Assessment of attitudes towards assisted reproduction: A survey among medical students and parous women

Background.?The present paper explores attitudes towards different aspects of assisted reproductive technologies among parous women and future doctors (third- and fourth-year medical students).

Methods.?We anonymously surveyed 200 parous women who had at least three infants and had given birth at Kuopio University Hospital, and 200 medical students of Kuopio University.

Results.?The overall response rate was 45%. Most of the medical students were childless (95.7%), unmarried (63.8%), and younger (24 vs. 35 years) compared with the parous women (p < 0.001). Medical students were liberal in questions of who has the right to get infertility treatment: 49% of them would allow the possibility to lesbian couples, 43% to homosexual couples and over 50% to single women. Over 40% of medical students would allow the use of a surrogate mother for lesbian and homosexual couples; the number was under 20% in the group of parous women. Their setting of priorities within the field of reproductive health also showed differences in prostate cancer screening, doctor's appointments for contraception, abortion and menopausal hormone replacement therapy.

Conclusions.?Medical students take a rather liberal stance on reproductive issues. On the other hand, baseline attitudes among medical students reveal some degree of subjectivism when it comes to allocation of scarce healthcare resources within the field of reproductive health. Medical education faces a challenge in ensuring that future physicians are able to set priorities and balance resources between preventive medicine and management of specific medical conditions, and to base their attitudes on evidence.     

Abortion education in medical schools: a national survey

OBJECTIVE: This survey was performed to examine the inclusion and extent of abortion education in US medical schools. STUDY DESIGN: A 3-item confidential survey requesting information about abortion education throughout the 4 years of medical school was mailed to the OB-GYN clerkship directors of the 126 accredited US medical schools. RESULTS: Seventy-eight surveys were returned, for a response rate of 62%. Overall, 17% of clerkship directors reported no formal education about abortion either in the preclinical or clinical years. In the third-year OB-GYN rotation, 23% reported no formal education, whereas 32% offered a lecture specifically about abortion. While 45% of third-year rotations offered a clinical experience, participation was generally low. About half of schools offered a fourth-year reproductive health elective, but few students participated. CONCLUSION: Abortion education is limited in US medical schools. As an integral part of women's reproductive health services, abortion education deserves a place in the curricula of all medical schools.     

Attitudes of faculty and students toward case-based learning in the third-year obstetrics and gynecology clerkship

OBJECTIVE: This study was undertaken to compare the attitudes of faculty and medical students toward case-based learning and lecture format during the obstetrics and gynecology clerkship. STUDY DESIGN: For this prospective comparative study, student presentations were alternately assigned to traditional lecture- or case-based format every 6 weeks. Presentations were made to other students and a single faculty. A total of 31 faculty members, 30 student presenters, and 122 student participants completed evaluations. Teaching methods were compared. RESULTS Faculty members favored lecture format over case-based learning for "attentiveness and interaction of the group" (3.9 vs 4.5, P < .018) and for "meeting the objectives" (3.7 vs 4.5, P < .002). Student participants favored case-based learning in "understanding the relationship between knowledge and clinical practice" (4.34 vs 4.06, P < .05) and "enjoyed" (4.34 vs 3.90, P < .008). Student presenters showed no differences between groups. CONCLUSION: Faculty favored lecture format whereas student participants favored a case-based presentation. Student presenters were comfortable with both formats.     

Premenstrual syndrome and attitudes toward menstruation in a sample of nursing students

Objective: The aim of this study was to evaluate baccalaureate nursing students’ attitudes toward menstruation, and to analyze the frequency of premenstrual syndrome (PMS) symptoms, as well as the relationship between attitudes toward menstruation and PMS symptoms. Methods: This cross-sectional study was carried out between February 15 and March 10, 2009, in Ankara Turkey. The study participants were 250 undergraduate nursing student volunteers. Data were collected using a demographic questionnaire, the validated Turkish version of the Menstrual Attitude Questionnaire (MAQ), and the validated Turkish Premenstrual Syndrome (PMS) Scale. Obtained data were analyzed using SPSS version 15.0. Findings: The average age of participants was 19.89 ± 1.43. The MAQ’s five subscales’ mean scores ranged from 2.67 ± 0.58 to 3.37 ± 0.52, indicating natural to moderate attitudes toward menstruation. The mean PMS score was 114.86 ± 35.15, indicating moderate PMS symptoms. PMS symptoms were detected in 36.4% of the nursing students. Thirty one percent of the students reported having dysmenorrhoea during every menstrual cycle. Students who had PMS symptoms scored significantly higher on the debilitation subscale and scored significantly lower on the denial subscale of the MAQ (p < 0.05). Conclusions: The findings of this research showed that menstruation was considered to be a natural event by most of the nursing students. In addition, dysmenorrhea was found to be the most common menstrual problem and the rate of PMS was found lower than that found in previous researches conducted in Turkey.     

Prediction of a caesarean delivery by labour and delivery nurses

The predictive accuracy of a nurse on labour and delivery to foretell the route of delivery is unknown. Registered nurses directly involved in managing women's labour predicted the route of delivery on 199 women between September 2005 and September 2006. The sensitivity to identify women who subsequently would deliver by caesarean was 26% (95% CI 13-42%); positive predictive value of 38% (20-39%) and likelihood ratio of 2.6 (1.3-7.5). Experience did not improve the predictive accuracy.     

Knowledge, practices, and attitudes regarding emergency contraception among students at a university in Ghana

Objectives

To investigate the knowledge, practices, and attitudes among students at a university in Ghana regarding emergency contraception (EC).

Methods

An anonymous, self-administered, 39-item questionnaire was sent to 3200 students. The sample size was stratified and 2292 students were randomly selected.

Results

Of the 71.6% of students who responded, 51.4% had heard of EC. Among those, 19.4% thought EC consisted of contraceptive pills, 19.1% of “morning-after pills,” and 12.8% of an intrauterine device. Only 4.2% had ever used EC but 73.9% wished it were provided on campus. Of all the respondents, 90.9% called for the establishment of a reproductive health counseling center on campus.

Conclusion

Student knowledge and use of EC were poor, and there is urgent need for reproductive counseling and EC services on campus.     

Obstetricians' opinions and attitudes toward maternal refusal of recommended cesarean delivery in Nigeria

Objective

To assess the opinions and attitudes of Nigerian obstetricians toward women's refusal of cesarean delivery.

Method

We used a questionnaire with 5 clinical scenarios drawn from published cases in which Nigerian women refused to undergo a recommended cesarean delivery.

Results

Most obstetricians (84.8%) advocated continuous counseling of these women but, from their response to the scenarios, few (13.7%-16.1%) would actually do so. Insufficient facilities and poor logistics for emergency obstetric care were their stated major reason for not respecting maternal choices in situations where vaginal delivery could have been given a chance.

Conclusion

The possibility of providing emergency obstetric care would remove many indications for cesarean delivery from the list of absolute indications in Nigeria; and management guidelines would protect obstetricians in the event of litigation, and improve their acceptance and respect of maternal choice.     

The obstetrics and gynecology clerkship: building a better model from past experience

OBJECTIVE: The study was undertaken to identify factors contributing to the poor student perception of the obstetrics and gynecology clerkship. STUDY DESIGN: Third-year medical students at the University of Michigan complete an annual questionnaire about the overall quality of their clinical experiences. In addition, at the end of each rotation, the students complete an evaluation form assessing various aspects of their learning experience. We reviewed data collected from 2000 to 2002. We calculated effect sizes using mean scores and SDs to compare individual aspects of the learning environment across the clerkships. RESULTS: Twenty-six percent of the third-year medical students at the University of Michigan rated the strength of their obstetrics and gynecology experience as very or exceptionally strong. Compared with the other 6 clerkships, the rotation had one of the lowest ratings for overall quality. Aspects of the clerkship experience we identified as potentially explaining this overall poor rating include the clarity of the clerkship goals and objectives, clarity of expectations for student performance, accessibility of faculty, experiences in learning history-taking skills, experiences in learning physical examination skills, and student perception that they were treated in a respectful/professional manner. CONCLUSION: Aspects of the clerkship experience identified by this study as potentially explaining the low ratings of the obstetrics and gynecology rotation should be studied in greater detail. Addressing these factors will be critical for improving the overall student perception of the obstetrics and gynecology clerkship.     

Chewing gum improves postoperative recovery of gastrointestinal function after cesarean delivery: a systematic review and meta-analysis of randomized trials

Objective: To examine whether chewing gum hastens the return of gastrointestinal function after a cesarean delivery.

Methods: All randomized controlled trials comparing the use of chewing gum in the immediate postoperative recovery period (i.e. intervention group) with a control group were included in the meta-analysis. The primary outcome was the time to first flatus in hours. Meta-analysis was performed using the random effects model of DerSimonian and Laird, to produce summary treatment effects in terms of mean difference (MD) or relative risk (RR) with 95% confidence interval (CI).

Results: Seventeen trials, including 3041 women, were analyzed. Trials were of moderate to low quality with different inclusion criteria. In most of the included trials chewing gum was given right after delivery, three times a day for 30?min each and until the first flatus. Women who were randomized to the chewing gum group had a significantly lower mean time to first flatus (MD – 6.49?h, 95%CI ?8.65 to ?4.33), to first bowel sounds (MD – 8.48?h, 95%CI ?9.04 to ?7.92), less duration of stay (MD – 0.39?days, 95%CI –0.78 to ?0.18), lower time to first feces (MD – 9.57?h, 95% CI ?10.28 to 8.87) and to the first feeling of hunger (MD – 2.89?h, 95%CI ?4.93 to ?0.85), less number of episodes of nausea or vomiting (RR 0.33, 95%CI 0.12 to 0.87), less incidence of ileus (RR 0.39, 95%CI 0.19 to 0.80) and significantly higher satisfaction.

Conclusions: Gum chewing starting right after cesarean delivery three times a day for about 30?min until the first flatus is associated with early recovery of bowel motility. As this is a simple, generally inexpensive intervention, providers should consider implementing cesarean postoperative care with gum chewing.     

Effect of a specialized prenatal clinic on medical student attitudes toward women with drinking problems

Objective. To determine if student attendance at a specialized prenatal clinic would yield any change in their comfort level and in their attitudes toward pregnant women with drinking problems.

Methods. A total of 117 third-year students rotating consecutively on our core obstetrics–gynecology clerkship consented to enrolling in this prospective cohort study between February 2004 and June 2005. Each was assigned either to attend a half-day prenatal clinic designed specifically for women with alcohol and substance use disorders (study group) or not to attend the clinic (control group). The students answered anonymously a 15-question survey (using a 5-point Likert scale from ‘strongly disagree’ to ‘strongly agree’) at the beginning and at the midway point of the eight-week clerkship. Scores averaged for each question at the two points were compared within and between the two groups using paired-samples and independent-samples t-tests.

Results. No differences in responses to the survey were found between the study and control groups at the beginning of the clerkship. Students who attended the clinic became more comfortable in inquiring about patient alcohol consumption (p < 0.001) and about social problems such as domestic violence (p < 0.001). After attending the clinic, students reported that alcoholism was associated less with a weak will (p < 0.01) and that group therapy has more importance (p < 0.05). In contrast, the control group disagreed less that alcohol use was more of a moral and legal problem than a medical problem (p < 0.05).

Conclusions. An experience at this special prenatal clinic improved medical student awareness of complexities faced by problem drinkers, enhanced their comfort in talking to pregnant alcohol drinkers, and favored more sympathy toward alcoholism in general but not necessarily during pregnancy.     

Assessment of attitudes towards assisted reproduction: a survey among medical students and parous women.

BACKGROUND: The present paper explores attitudes towards different aspects of assisted reproductive technologies among parous women and future doctors (third- and fourth-year medical students). METHODS: We anonymously surveyed 200 parous women who had at least three infants and had given birth at Kuopio University Hospital, and 200 medical students of Kuopio University. RESULTS: The overall response rate was 45%. Most of the medical students were childless (95.7%), unmarried (63.8%), and younger (24 vs. 35 years) compared with the parous women (p < 0.001). Medical students were liberal in questions of who has the right to get infertility treatment: 49% of them would allow the possibility to lesbian couples, 43% to homosexual couples and over 50% to single women. Over 40% of medical students would allow the use of a surrogate mother for lesbian and homosexual couples; the number was under 20% in the group of parous women. Their setting of priorities within the field of reproductive health also showed differences in prostate cancer screening, doctor's appointments for contraception, abortion and menopausal hormone replacement therapy. CONCLUSIONS: Medical students take a rather liberal stance on reproductive issues. On the other hand, baseline attitudes among medical students reveal some degree of subjectivism when it comes to allocation of scarce healthcare resources within the field of reproductive health. Medical education faces a challenge in ensuring that future physicians are able to set priorities and balance resources between preventive medicine and management of specific medical conditions, and to base their attitudes on evidence.     

Closing the gap in education: Raising medical professionals' knowledge and attitudes in transgender health

Transgender and gender diverse (TGD) health is a rapidly evolving, underserviced, and underresearched healthcare field. This chapter will provide a brief review of the research in TGD health and medical education and offer further areas of research and curriculum design.     

An evaluation of trends in obstetrics and gynecology clerkships in the United States and Canada

OBJECTIVE: The purpose of this study was to provide an updated profile of clerkship directors and third-year clerkships for Departments of Obstetrics and Gynecology at US and Canadian medical schools. STUDY DESIGN: All 142 accredited medical schools in the US and Canada were contacted to identify the individual(s) responsible for third-year medical education in Obstetrics and Gynecology. Additional clerkship sites (n=10) were identified using the Association of Professors in Gynecology and Obstetrics' (APGO) list of current members self-identified as clerkship directors. Written surveys were mailed to the individuals identified above. The survey included questions about demographic and academic profiles, 11 attitude statements, as well as potential interest in a national organization of clerkship directors under APGO and interest in the creation of web-based resources specifically for clerkship directors. RESULTS: One hundred twenty-three (81%) responses were received. Demographic and academic characteristics of clerkship directors were similar to those published 13 (1) and 6 (2) years ago, except that the proportion of female clerkship directors has steadily increased (20% in 1989 [1], 25% in 1994 [2], and 44% in 2000, P <.0001). Thirty-five percent of departments have a specialized division of medical education, and 21% of respondents stated that their affiliated medical school had a formal multidisciplinary women's health care curriculum. Eighty-nine percent of respondents felt that their job as clerkship director was personally fulfilling. Eighty- nine percent supported a national organization of clerkship directors under APGO and the majority supported other activities specific for clerkship directors, including web-based resources. CONCLUSION: The profiles of obstetrics and gynecology clerkships and clerkship directors in the US and Canada have remained relatively stable over the last 13 years. However, the proportion of female clerkship directors continues to increase. Interest in more organized activities specifically for clerkship directors and web-based resources is high.     

Obstetrician-gynecologists' patients' knowledge of and attitudes toward hormone therapy: a survey

OBJECTIVE: To investigate the opinions of obstetrician-gynecologists' patients toward hormone therapy (HT). STUDY DESIGN: Survey questionnaires for patients were mailed to obstetrician-gynecologists who belong to the Collaborative Ambulatory Research Network. RESULTS: Surveys were returned by 1,659 patients from 39 states and the District of Columbia. Women over 50 years old and postmenopausal women of all ages were more likely to report being well informed. Perimenopausal and postmenopausal women were significantly more likely than premenopausal women to have extensively considered the risks and benefits of HT (p<0.001). More highly educated women were more likely to be aware of the results of the recent clinical trials of HT and to have formed an opinion about the risks and benefits of HT. Women who had formed an opinion were essentially divided over whether HT use after menopause would be helpful or harmful. Less than half the women thought that physicians know enough about HT to give appropriate advice. CONCLUSION: There was little consensus regarding the risks and benefits of HT. Postmenopausal and more educated women considered themselves more informed and were more likely to have reached a decision regarding HT but were as evenly divided regarding the risks and benefits.     

Required research by medical students and their choice of a women's health care residency

OBJECTIVE: This study searches for association between the subject of medical students' required research projects and subsequent choices of residency, focusing specifically on women's health fields. STUDY DESIGN: Students at our school graduating between 1997 and 2004 (n = 535) were required to undertake a research project beginning in the preclinical years. The subject of their required research project was related to their subsequent choice of residency. RESULTS: Ninety-nine of the 535 projects (18.5%) were women's health related. Although overall there was no significant relationship between the research project and residency choice, students who completed a women's health care project were nearly twice (1.8, 95% CI, 1.4-2.3) as likely to enter a women's health (obstetrics and gynecology or family medicine) residency than those who did not. CONCLUSION: An association exists between student participation in women's health research beginning during preclinical years and the subsequent choice of a women's health residency.