Association of Reproductive Health Training on Intention to Provide Services After Residency: The Family Physician Resident Survey

摘要

Background and Objectives: High rates of unintended pregnancy and need for reproductive health services (RHS), including abortion, require continued efforts to train medical professionals and increase availability of these services. With US approval 12 years ago of Mifepristone, a medication abortion pill, abortion services are additionally amenable to primary care. Family physicians are a logical group to focus on given that they provide the bulk of primary care.Methods: We analyzed data from an annual survey (2007–2010) of third-year family medicine residents (n=284, response rate=48%–64%) in programs offering abortion training to examine the association between such training and self-reported competence and intentions to provide RHS (with a particular focus on abortion) upon graduation from residency.Results: The majority of residents (75% in most cases) were trained in each of the RHS we asked about; relatively fewer trained in implant insertion (39%), electric vacuum aspiration (EVA) (58%), and manual vacuum aspiration (MVA) (69%). Perceived competence on the part of the graduating residents ranged from high levels in pregnancy options counseling (89%) and IUD insertion (85%) to lows in ultrasound and EVA (both 34%). Bivariate analysis revealed significant associations between number of procedures performed and future intentions to provide them. The association between competence and intentions persisted for all procedures in multivariate analysis, adjusting for number of procedures. Further, the total number of abortions performed during residency increased the odds of intending to provide MVA and medication abortion by 3% and 2%, respectively.Conclusions: Findings support augmenting training in RHS for family medicine residents, given that almost half (45%) of those trained intended to provide abortions. The volume of training should be increased so more residents feel competent, particularly in light of the fact that combined exposure to different abortion procedures has a cumulative impact on intention to provide MVA and medication abortion.(Fam Med 2015;47(1):22-30.)The widespread need in the United States for reproductive health services has been clearlydocumented.1 Improved family planning services to better space pregnancies and decrease unintended pregnancies is one of the goals of Healthy People 2020.2 That approximately half of pregnancies each year are unintended, 43% of which end in abortion,3 attests to the importance of increased availability of reproductive-related services. Given that reproductive health services are among the most commonly performed in the United States (including abortion),4 numerous efforts have been undertaken to increase the number of health care providers offering these services.5,6 Over the past decade, a concerted effort to consider physicians other than obstetrician-gynecologists (ie, family physicians)7-11 and advanced practice clinicians (eg, nurse practitioners, physician assistants, and certified nurse-midwives)12-14 has been important for increasing providers of these services.Family physicians are an obvious group to consider since they provide the bulk of primary care in this country.15 The geographic location of family physicians mirrors the distribution of the population—77% practice in urban areas (where 79% of the population lives), and 22% practice in rural areas (where 21% of the population lives). Thus, integrating contraception and abortion into family medicine residency training has the potential of greatly expanding access to these services. There are 461 family medicine residency programs nationwide.16 In 2002, 11 of these provided abortion training as part of their core curriculum.17 Today, approximately 25 programs (5.4%) offer “opt-out” abortion training, meaning that residents will receive such training unless they explicitly elect not to (The Center for Reproductive Health Education in Family Medicine (http://rhedi.org/resources/programs.php). Other residen