives, but no association was observed between such support and acceptance of IUDs or sterilization. Comprehensive service‐delivery interventions, including ensuring availability of skilled providers and contraceptive commodities, offering clinical mentoring for providers, identifying and addressing provider bias, and improving provider counseling skills, can increase postabortion contraceptive acceptance and reduce unintended pregnancy.     

未婚人工流产女性生殖健康知识、态度、行为及影响因素研究

目的:了解未婚人工流产女性生殖健康相关知识、态度、行为情况及影响因素,为计划生育和妇幼保健工作提供科学依据。方法:对2009年3～8月在湖南省、长沙市、长沙县三所妇幼保健院计划生育门诊确诊并要求终止妊娠的734名未婚女性进行问卷调查。结果:本次调查人群平均年龄为23.61岁,主要是公司职员、学生和无业者,文化程度较高;大部分对生殖健康知识了解不多,74.8%对婚前性行为持支持或无所谓态度,91.3%的女性采取过避孕措施,但仅有8.5%能每次坚持,主要措施是避孕套、体外排精和安全期避孕;年龄、籍贯、文化程度、职业、月收入、更换工作的次数、家庭经济状况、父母婚姻状况、学校或社区对生殖健康的宣传等多个因素对未婚人工流产女性生殖健康知识、态度、行为有影响。结论:未婚人工流产女性对生殖健康知识了解不深,性观念开放且避孕措施使用率低。今后的工作中,社区、学校、家庭应相互配合,为未婚女性提供更多有效的生殖健康服务。     

Attitudes of patients to medical student participation: general practice consultations on the Cambridge Community-Based Clinical Course

The clinical medical students on the Cambridge Community-Based Clinical Course (CCBCC) derive part of their training by taking part in consultations between patients and their general practitioners. Patients' attitudes to this arrangement and their support for student training in a general practice setting are an important factor in the development of community-based education. A postal questionnaire seeking information from patients achieved an 84% response rate. Both the numerical results and the patients' comments are presented. Patients proved generally supportive of the community-based course and some identified positive benefits to themselves from this provision. The large majority of patients did not mind the presence of medical students during consultations, although there are some areas in which patients are less willing to involve students.     

The delivery of medical abortion services: the views of experienced providers.

This study examined beliefs about the delivery of medical abortion services and current roles of 76 providers of methotrexate-induced abortion. The sample included physicians, midlevel professionals, administrators, and counselors/other medical staff. Over 75% of participants believed that, given proper training and emergency backup, physicians and midlevel clinicians alike could provide medical abortions. Over 85% agreed that methotrexate-induced abortions could be provided in any physician's office or medical facility. There were no differences in perceptions by participant group. Involvement of midlevel providers in provision of medical abortion could potentially increase access and options for women seeking to terminate an early pregnancy.