Change in Medical Students’ Attitudes Towards Family Planning After Pregnancy Counseling Panel Intervention

Abstract

Purpose: This study evaluates changes in medical students’ attitudes after a virtual pregnancy counseling panel intervention during pre-clinical medical education at Indiana University School of Medicine. We hypothesized that students would feel more comfortable counseling and treating patients for unplanned pregnancy after attending the virtual panel. Methods: Students participated in a “Pregnancy Options Panel” during their second-year course covering reproductive health. The panel consisted of five health professionals: two complex family planning fellowship-trained physicians, an obstetrician gynecologist that does not perform abortions, a pediatrician with adolescent health training, and a licensed clinical social worker with expertise in adoption. The panelists discussed appropriate care for patients diagnosed with unintended pregnancy. Two identical 19-item surveys consisting of multiple-choice and open-ended questions were electronically disseminated before and after the panel to assess students’ comfort and beliefs about family planning counseling and treatment. A $10 gift card incentive was given to all students who completed both surveys. The survey asked students to rank their comfort on a Likert scale from zero to five with zero being “not comfortable at all” and five being “very comfortable” after considering the following question: “Assuming you have the knowledge and training required, if a patient presents in her first trimester requesting an abortion of a normal pregnancy, indicate how comfortable you would feel a) referring the patient to an abortion provider, b) prescribing an ‘abortion pill,’ and c) performing a surgical abortion?” Students were asked the same question under the circumstance of a fetal anomaly incompatible with life or pregnancy posing a life-threatening risk to the mother. Students were furthermore asked to report how they believe a doctor should behave while counseling patients with unintended pregnancy (i.e., having a neutral status or disclosing their personal beliefs). Statistical analyses were performed using non-parametric statistics (Wilcoxon signed rank and McNemar’s test) to compare before and after responses of participants. Results: The second-year medical school class enrolled in the reproductive health course at Indiana University was composed of 366 students with 189 students (51.6%) identifying as female. Of the 366 students, 207 (60.5%) completed the survey before the panel and 181 (49.5%) completed the survey after the panel. The demographics of the students who completed both surveys before and after the panel (171 students, 46.7%) were as follows: 60.6% female, 37.6% male, 64.9% white, 2.9% black, 84.6% non-Hispanic, and 10.7% Hispanic. After the pregnancy panel, students reported increased comfort when contemplating referral to an abortion provider, prescribing a medication abortion, and performing a surgical abortion compared to prior to the panel (p<0.01, all comparisons). Students felt more comfortable referring a patient to an abortion provider (p<0.01), prescribing an abortion pill (p=0.02), and performing a surgical abortion (p=0.05) knowing the fetus had a condition incompatible with life or the mother’s life was at risk after the educational intervention. In addition, students were more likely to withhold disclosing their personal beliefs about abortion when counseling a pregnant patient (64.6% vs 42.3%, p<0.01), felt more capable of approaching the conversation about pregnancy options in a genuinely neutral manner (86.4% vs 71.6%, p<0.01), and had a significant increase in preparedness to counsel on continuing pregnancy, abortion, and adoption (p<0.01). There was no change in students’ beliefs when considering if it is ethical for a physician to advocate their position on abortion when counseling a patient, as 90.0% and 95.3% answered “No” before and after the panel, respectively (p=0.08). Conclusions: Our pregnancy options counseling panel effectively guided students through a common reproductive health scenario counseling a patient who has been diagnosed with unintended pregnancy. Second year preclinical medical students felt more prepared to counsel patients neutrally and without influence of their own beliefs after attending the educational event. Students additionally felt more comfortable referring to an abortion provider, prescribing a medical abortion, and performing a surgical abortion after the panel, emphasizing how exposure to family planning scenarios can influence future physicians’ comfort providing non-judgmental counseling and abortion care. Expert panels comprised of health professionals with diverse clinical and social perspectives on pregnancy options can serve as an instructional model for preparing medical students for their obstetric and gynecological clinical clerkship and improving pre-clinical medical curriculum on the often-neglected topic of abortion.