Family Planning Training at Catholic and Other Religious Hospitals: A National Survey

摘要

The Accreditation Council for Graduate and Medical Education (ACGME) has recognized family planning and abortion training as essential components of all obstetrics and gynecology residency programs, regardless of institutional affiliation, and has stipulated that such training be a comprehensive part of their planned curriculum ("routine training"). It has also been recognized by ACGME that residents who have religious or moral objections to abortion training may decline ("opt-out") of training. A large number of studies have demonstrated that a key predictor of later provision of family planning services is incorporation of adequate residency training in family planning and abortion training. A survey conducted in 2019 found that directors at religiously affiliated programs are more likely to report abortion training restrictions that are often secondary to hospital polices. Accredited residency programs in obstetrics and gynecology at restrictive, faith-based hospital accounted for approximately 11% of all ACGME programs. This presents a challenge to educational leaders who must ensure comprehensive family planning training. The aim of this study was to evaluate and summarize family planning training at obstetrics and gynecology residency programs affiliated with Catholic and other faith-based hospitals, which restrict reproductive services. A surveywas conducted of educational leaders at religious hospital training programs with the goal of delineating the current provision and adequacy of family planning training as well as highlighting strategies and training gaps in order to provide best practices in these settings. The survey was designed to understand how Catholic and other religious hospital training programs provide comprehensive family planning training to their residents, despite institutional restrictions to provision of services. Using an online database of 2017-2018 residency programcharacteristics, the authors identified that there were 30 of 278 accredited programs in which at least 70% of resident time was spent in faith-based hospitals restricting family planning services. Jewish training programs were excluded because of lack of such restrictions. Program leaders were queried between March 2017 and April 2018 about education and training using an online or paper survey and were asked to report on training settings, provision of family planning services and to rate aspects of training as "poor," "adequate," or "strong." Responses were compared at Catholic and other faith-based programs using Fisher exact tests,.2 analyses, and median tests. A total of 48 ACGME-accredited programs were identified that were associated with religious hospitals. Among these, 18 sites were excluded that did not meet the inclusion criteria, leaving 30 programs, which were asked to complete the survey; 25 of these responded (83%). Most respondents were programdirectors (88%) and represented Catholic hospitals (76%). All programs reported adequate contraceptive training; 47% of Catholic programs relied on off-site locations for such training; the remaining programs relied on a clinic owned by or affiliated with the primary hospital. Most Catholic sites (84%) relied on off-sites for sterilization training. Catholic programs were more likely than others to report inadequate training in postpartum tubal ligations following vaginal deliveries (53% Catholic vs 0% other faith-based, P = 0.05); only 21% of Catholic sites provided off-site postpartum training.