Does your school cover abortion?

[guydudcl371]

Hey everyone, so I want to start out by saying that this is not a post about whether or not you think abortion should be discussed in medical school curriculum, and I really don't want to engage in debates on here about it. Based on my research and my experiences at my current school, I am a little pessimistic about how well schools discuss this surgical procedure. Can you please comment on whether or not your school discusses it/lectures on it, how much they do, etc. I've also received the response of "well they will cover it in your residency." Based on my research this is not necessarily true, and so I am inquiring at the medical school level, how many of you have had this in your curriculum and to what extent? Thanks!

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[Colbert]

At what point would you expect them to cover it? It doesn't make any sense to cover it during the preclinical years. If anything, it could be covered by an attending during your OBGYN rotation, but it would be more because that particular attending wanted to, not because it's required for your education. And what would lead you to believe they wouldn't cover it in residency? If you did your residency at a Catholic hospital they may not, otherwise they likely would.

I'm not arguing for or against it either, I'm just saying it's not covered by the COMLEX/USMLE, so it doesn't make sense to have it be part of the core curriculum.

 

[Rollo]

At what point would you expect them to cover it? It doesn't make any sense to cover it during the preclinical years. If anything, it could be covered by an attending during your OBGYN rotation, but it would be more because that particular attending wanted to, not because it's required for your education. And what would lead you to believe they wouldn't cover it in residency? If you did your residency at a Catholic hospital they may not, otherwise they likely would.

I'm not arguing for or against it either, I'm just saying it's not covered by the COMLEX/USMLE, so it doesn't make sense to have it be part of the core curriculum.

Agreed.

It's a very specific surgical procedure. And preclinical years aren't required to cover any procedures, much less a minor procedure.

Our school did offer an after-hours guest lecture on this topic, though right around when we did Ob-Gyn in 2nd year.

 

[guydudcl371]

I would just expect it because it is one of the most common surgical procedures in the US (second behind only cesareans I do believe), and statistically only a small number of OB/GYB residencies cover it at all....
http://www.medicalstudentsforchoice.org/index.php?page=residency-guides

I do understand the part about it not being taught because it isn't on the boards though.

At what point would you expect them to cover it? It doesn't make any sense to cover it during the preclinical years. If anything, it could be covered by an attending during your OBGYN rotation, but it would be more because that particular attending wanted to, not because it's required for your education. And what would lead you to believe they wouldn't cover it in residency? If you did your residency at a Catholic hospital they may not, otherwise they likely would.

I'm not arguing for or against it either, I'm just saying it's not covered by the COMLEX/USMLE, so it doesn't make sense to have it be part of the core curriculum.

 

[Rollo]

I would just expect it because it is one of the most common surgical procedures in the US (second behind only cesareans I do believe), and statistically only a small number of OB/GYB residencies cover it at all....
http://www.medicalstudentsforchoice.org/index.php?page=residency-guides

I do understand the part about it not being taught because it isn't on the boards though.

Please cite unbiased references regarding "the most common surgical procedures in US".

And I have a feeling that the intent of this thread was to subtly highlight the oh-so-tragic issue of not being trained in abortion procedures in medical school.

 

[Bacchus]

Please cite unbiased references regarding "the most common surgical procedures in US".

And I have a feeling that the intent of this thread was to subtly highlight the oh-so-tragic issue of not being trained in abortion procedures in medical school.

I wish PCOM would have at least mentioned it besides the after hours lecture. That's just my opinion. Our lectures aren't mandatory anyway so they could fit it in somewhere. $0.02

 

[Rollo]

I wish PCOM would have at least mentioned it besides the after hours lecture. That's just my opinion. Our lectures aren't mandatory anyway so they could fit it in somewhere. $0.02

As the resident above you mentioned, if something like C-sections doesn't get any mention during lectures then there really is no place for this abortion surgical procedure in the curriculum.

What would be the utility from that lecture, anyway?

 

[Bacchus]

As the resident above you mentioned, if something like C-sections doesn't get any mention during lectures then there really is no place for this abortion surgical procedure in the curriculum.

What would be the utility from that lecture, anyway?

I think that all started d/t the "citing" of it being the second most common procedure or something... it really shouldn't be presented that way but more in a legal/ethical/moral issue of providing all options or how to refer for the procedure. I'm sure Dr. Jeck would have been able to give us an hour of talk about it.

It'll never happen though. Too much potential of uproar from students, community members, etc. I'd never expect to see an OB/GYN in lecture talking about performing the procedure. And, if that ever does happen, may our school not burn in flames.

 

[smq123]

That being said, I wouldn't assume that the line you are fed in med school is actually true. I have found that, outside of the Ob/Gyn crew, there is a significant anti-abortion streak among physicians. It is a distasteful procedure, and feels emotionally different than other procedures. Practice is always different in the real world.

Even amongst the older OB/gyns, I've found a significant anti-abortion streak. Some who aren't anti-abortion may still not be willing to actually perform the procedure themselves.

Based on my research and my experiences at my current school, I am a little pessimistic about how well schools discuss this surgical procedure. Can you please comment on whether or not your school discusses it/lectures on it, how much they do, etc. I've also received the response of "well they will cover it in your residency." Based on my research this is not necessarily true, and so I am inquiring at the medical school level, how many of you have had this in your curriculum and to what extent? Thanks!

Okay, to clarify:

"Abortions" are not a specific type of surgical procedure. Abortion is just a term that refers to a pregnancy that ends early. You can have "spontaneous abortions" (i.e. miscarriages), or "elective abortions"/"therapeutic abortions" (i.e. the procedure that Roe v. Wade was fought over).

An elective abortion is, essentially, nothing more than a D&C (dilatation and curettage) or a D&E (dilatation and evacuation). There is nothing special about an abortion, from a strictly surgical standpoint, except that it's being done electively, and not because there is some physiological need to end the pregnancy early.

There is no need to have a special "lecture" on D&C's or D&E's in the preclinical years, just like there is no need to have special lectures on appendectomies, cholecystectomies, or total knee replacements.

Finally, you will likely see a D&C or a D&E on your OB/gyn rotation. It may be done for medical purposes (i.e. if you keep the woman pregnant she may die), but the procedure itself is, for all intents and purposes, the same.

I think that all started d/t the "citing" of it being the second most common procedure or something... it really shouldn't be presented that way but more in a legal/ethical/moral issue of providing all options or how to refer for the procedure.

Maybe it's just me, but I think the line that people need to be "taught how to refer for an abortion" is just silly. Most women of reproductive age know, perfectly well, where to go to get an abortion in most places. And most women of reproductive age are well aware that abortion is a legal option. I've yet to have a patient look me in the eye and say, "What is this 'abortion' thing that you speak of?"

 

[guydudcl371]

Yes, sorry for my vague language use. Some of the rest of you are rather rude about how you respond to genuine inquiries for information. Why so uptight?

Also, I asked because I know for a fact that SOME medical schools do incorporate it into the curriculum. I sat in on one such lecture at the medical school at my undergraduate institution because my former advisor gives it every year. Her explanation for why it was important to be in the curriculum was because so many medical students come with inaccurate perspectives on elective pregnancy termination. This particular school had two hours on the topic, the first being a specific lecture on D&C, D&E and medication abortion. The second was information on global statistics and consequences of unsafe surgical abortion procedures.

Even amongst the older OB/gyns, I've found a significant anti-abortion streak. Some who aren't anti-abortion may still not be willing to actually perform the procedure themselves.



Okay, to clarify:

"Abortions" are not a specific type of surgical procedure. Abortion is just a term that refers to a pregnancy that ends early. You can have "spontaneous abortions" (i.e. miscarriages), or "elective abortions"/"therapeutic abortions" (i.e. the procedure that Roe v. Wade was fought over).

An elective abortion is, essentially, nothing more than a D&C (dilatation and curettage) or a D&E (dilatation and evacuation). There is nothing special about an abortion, from a strictly surgical standpoint, except that it's being done electively, and not because there is some physiological need to end the pregnancy early.

There is no need to have a special "lecture" on D&C's or D&E's in the preclinical years, just like there is no need to have special lectures on appendectomies, cholecystectomies, or total knee replacements.

Finally, you will likely see a D&C or a D&E on your OB/gyn rotation. It may be done for medical purposes (i.e. if you keep the woman pregnant she may die), but the procedure itself is, for all intents and purposes, the same.



Maybe it's just me, but I think the line that people need to be "taught how to refer for an abortion" is just silly. Most women of reproductive age know, perfectly well, where to go to get an abortion in most places. And most women of reproductive age are well aware that abortion is a legal option. I've yet to have a patient look me in the eye and say, "What is this 'abortion' thing that you speak of?"

 

[Rollo]

Sounds like your advisor was pushing her own agenda because those 2 hours sound like a complete waste of time.

If 2 hours on that topic, then why not 2 hours on appendectomies? Or 2 hours on tonsillectomies? Or 2 hours on wound debridement?

What she was doing was exploring social-public health arena behind this topic, which frankly belongs in a MPH curriculum rather than standard medical school curriculum.

Yes, sorry for my vague language use. Some of the rest of you are rather rude about how you respond to genuine inquiries for information. Why so uptight?

Also, I asked because I know for a fact that SOME medical schools do incorporate it into the curriculum. I sat in on one such lecture at the medical school at my undergraduate institution because my former advisor gives it every year. Her explanation for why it was important to be in the curriculum was because so many medical students come with inaccurate perspectives on elective pregnancy termination. This particular school had two hours on the topic, the first being a specific lecture on D&C, D&E and medication abortion. The second was information on global statistics and consequences of unsafe surgical abortion procedures.

 

[Goro]

Yes, ours does. I beleive that some states mandate it by law.

 

[AMEHigh]

Sounds like your advisor was pushing her own agenda because those 2 hours sound like a complete waste of time.

If 2 hours on that topic, then why not 2 hours on appendectomies? Or 2 hours on tonsillectomies? Or 2 hours on wound debridement?

What she was doing was exploring social-public health arena behind this topic, which frankly belongs in a MPH curriculum rather than standard medical school curriculum.

Why not 2 hours on other procedures? Maybe because they aren't controversial and usually don't involve personal ethical decisions.

It's pretty obvious that some people may biased and/or have mis-perceptions about abortion, therefore it would be beneficial to touch upon the procedure.

Not necessarily saying that abortion must be covered, but to question why abortion would be discussed seems ignorant.

 

[Rollo]

Why not 2 hours on other procedures? Maybe because they aren't controversial and usually don't involve personal ethical decisions.

It's pretty obvious that some people may biased and/or have mis-perceptions about abortion, therefore it would be beneficial to touch upon the procedure.

Not necessarily saying that abortion must be covered, but to question why abortion would be discussed seems ignorant.

I think most med students are well informed on what abortion is and what it isn't. Most aren't backwards grass-chewing rednecks who drink moonshine and don't know what a high school is.

Now, get off your high horse, princess.

 

[AMEHigh]

I think most med students are well informed on what abortion is and what it isn't. Most aren't backwards grass-chewing rednecks who drink moonshine and don't know what a high school is.

Now, get off your high horse, princess.

I didn't mean that med students don't know what an abortion is. There are facts and myths surrounding abortion that could be addressed that I don't think go along with other procedures. I'm pro-choice and pretty liberal, but there are several facts about abortion, reasons for abortions, and women who get abortions that I didn't know until I researched them on my own. Unfortunately there are med students (and doctors) that are closed minded and judgmental.

No need to get sarcastic and call me "princess"

 

[smq123]

I didn't mean that med students don't know what an abortion is. There are facts and myths surrounding abortion that could be addressed that I don't think go along with other procedures. I'm pro-choice and pretty liberal, but there are several facts about abortion, reasons for abortions, and women who get abortions that I didn't know until I researched them on my own. Unfortunately there are med students (and doctors) that are closed minded and judgmental.

No need to get sarcastic and call me "princess"

I still don't really see a need to subject an entire school to lectures on the topic of abortion. Would students be able to opt out without worrying that it will affect their grade? I have several friends in residency who would be unwilling or morally unable to sit through a school mandated lecture series on this topic. After my experiences in residency, I don't know if I could, either.

 

[Rollo]

I didn't mean that med students don't know what an abortion is. There are facts and myths surrounding abortion that could be addressed that I don't think go along with other procedures. I'm pro-choice and pretty liberal, but there are several facts about abortion, reasons for abortions, and women who get abortions that I didn't know until I researched them on my own. Unfortunately there are med students (and doctors) that are closed minded and judgmental.

No need to get sarcastic and call me "princess"

Those issues can be easily discussed with an Ob attending on the Ob clerkship if a student desires. Otherwise, abortion is an elective procedure that is done by specialist in Ob/Gyn. I don't believe that EVERY doctor needs to have an in depth lecture on this topic which will be, no doubt, given by a pro-choice lecturer thus introducing bias. With bias in place, I don't believe that an objective education can be obtained.

And medical school curriculum has no place for a subjective education. They belong with guest lecturers after-hours.

Besides, why would a non-Ob physician needs to learn in-depth about this topic? As stated earlier, just tell the patient, "You need to discuss this with your Ob". It's not a topic like vaginal delivery or myocardial infarction which every physician should be knowledgeable on, if not comfortable managing.

 

[st2205]

There are a lot of facts about breast augmentation, and reasons that women get it done, that I didn't know until I did a month of Plastics.

Personally I think that lecture would be a lot more fun, and well-attended, than what you are proposing.

There are a lot of facts about genital mutilation in Africa, reasons for women getting mutilated and for people doing it that people may not know until they are educated on it. Could do that, too. Could clear up a lot of misconceptions if an unbiased source, say a genital mutilator, were to give an educational discourse on the subject.

 

[NontradICUdoc]

While controversial, the procedure is still a medical one. It is one that as clinicians we should know about because our patients may have had one, may be contemplating one, or may have been too scared to get a legal one and would need to fix things.

Abortions are, as you can see, very touchy subjects. At my school we had 1 lecture on the kinds of abortions and tied it in into medical legal aspects of it. Including, but not limited to, pregnant minors who want one and do not require parental consent all the way to late term procedures.

In the end, we should not be imparting our own system of values and beliefs to our patients. We should be be caring for our patients and causing no harm regardless. We may not have to agree but we must be able to explain.

 

[guydudcl371]

I agree. It should be included as well. This affects several specialties and the information could be valuable to all sorts of future physicians.

There are a lot of facts about genital mutilation in Africa, reasons for women getting mutilated and for people doing it that people may not know until they are educated on it. Could do that, too. Could clear up a lot of misconceptions if an unbiased source, say a genital mutilator, were to give an educational discourse on the subject.

 

[guydudcl371]

Also, to clarify your misconceptions (see, you could benefit from this lecture). Elective pregnancy terminations are performed by people other than OB/GYNs. I know FM and IM docs who regularly perform these procedures as part of their private practice. I also similarly, do not understand your "specialist" comment, but I'll let it go.

Here is a good article you should read: Harris, Lisa. "Second Trimester Abortion Provision." I'm sure you can find it based on that information alone, I do not remember the journal off the top of my head. It is a great article that talks about the struggles even the most "pro-choice" physicians have with this procedure. And the numerous legal/medical conflicts that can arise.

Why would a non-OB need to know about this topic? Um....are you kidding me? The same reason any physician likes to know the surgical history of all of their patients. While a bit more controversial, I feel psych. physicians would also take a certain interest in what could be an incredibly emotional and complicated experience. But I dont know...maybe you think medical histories are pointless though, and if so, we are definitely just not on the same page.

Those issues can be easily discussed with an Ob attending on the Ob clerkship if a student desires. Otherwise, abortion is an elective procedure that is done by specialist in Ob/Gyn. I don't believe that EVERY doctor needs to have an in depth lecture on this topic which will be, no doubt, given by a pro-choice lecturer thus introducing bias. With bias in place, I don't believe that an objective education can be obtained.

And medical school curriculum has no place for a subjective education. They belong with guest lecturers after-hours.

Besides, why would a non-Ob physician needs to learn in-depth about this topic? As stated earlier, just tell the patient, "You need to discuss this with your Ob". It's not a topic like vaginal delivery or myocardial infarction which every physician should be knowledgeable on, if not comfortable managing.

 

[Daedra22]

For one, I do believe there is a misconception/lack of understanding about what an abortion is among medical students. I didn't really know the details of it until I attended a med students for choice meeting in first year. Plenty of other students in my class are still in the dark (or still buying the misinformation perpetuated by the religious club on campus).

I think that at a minimum there should be a discussion of abortion in the ethics portion of the curriculum. Regardless of how common people say it is, it is a very common procedure which is subject to a great deal of controversy. Basically everyone will encounter someone who has had or currently wants an abortion, so it would be good if they had some kind of perspective from an objective source going into it (or, as objective as possible). I know several classmates who would never refer a patient for an abortion/refuse to address it, and I've met physicians who try to push their beliefs on patients who have had abortions. I don't think either of these scenarios are good for patients.

 

[Daedra22]

Those issues can be easily discussed with an Ob attending on the Ob clerkship if a student desires. Otherwise, abortion is an elective procedure that is done by specialist in Ob/Gyn. I don't believe that EVERY doctor needs to have an in depth lecture on this topic which will be, no doubt, given by a pro-choice lecturer thus introducing bias. With bias in place, I don't believe that an objective education can be obtained.

And medical school curriculum has no place for a subjective education. They belong with guest lecturers after-hours.

Besides, why would a non-Ob physician needs to learn in-depth about this topic? As stated earlier, just tell the patient, "You need to discuss this with your Ob". It's not a topic like vaginal delivery or myocardial infarction which every physician should be knowledgeable on, if not comfortable managing.

Actually, primary care physicians can (and do) also perform abortions. Some of them do it exclusively, others just offer it to patients when they say they are seeking one. Further, abortions are not always elective procedures, and this is a significant problem. In some rural areas, women who need to have a fetus evacuated have an extremely hard time finding someone who knows how to do it - even if the fetus is no longer viable.

I'm a little confused by the problem with the lecture being given by a pro-choice person. An abortion is a medical procedure which is performed by a physician - would you suggest that a cardiothoracic surgeon speak on the topic instead? A neurosurgeon? Would that introduce less "bias" when discussing the mechanics of a medical procedure that most people have never witnessed?

I do agree that it shouldn't necessarily be included in the general/systems curriculum, but I truly do see a place for it in an ethics class. There is always bias when you're taking an ethics class, but that goes for everything - abortion does not have to be treated significantly different than the other ethical issues (refusal of care, parent/child consent, malpractice, etc.). Ignoring the problem of physician education on abortion only makes the shortage of providers - and the shortage of understanding - that much worse.

 

[AMEHigh]

There are a lot of facts about breast augmentation, and reasons that women get it done, that I didn't know until I did a month of Plastics.

Personally I think that lecture would be a lot more fun, and well-attended, than what you are proposing.

Just want to be clear that I wasn't proposing anything. I stated above that I have no real opinion on whether or not abortion should be a small portion of school curriculum.

Someone asked why other procedures aren't discussed in depth and I was responding to that. I'm just pointing out that I can indeed see why it might be topic that might be addressed because it comes with controversy and ethical considerations that aren't attached to many other medical procedures.

 

[AMEHigh]

Those issues can be easily discussed with an Ob attending on the Ob clerkship if a student desires. Otherwise, abortion is an elective procedure that is done by specialist in Ob/Gyn. I don't believe that EVERY doctor needs to have an in depth lecture on this topic which will be, no doubt, given by a pro-choice lecturer thus introducing bias. With bias in place, I don't believe that an objective education can be obtained.

And medical school curriculum has no place for a subjective education. They belong with guest lecturers after-hours.

Besides, why would a non-Ob physician needs to learn in-depth about this topic? As stated earlier, just tell the patient, "You need to discuss this with your Ob". It's not a topic like vaginal delivery or myocardial infarction which every physician should be knowledgeable on, if not comfortable managing.

Ob/gyns aren't the only ones that perform abortions.

Talk about abortion can be very objective. There are plenty of facts, not on biased sites, that discuss how many women have abortions, when they have abortions, laws surrounding abortions, different types of abortions, etc.

I don't think anyone is saying an indepth discussion is needed, but like I previously said abortion is a procedure unlike many others, so I can see why some education about the facts might be helpful.

 

[peppy]

My med school had a lecture during our pre-clinical years about abortion that talked about the different techniques of abortion and so forth. In our ethics class we did talk about the ethics of a doctor who does not agree with abortion referring for abortion and such.

If a school is going to have this issue as part of the curriculum, I think that the best way to handle it would be to have physicians from both sides of the abortion debate address the class. Since this is a subject that most people have strong opinions about, it is very difficult for any one individual to have a truly unbiased view of it.
For example, while an abortion advocate might consider it very important to talk about the dangers of illegal abortions, if I were involved in designing a course talking about abortion I'd want to make sure that any discussion of abortion ethics included a discussion of the complications of legal abortions
and how some abortion clinics do not engage in ethical practices (like this awesome guy; note that I am being extremely sarcastic there). I'd also include a discussion of the ethics of the future of prenatal testing when we may be able to screen out anyone with the slightest imperfection (or perceived imperfection) before birth.
Meanwhile, I bet there are a lot of Catholic doctors who would consider it vital to include a discussion on natural family planning so that you can properly educate your future patients on it. When you consider all the different potential opinions, angles, and agendas on this sort of controversial issue, actually, I don't blame schools for not wanting to get into it. Most schools have student clubs for both side of the abortion debate if a student really wants to deal with the topic.

 

[guydudcl371]

A) Clinics not engaging in ethical practices is not unique to abortion providers. With any specialty or any procedure there are some people who try and get around the law.
B) I think this topic is unique because it is one of the FEW medical procedures that have drastically different laws from state to state. I think that this is important for medical students to understand because it may have drastic implications on where they want to practice.
C) I am going to completely disagree as to the arguments being presented on the "many different sides" of presenting information. We are medical students/future doctors. We are here to gain the scientific and medical information necessary to do our jobs. This is like saying that "creationism" needs to be taught in biology classrooms to provide "both sides." The concept to me is nothing short of absurd. I do not sign up for biology courses to gain every perspective on how the world was created, I sign up for it to learn biology. Similarly, I do not go to medical school to learn every side to the abortion debate. I go to medical school to learn the medicine that is required to improve the health of my community. I think in an ethics class people need to be made aware of the fact that there are different opinions on this topic (as if you do not know that already), and how to be open and honest with patients about their legal and medically safe options. However, the extent to which non-medical perspectives need to be honored should not extend beyond that. Like I said, the few major schools that I have worked with do not present sides. You are presented with the medical facts of what the procedure is, physiologically how it works, and the like. It ends there, as it should.

My med school had a lecture during our pre-clinical years about abortion that talked about the different techniques of abortion and so forth. In our ethics class we did talk about the ethics of a doctor who does not agree with abortion referring for abortion and such.

If a school is going to have this issue as part of the curriculum, I think that the best way to handle it would be to have physicians from both sides of the abortion debate address the class. Since this is a subject that most people have strong opinions about, it is very difficult for any one individual to have a truly unbiased view of it.
For example, while an abortion advocate might consider it very important to talk about the dangers of illegal abortions, if I were involved in designing a course talking about abortion I'd want to make sure that any discussion of abortion ethics included a discussion of the complications of legal abortions
and how some abortion clinics do not engage in ethical practices (like this awesome guy; note that I am being extremely sarcastic there). I'd also include a discussion of the ethics of the future of prenatal testing when we may be able to screen out anyone with the slightest imperfection (or perceived imperfection) before birth.
Meanwhile, I bet there are a lot of Catholic doctors who would consider it vital to include a discussion on natural family planning so that you can properly educate your future patients on it. When you consider all the different potential opinions, angles, and agendas on this sort of controversial issue, actually, I don't blame schools for not wanting to get into it. Most schools have student clubs for both side of the abortion debate if a student really wants to deal with the topic.