by Clara Keegan, MD, and Amanda Grafstein, MD, University of Vermont Medical Center; and Marji Gold, MD, Montefiore Medical Center

Introduction

The Accreditation Council for Graduate Medical Education (ACGME) Program Requirements for Graduate Medical Education in Family Medicine indicate that “Residents must have at least 100 hours (or one month) or 125 patient encounters dedicated to the care of women with gynecologic issues, including well-woman care, family planning, contraception, and options counseling for unintended pregnancy.” ¹ With grant support from Reproductive Health Education in Family Medicine (RHEDI), we are revitalizing our gynecology curriculum to meet and exceed the ACGME requirements in collaboration with the Obstetrics & Gynecology residency program at our institution.

Development

RHEDI funding was used to develop our abortion training program through support of faculty training in abortion and ultrasound, as well as dedicated faculty time for curriculum development and implementation. As first trimester abortion with medication or uterine aspiration is safe and within the scope of Family Medicine, we include abortion care in the training of all residents, except those who request to opt-out.² Abortion training includes experience with pregnancy options counseling and patient-centered shared decision making, skills which are vital for all family physicians. Even for residents who do not plan to provide abortions in the future, uterine aspiration training enhances their comfort with all intrauterine procedures and prepares them to provide high-quality gynecologic care. 

In collaboration with our hospital’s OB/Gyn department, we developed the Family Planning Clinic to provide outpatient abortion care at our medical center. Starting a new clinical service required regular planning meetings with faculty and administrative leadership from both departments. We met with staff to address questions about security and confidentiality, and built new templates within our electronic health record. Program faculty provided education to other departments, including emergency medicine, primary care internal medicine, pediatrics, medical subspecialties, and surgery, to increase our referral base.

Curriculum

The core components of the one month rotation are the same for Family Medicine residents and for Obstetrics & Gynecology residents and include: 1) ultrasound training, 2) aspiration procedures with supervision by the attending at a local Planned Parenthood affiliate, and 3) contraception, miscarriage, and abortion care in the general office setting with supervision from Family Medicine and Ob/Gyn faculty. The Early Abortion Training Workbook published by Advancing New Standards in Reproductive Health (ANSIRH) is our primary resource for self-directed learning.³ Residents also meet with faculty for interactive didactic sessions. Our behavioralist clinician meets individually with each resident to role-play options counseling, and discusses the language we use when discussing adoption, abortion, and parenting.

Results

Our new gynecology curriculum is providing more consistent opportunities for exposure to abortion, contraception procedures, and colposcopy for Family Medicine residents. The curriculum has been well-received. We have noticed a cohort of medical students who apply to our program because we are affiliated with RHEDI, as we are included on the list of family medicine residency programs offering integrated abortion training.⁴ This shows that the availability of abortion training is a powerful recruitment tool.

We have not experienced any adverse consequences of adding abortion training to the services offered at our outpatient clinical sites. We have not had any security concerns. Staff who do not want to be involved with abortion services maintain good relationships with the providers and staff offering those services.

Next Steps 

We are developing self-study modules that help residents navigate the ANSIRH workbook for didactic curriculum, integrated with RHEDI resources on shared-decision making.⁵ RHEDI assessment tools will help us evaluate resident skills with procedures and communication.⁶

Conclusion

Implementation of a collaborative Family Planning program for education and expansion of clinical services required advance planning across many levels at our medical center. After one year of clinical services, we have found the program to be a universally positive addition in terms of patient access to care, resident education, and recruitment to our residency program.

Figure 1: Rotation Schedule

*These experiences are the same for FM residents and for Ob/Gyn residents. Only one resident is assigned at a time so residents are not competing for exposure.

References

1. Accreditation Council for Graduate Medical Education. Program Requirements for Family Medicine. https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/120FamilyMedicine2018.pdf?ver=2018-06-15-112624-307. Published July 1, 2018. Accessed January 29, 2019.
2. National Academies of Sciences, Engineering, and Medicine. The safety and quality of abortion care in the United States. Washington, DC: The National Academies Press; 2018. https://doi.org/10.17226/24950.
3. Goodman S, Wolfe M; TEACH Trainers Collaborative Working Group. Early Abortion Training Workbook. 4th ed. San Francisco, CA: UCSF Bixby Center for Global Reproductive Health; 2012. https://www.ansirh.org/publications/training/early-abortion-training-workbook. Accessed February 27, 2019.
4. Reproductive Health Education In Family Medicine. Family Medicine Residencies With Abortion Training. https://rhedi.org/rhedi-programs/. Accessed January 29, 2019.
5. Reproductive Health Education In Family Medicine. RHEDI Curriculum. https://rhedi.org/education/rhedi-curriculum/. Accessed January 29, 2019.
6. Reproductive Health Education In Family Medicine. Assessment Tools. https://rhedi.org/assessment-tools/. Accessed January 29, 2019.