By Dr Corrina Horan
Abortion is a very common gynaecological procedure, with an estimated 1 in 3 women undergoing an abortion in mainland UK within their reproductive lifetime. Despite the common nature of abortion, it is a subject surrounded by stigma – a US study found that the majority of people, 1 week following an abortion, were concerned that they would be looked down upon by their community (56%) or someone close to them (60%) if they knew they had accessed abortion care. I personally have been interested in this topic since medical school and after starting clinical work as a junior doctor, noticed that, despite the common nature of unplanned pregnancy and abortion, a lot of my colleagues had not been provided with teaching on how to provide consultations or appropriate support without judgement or stigma. This then led me to start research on how abortion is taught to undergraduates, in order to best understand how the abortion curriculum can be improved. We have discovered that abortion education varies widely between different medical schools, but we wanted specifically to understand how undergraduates felt about the teaching they received.
This research, which looked at how undergraduate medical students feel about their abortion teaching, was undertaken in collaboration with UCL Medical School and formed the qualitative arm of a two-armed project; the quantitative arm found that the make-up of abortion education, as delineated by Obstetrics and Gynaecology and Ethics and Law leads, varied greatly. Students were rarely given the opportunity to practice their consultation skills through role play and learning on abortion was infrequently assessed. Many barriers to providing abortion education were identified by curriculum leads, including lack of curriculum time and qualified and willing staff, and the perception of abortion as a sensitive topic.
Following on from these results, we wanted to find out how medical students themselves felt about the teaching they were receiving; including whether they found teaching on abortion valuable, what makes such teaching effective, and importantly whether they felt prepared to be competent practitioners following graduation.
We selected medical students from 5 different medical schools, which had been purposively selected based on the quantitative results to ensure we gained the opinions of students receiving a range of undergraduate education (both in terms of how much curriculum time was provided and practically how the teaching was delivered). In total, 19 students participated in a qualitative, semi-structured interview, lasting between 45 minutes and 1.5 hours in length. These interviews were subsequently transcribed and thematically analysed to draw out the key topics of interest for the participating medical students.
We found four overarching and interlinking themes within the conducted interviews. Firstly, interviewees highlighted how valuable they perceived compulsory, comprehensive abortion teaching. This importance was expressed both by those who felt they had received a good standard of education and those who found their teaching lacking. In addition, students discussed the importance of their education preparing them to provide care once they are working as junior doctors. This was highlighted as students felt they were likely to encounter people with an unwanted pregnancy, and should therefore understand how to conduct an abortion consultation and explain what an abortion actually entails. The ability to access clinic-based placements and have interactive teaching methods, such as role play, were suggested as useful strategies to provide this preparation. Beyond preparation for work as a junior doctor, students also appreciated the ability to discuss conscientious objection, which enables students with a diverse range of attitudes towards abortion to engage with the subject and appreciate how to appropriately conscientiously object without obstructing care. Finally, students explained that the perception of abortion as a sensitive topic made it more important to provide adequate undergraduate teaching on this topic, with a specific reference to the societal stigma that still surrounds abortion and how doctors can provide non-judgemental care.
This research presents a clear message: medical students want inclusive, clinic-based undergraduate abortion education, which prepares them to provide care for those who have unwanted pregnancies. Many report that their teaching does not currently meet this standard, and Doctors for Choice UK, in combination with UCL Medical School, is hoping to change that. We have developed detailed resources, which are open access and available on the Education section of the Doctors for Choice UK website for anyone interested. However, resources alone are not enough, and Doctors for Choice UK have set up a Curriculum Champions programme to support medical educators and medical students alike to advocate for enough curriculum time to provide high quality abortion education. Above all, preparing students to provide non-stigmatising, empathetic care will allow pregnant people with unwanted pregnancies to be supported throughout their decision making, and this can only be a good thing.
Dr Corrina Horan is an Academic Trainee in Community Sexual and Reproductive Health in London, and is currently researching contraception and abortion within Relationships and Sex Education. She is also the Education Representative of Doctors for Choice UK.