COMMENTARY

Abortion and Medical Students: Education at a Crossroads

Emily Kahoud

Disclosures

July 30, 2019

Recently, southern states, including Alabama, Georgia, and Mississippi, have pushed forward abortion legislation suggestive of a time prior to Roe v Wade. Meanwhile, New York, Maine, Illinois, and Vermont moved to enact laws that preserve the rights of women to choose. The complexity of this ongoing legal battle has not been lost on those of us still receiving our medical education.

Just beyond the rote memorization required of us lay nuances of life and death, scenarios that can force those of us in medical training to perform mental and moral gymnastics. What medical students should learn about abortion and family planning versus what we will learn can often be quite different.

Ob/gyn physician Lauren Barlog, MD, an assistant professor at Rutgers New Jersey Medical School (NJMS), explains, "Regardless of whether you agree with abortion, your opinion in medicine shouldn't be a part of your patient interactions." She suggests that beyond procedural training, abortion history is also important for students to learn. However, obtaining an authentic and accurate context through which to fully understand abortion care can be challenging, even for those of us who will soon be on the front lines.

When Passion Meets Lack of Training

Medical education on abortion can be sparse. In one of the few attempts to comprehensively measure these training levels, 17% of clerkship directors reported no formal education about abortion either in the preclinical or clinical years. The paltry response to the substantial need is due to a multitude of factors, explains Kelly Blanchard, MSc, president of Ibis Reproductive Health. "In some cases, it's explicitly because of religious affiliation of institutions," she says. "In other cases, it may be because of general stigma. And finally, it could also be fear of attention from anti-abortion rights activists or legislators or other stakeholders."

However, some medical students who will soon be entering the workforce have demonstrated a clear passion for a "justice approach to childbirth," according to Icahn School of Medicine at Mount Sinai's Medical Students for Choice representative Kevin Cheung, MD. He says that this grows from the "recognition that maternal health and mortality in the United States is really horrendous; it's among the worst in the developed world, and it's been getting worse over the past decade or so." The justice approach, Cheung says, aims to "turn obstetric care into something that is more woman-centered, that's more about shared decision-making and really seeing what it is that the patients want."

Cheung states that most of the emerging physician workforce will not have had appropriate exposure and training "on something that they will undoubtedly encounter in some way." He believes that abortion education will only grow more limited given increasingly restrictive legislation. Cheung believes the time is now to convince schools that training the best physicians possible means providing a core competency on abortion to all trainees. Regardless of individual attitudes toward abortion, Cheung says, "A competent provider needs to know, at the very least, what is done" to provide adequate care.

This mirrors what Kristina Tocce, MD, former program director for the Department of Obstetrics/Gynecology at the Colorado University School of Medicine and current Planned Parenthood of the Rocky Mountains medical director, used to tell her students. "I felt so strongly in conveying to the audience that, no matter what aspect of medicine you ultimately go into, you will be faced with a patient that is going to have to make a decision [about abortion], and every single provider needs to be able to counsel a patient appropriately and get that individual to the appropriate services."

However, medical students are not always easy to convince. Tocce recalls one particular conversation, when a student said, "I'm going into cardiology. Are you telling me that I need to know all about family planning?" Tocce responded, "Actually, for some patients who have a really serious medical problem, the one provider they may see consistently is their specialty provider, such as their cardiologist."

Tocce explains that the urgency of this teaching point derives from tragedy. "One of the only patients I had who died after an abortion did not die because of her abortion. The abortion was done to try to help save her life because she could not compensate for the additional demands of pregnancy. And it was such a desired pregnancy that she could not bring herself to terminate until, honestly, it was too late."

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