How Does OBGYN Resident Training at Restrictive Faith-based Institutions Impact Subsequent Provision of Reproductive Healthcare for Women? A Qualitative Analysis

Abstract

Local Mentor: Stephanie Teal, MD, MPH ASL Advisor: Nancy Hueppchen, MD, MSc PURPOSE: To understand how institutional restrictions at faith-based hospitals impact OBGYN trainees who subsequently provide care for women at secular institutions. BACKGROUND: OBGYN residency prepares trainees to become experts in women's healthcare. Trainees at faith-based hospitals may not receive adequate training in family planning services. METHODS: We set out to conduct semi-structured individual interviews with recent graduates from 10 faith-based hospitals who are generalists at secular institutions. Participants were queried about their experiences, perceived deficiencies, and current provision of family planning services. Three researchers independently coded transcripts using grounded theory; overarching themes and discrepancies were subsequently resolved. RESULTS: 15/31 graduates from 7 hospitals participated; we reached thematic saturation after analysis of these interviews. None of the participants cited a preference to match at their program based on restrictive family planning policies. All participants reported reproductive healthcare training deficiencies that were partially attenuated by didactic educational activities, variations in on-site restrictions, and off-site training. Participants expressed frustration about inadequate on-site training in postpartum tubal ligations; upon graduation they either avoided provision or required mentorship from partners to achieve competency. A few participants who sought off-site training now provide outpatient D&Cs and/or inpatient D&Es. All participants proposed that faith-based programs improve family planning training by providing routine, opt-out opportunities. DISCUSSION: OB-GYNs trained at faith-based institutions feel that religion-based policies negatively impact training experiences and the range of health services they subsequently can provide. Forming collaborations with off-site facilities, particularly for tubal ligation and outpatient uterine evacuation procedures, may improve the reproductive care these physicians provide to women.