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Appendix 11
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A Medical Student's Guide to Improving Reproductive Health Curricula

Appendix 11
Abortion Education and Curriculum Reform in Medical School: A Practical Guide to Designing a Clinical Elective

By Nassim Assefi, Regional MSFC Coordinator of the West (March 1996)

In many medical school curricula across the country, women’s reproductive health issues, abortion in particular, are glaringly absent. One approach to introducing educational reforms in medical schools is to integrate abortion and related issues in already existing courses, such as the ob/gyn third-year rotation, ethics, psychiatry, the patient-doctor relationship, introduction to clinical medicine, genetics, pharmacology, reproductive physiology, and public/health policy. Another strategy is to create a course that focuses on abortion. This Guide will detail the steps in implementing the latter approach in a clinical setting.

1. Where to Start

Identify pro-choice faculty and administration. Determine which ob/gyns or primary care doctors among the faculty perform abortions or conduct research in abortion. Alternatively, if there are no clinical faculty members who do abortions or support abortion education, contact abortion providers in the area, and find out how they can acquire clinical faculty appointments. Two students at the University of Pennsylvania have detailed their experience in founding both a clinical and seminar course on abortion (see Appendix 15).

2. Objectives of the Course

Consult interested students, faculty, and administration, and decide on the general objectives of your proposed course. For example, the objectives for one proposed medical school course:

  1. Orient student to the clinic routine, including the need for security and confidentiality
  2. Observe counseling sessions, including pregnancy options and contraceptive counseling, and the abortion consent process
  3. Familiarize student with pregnancy testing: urine, ultrasound, and physician exam, and understand the criteria of dating the pregnancy for determination of abortion type
  4. Observe the abortion procedure for first-trimester abortions and D&E (if available), including an understanding of pain management
  5. Observe pathology to understand the need for immediate and appropriate evaluation of tissue
  6. Observe post-abortion visits to appreciate the follow-up, potential complications, and return to the non-pregnant state
  7. Read text and syllabus to gain a further understanding of the comprehensive issues – from political to public health to medical research – surrounding abortion

3. Logistical Issues

Decide the time period for the prerequisites. Write a catalog description and explain how the course will be graded, how the students will be evaluated, what reading materials will be used, and whether there will be lectures. Detail the clinical objectives. Often it is useful to state the minimum number of abortions, counseling sessions, post-abortion follow-up visits, etc., that should be observed for successful completion of the course.

4. Example of New Course Application (obtained from the curriculum committee)

Course Title: Voluntary Pregnancy Termination: An Overview of Medical and Social Issues

Number: OB 680 (fourth-year elective)

Prerequisites: OB 665 (third-year ob/gyn clerkship completion)

Sponsoring Departments: ob/gyn (also may want to involve family medicine department)

Chair of Course: TBD

Justification (briefly stated): Abortion is one of the most common gynecologic procedures, with 1.3 million abortions reported for the United States in 1993. The ob/gyn department currently offers fourth-year electives in oncology, high-risk obstetrics, and reproductive endocrinology. Although it is unusual to select a single procedure for a clinical course, very few physicians expose their students to abortion in the curriculum. Currently, the second-year reproduction course has begun to include a two-hour session on abortion, and the third-year ob/gyn clerkship offers an introduction to abortion in the reading material, but no clinical time is specifically dedicated to this topic. Consequently, a majority of students will complete medical school having never seen an abortion and will have only minimal understanding of the procedure.

Catalog Description: The goal of this course is to familiarize medical students with abortion and related issues, including indications, procedures, complications, counseling, and consent. With lectures, assigned readings, and clinical experiences, students will be exposed to pregnancy options counseling (including genetics counseling), first- and second-trimester abortion procedures, medical abortions, ethical and epidemiological issues, and post-abortion care.

Reading Materials:

  1. Textbook: Hern W. Abortion Practice. (Philadelphia: J.B. Lippincott, 1990). Cost is $34.95.
  2. Syllabus with articles to complement textbook, i.e., to address medical abortions, fetal indications, induction procedures, and an update on statistics/regulations/funding.

Credit/Hours: Two credits = 70 hrs (30 hrs clinical observation, 10 hrs lecture, 30 hrs reading)

Evaluation: Credit/no credit based on confirmation of attendance at clinic and lectures and written evaluation based on Hern’s textbook and syllabus articles.

Anticipated student enrollment per quarter: Five (20 per year)

Clinical Sites and Faculty Members: i.e., Planned Parenthood, Feminist Women’s Health Center, private practices.

Lectures: Because a small number of students will be enrolled at any given time, one school has proposed a yearly Saturday Symposium, to which attendance is required to receive credit for the course (alternatively, a paper can be written if the students cannot participate in the symposium).

Symposium Topics and Tentative Program

8 – 8:30 am

Introduction and overview

8:30 – 9:30 am

Historical perspective/epidemiology/statistics

9:30 – 9:45 am

Break

9:45 – 10:30 am

Prenatal diagnosis and terminations for anomalies

10:30 – 11 am

Decision making, video on abortion choices

11 am – noon

Medical abortions: RU-486/MTX/Misoprostol

Noon – 1 pm

Lunch

1 – 2 pm

Surgical techniques/paracervical blocks

2 – 3:30 pm

Laws, politics of choice, provider shortages, clinic violence (panel)

3:30 – 4 pm

Break

4 – 5 pm

Post-abortion contraception/long-term follow-up and outcomes

5 – 6 pm

Complications and controversies/induction procedures

6 pm

Social dinner/evening program

5. Sharing Information

Once the course has been approved, it is important to disseminate information regarding its existence to the students at your school; MSFC (so that students at other institutions who want to initiate such a course can contact you for advice and perspective); and local/national pro-choice organizations (particularly groups that are invested in medical student activism, e.g., AMSA, AMWA, ARHP).