Abortion training lacking for new family docs: study

Medical professor calls findings ‘a bit depressing’

When Susan Phillips did her family medicine residency in the ’70s, back when abortion was quasi-legal and three-doctor panels had to approve a woman’s request to terminate a pregnancy, all residents rotated through the abortion clinic. It was a routine part of training.

Today, with no legal restrictions on abortion, formal training appears to have gone underground.

Approximately one in three Canadian women will have an abortion in her lifetime.

Only doctors are licensed to provide abortions and family physicians perform the majority of procedures (76 per cent of the 86,824 reported abortions in 2014-15). But the pool of willing providers appears to be shrinking, and new doctors need to be trained to replace them, according to a new study that surveyed family medicine residents in Canada.

Eighty per cent of respondents received less than one hour of formal education on abortion. Similarly, 79 per cent had never observed or assisted in one.

“The majority of family medicine residents do not feel competent to provide abortion services,” the authors report in the journal BMC Medical Education.

For Phillips, a professor in family medicine and public health sciences at Queen’s University in Kingston, Ont., the findings are “a bit depressing.”

“We have 66 residents a year in family medicine and a number of them come to me saying, ‘I really want to become (an abortion) provider. Help me find somewhere to do the training.’ And they can’t get anywhere to do it,” she said.

Abortion has virtually disappeared from medical education, for a variety of reasons, Phillips said. More conservative and religious faculty members, a fear of public backlash, and pressure from “a very small but vocal group of students that believes abortion is killing and we shouldn’t be teaching it, we shouldn’t be condoning it and we shouldn’t be doing it.”

“The schools have perhaps capitulated, or seen that it is better to just be a bit quiet about this,” Phillips said.

Phillips also blames a new era of “accommodation — putting accommodation of the individual learner or teacher ahead of publicly held values and standards.”

Abortion was decriminalized in Canada in 1988 when the Supreme Court struck down what it ruled were overly restrictive laws. Still, barriers remain, including a lack of willing doctors in rural areas and some provinces, and “ongoing stigma toward abortion provision,” write the study authors.

For their study, the researchers developed an anonymous online survey. Eight medical schools outside Quebec and the Maritimes agreed to distribute it. In total, 436 family medicine residents responded.

Among the findings: only 21 per cent reported being exposed to one or more abortions during residency and 57 per cent said they received no formal education on abortion.

The authors said medical schools “should focus on normalizing” abortion training, while respecting the right to opt out.

“We believe that if you make abortion something that is part of the scope of family medicine training, while respecting people’s rights ... you remove a lot of the stigma and you make people more likely to get exposed,” said lead author and family physician Dr. Daniel Myran.

“These are essential — not ‘niche’ — competencies. We need to have the current generation of family physicians graduating and being, at a minimum, able to counsel and speak with women on this topic.”

Sixty-one per cent of the residents surveyed said they supported more abortion training.

‘THE MAJORITY OF FAMILY MEDICINE RESIDENTS DO NOT FEEL COMPETENT TO PROVIDE ABORTION SERVICES.

The survey was conducted before the abortion pill Mifegymiso was released last year. But the new drug can only be prescribed up to nine weeks.

“And it doesn’t detract from the clear need for an approach to offering abortion training as a core aspect of family medicine,” said Dr. Wendy Norman, a leading researcher in reproductive health at the University of British Columbia.

The College of Family Physicians of Canada doesn’t include abortion on its list of 99 priority topics.

But, in a statement to the Post, the body responsible for setting training standards said the survey has prompted it to look at “how to enhance abortion education in family medicine education programs in Canada.”

That could include mandatory lectures or training, with exemptions for conscientious objection.

The exact approach will be up to individual programs, the college said.

The University of Ottawa, whose residents were among those least likely to report exposure to formal abortion training, said it has taken steps as well, creating an hour-long session for all residents that covers how to counsel women, which services are available and how to prescribe the abortion pill.