Training In Family Planning Research Articles

Comparison of the adolescent pregnancy outcomes between refugees and Turkish citizens.

Adolescent pregnant women have significant risk factors in terms of preterm birth, low birth weight, gestational and neonatal complications, and neonatal and infant deaths. In many countries, living as a refugee differs from living as a local citizen regarding education level, access to health services, and lifestyle. We aimed to compare the obstetric, perinatal, and neonatal outcomes of Turkish and refugee adolescent pregnant women admitted to a tertiary maternity center. The study was planned as a retrospective cross-sectional. We included adolescent pregnant women who delivered between February 2018 and August 2023. Adolescent pregnant women were divided into two groups, the Turkish group and the Syrian refugee group, and compared with each other. One thousand and fifty-one Turkish and 742 refugee adolescent pregnant women were included in the study. Adolescent pregnancy rates are higher in refugees than in the Turkish group (p < 0.001). We found that maternal age (p < 0.001), preeclampsia rates (p=0.029), gestational age at delivery (p < 0.001), and cesarean delivery rates (p=0.02) were lower in refugee adolescent pregnant women. Furthermore, we found that the anemia rates (p < 0.001) and low birth weight newborn rates (p = 0.011) were higher in refugee adolescent pregnant women. Enhancing the outcomes of adolescent pregnancies among refugees necessitates a heightened focus on education regarding sexual reproduction, increased prenatal follow-ups, and enhanced training in family planning.

Localization and removal of nonpalpable contraceptive implants: Experience from a teaching hospital in Ethiopia: Acase series.

To assess the outcome of women presenting with nonpalpable contraceptive implants to a referral center in Ethiopia. In addition, we discuss our approach and experience with localization and removal of nonpalpable contraceptive implants. We conducted a facility-based retrospective review of patients evaluated for a nonpalpable contraceptive implant between September 2019 and March 2022 at St. Paul's Hospital Millennium Medical College (SPHMMC) located in Addis Ababa, Ethiopia. SPHMMC is a tertiary teaching hospital with Obstetrics and Gynecology (OBGYN) residency as well as a Family Planning fellowship program. The present study was approved by the institutional review board of SPHMMC. Of the 68 patients reviewed, 48 were referred from other facilities. A total of 24 (35.3%) patients had at least one previous failed attempt at removal before referral. On ultrasound examination, 27 (40.3%) implants were found below the muscle fascia. Implant removal procedures were successfully done at the outpatient clinic in 65 (95.6%) patients including 40/40 (100%) suprafascial and 25/27 (92.6%) subfascial implants. Removal of subfascial implants was performed in the operating room in two patients. We failed to localize the device in one patient currently on follow-up. All removals were performed by OBGYNs with subspecialty training in family planning or current fellows supervised by subspecialists. No post-procedure complications have been documented. Our findings show that with meticulous evaluation and careful patient selection, localization and removal of nonpalpable implants in outpatient settings are successful. Initial ultrasonography minimizes delays and allows for same-day implant localization and removal.

Transparency around abortion training on obstetrics and gynecology residency program websites

ObjectivesThe availability of family planning and abortion training in residency is a concern for applicants, particularly following the overturning of Roe v Wade. We aimed to characterize public information on abortion training in obstetrics and gynecology residency programs in states with and without abortion bans. Study designWe abstracted residency program data using a publicly available database of obstetrics and gynecology residency programs. We performed a systematic internet search of each program’s website to identify information on abortion training. We defined states with abortion bans as those with total or near-total bans as of November 2022. Using Stata SE 16, we used Student t tests and Fisher exact tests to characterize differences between programs with public abortion training information and those without. ResultsOf 293 obstetrics and gynecology residency programs, 197 (67.2%) included online information regarding abortion training. Of 64 programs in states with abortion bans, 34 (53%) had public information regarding abortion training, compared to 163 (71%) of the 229 programs in states with legal abortion. Programs with publicly available abortion training information were more likely to be academic (49.8% vs 26%, p < 0.001) and have a higher percentage of female residents (86.6% vs 82.9%, p = 0.003). Programs in states with legal abortion were more likely to use words like “abortion” (36.2% vs 17.7%, p = 0.05). ConclusionsOnly two-thirds of obstetrics and gynecology residency programs publicize abortion training information. Almost half of all programs in states with abortion bans do not share this information, revealing a need for improved transparency to better inform residency applicant decision-making. ImplicationsDuring the 2022–2023 academic cycle, one-third of obstetrics and gynecology residency programs did not include information about family planning or abortion training online. In states with abortion bans, this number increased to almost one-half. These findings serve as a call to action for programs to clarify their commitment to abortion training.

Qualitative Analysis of Men's Involvement in Family Planning in The Philippines: An Ecological Assessment.

While family planning (FP) programs have the capacity to empower women, support gender equality, and reduce poverty, male involvement is an influential factor for the uptake of FP that has been lacking. In the past decade, there have been more progressive FP policies and growing attention on male involvement in FP in the Philippines, providing an opportunity to develop evidence-based interventions to better integrate men into FP services by approaching care delivery from a family-focused perspective. This paper sought to understand the current role of men in FP services and explore how to strengthen facilitators and overcome barriers to optimize men's involvement in FP in the Philippines. Using the Ecological Model for Health Promotion, this qualitative study used convenience sampling to collect data through in-depth interviews and focus group discussions at all levels of the ecosystem. All data were collected in the Albay area, with the exception of some policy data collected in Manila. Qualitative analysis was guided by content analysis. The final sample included 66 participants across the ecosystem. Two primary themes emerged: (1) Resources and health care systems structure impact on male involvement in FP and (2) Education and training that support male involvement in FP. The findings of our qualitative study suggest that while men in the Philippines and their ecosystems support men's FP involvement, the inconsistent health care systems and protocols are not yet reaching men with information and education they need to help them make informed FP decisions with their female partners.

Quality of family planning counseling: An evaluation in the context of premarital counseling services carried out within a provincial health directorate in Turkey.

Good quality family planning (FP) counseling meets the reproductive health needs of individuals and couples by supporting autonomous decision making. Survey-based assessments cannot catch nuances of FP counseling. This study aimed to evaluate the quality of FP counseling offered to couples in Turkiye (Kocaeli)- which is a primary example of a developing country. This study was conducted with health workers providing at least six months pre-marriage counseling services in five institutions. Data were obtained by information form, individual face-to-face interviews, and observation. Most of the 17 participants kindly welcomed, made simple explanations without making medical terms by making face-to-face and eye contact during the counseling. While some participants were able to provide information about contraception methods, other participants were not able to explain by showing an example of each method. This study's findings demonstrated that the quality of FP counseling in Turkiye is still sub-optimal. The time allocated to FP counseling was short and there was no given information about all methods of contraception. To increase the quality of FP counseling services offered by health providers, the existing FP guidelines and training packages must be reviewed.

The role of job aids in supporting task sharing family planning services to community pharmacists and patent proprietary medicine vendors in Kaduna and Lagos, Nigeria

BackgroundCPs and PPMVs are an important source of modern contraceptives in Nigeria, yet many lack the requisite knowledge and skills to capably provide these services. This skills gap might be addressed through targeted family planning (FP) training. This study measures family planning knowledge retention of CPs and PPMVs after receiving training in FP counseling and services in Kaduna and Lagos States, in Nigeria.MethodsIn a quasi-experimental longitudinal design without a comparison group, 559 CPs and PPMVs who were enrolled in the IntegratE project between January and December 2019, completed a self-administered questionnaire to assess their knowledge related to the provision of FP counseling, and injectable and implant contraceptive services at three points in time: 1) before the training; 2) immediately after the training; and 3) 9-months after the training in Kaduna and Lagos states, Nigeria. Adjusted multivariate logistic regression analysis was used to assess the effect of provider characteristics and receipt of job aids on FP knowledge retention 9 months after the training. 95% confidence intervals and p-values were used to assess statistical significance.ResultsMajority of study participants were females (60.3%) and between 30 and 49 years old (63.4%). The study revealed the importance of jobs aids as influence on knowledge retention. CPs and PPMVs who reported having the Balanced Counseling Strategy plus (BCS+) counseling cards, were more likely to retain knowledge (AOR: 2.92; 95% CI: 1.01–8.40, p-value = 0.05) at 9 months follow-up. Similarly, in terms of knowledge of injectable contraceptives, CPs and Tier 2 PPMVs who reported receiving the Medical Eligibility Criteria (MEC) Wheel were 2.1 times more likely to retain knowledge of injectable contraceptives 9-months later on (95% CI: 1.14–3.99, p-value = 0.02).ConclusionCommunity Pharmacists and Proprietary Medicine Vendors had good retention of family planning knowledge, especially when combined with job aids. Training and providing them with job aids on FP will therefore support task shifting and task sharing on family planning services provision in Nigeria.

Evaluation of family planning and abortion education in preclinical curriculum at a large midwestern medical school

ObjectiveEvaluate a Midwestern medical school's current pregnancy termination and family planning undergraduate medical curriculum (UMC) in accordance with Association of Professors of Gynecology and Obstetrics (APGO) guidelines. Assess 1) student interest 2) preparedness to counsel patients, and 3) preferred modality of instruction. Study designA survey assessed students about UMC. Course syllabus learning objectives and APGO educational guidelines were compared. ResultsThere were 309 responses total; six did not complete all survey questions and were excluded. Participants (n = 303) were primarily female (62%) and White (74%). Across all class levels, many (61%) students expected to learn about family planning and contraception in UMC. While most (84–88%) participants who completed the preclinical course with or without the clerkship felt prepared to counsel about common, non-controversial pharmacotherapies, only 20% of students felt prepared to counsel on abortion options, and 75% of students who had completed both the preclinical and OBGYN clerkship felt unprepared for abortion counseling Overall, 86% of all students surveyed believed that the medical school should enhance its reproductive health coverage in UMC. Traditional lectures, panels, and direct clinical exposure were the most popular instructional modalities. ConclusionWe identified potential gaps in UMC where students expressed high level of interest with low level of preparedness regarding abortion options counseling, even among senior students. Considering the high percentage of students expecting to learn about pregnancy termination and family planning in their UMC, this expectation is not being met. Students were open to a variety of modalities of instruction, indicating that several possible options exist for curricular integration. ImplicationsDespite evidence of need for training in family planning and abortion, few medical institutions have a standardized curriculum. Little available literature exists on curricula covering pregnancy options and contraception counseling, signifying a gap of knowledge and an opportunity to study how to integrate these important topics into UMC.

Work-arounds at faith-based obstetrics and gynecology residency programs to accomplish family planning training

To explore work-arounds at faith-based obstetrics and gynecology residency programs to accomplish family planning training. We invited educational stakeholders to participate in telephone interviews that elicited strategies for overcoming barriers to family planning training in religious settings. Eighteen out of 30 invited programs leaders participated. Work-arounds included reliance on non-contraceptive indications for contraception and permanent contraception provision, obtaining ethics committee approvals for service provision, and developing partnerships with offsite centers for training. Ob-gyn residency programs affiliated with religious hospitals utilize various work-arounds for family planning training and patient care. These findings may inform other programs that face similar barriers, secondary to institutional or governmental restrictions.

The role of advanced training in family planning and reproductive health in a low-income country; the experience of Ethiopia

Low- and middle-income countries continue to experience high fertility rates and unsafe abortion. Increased access to safe abortion services and family planning are cost-effective ways to reduce maternal morbidity and mortality. With a vision of improving the reproductive health workforce of the country, St. Paul's Hospital Millennium Medical College, in partnership with a university in the United States (U.S.), launched the first family planning and reproductive health fellowship program in Ethiopia. As the premier program in the country, the fellowship has introduced several new initiatives and skills to the existing reproductive health care training options. This program is a stirring example of successful collaboration between a U.S. university and a college in a low- or middle-income country. We have summarized the process of establishing the fellowship program as the first experience in Ethiopia and East Africa.

ВОЗРОЖДЕНИЕ ВНУТРИМАТОЧНОЙ КОНТРАЦЕПЦИИ

The topic of intrauterine contraception remains relevant for a very long time. The active search for optimal and safe means of intrauterine contraception began in the last century and is gaining more and more momentum in the modern world. The importance of this issue is due to the continuing need of the population of reproductive age to control childbearing, the popularization of data on various methods of birth control and the desire to use safe, effective, environmentally friendly methods of contraception. The presented topic touches on the aspects of family planning and pre-gravidar training, so it is not only a significant medical, but also a social problem. This leads to the constant need to study new mechanisms of systemic and local effects of intrauterine contraceptives on the female body. This article discusses the use of intrauterine contraceptives, the features of their impact on the endometrium, the reproductive potential of women, as well as the positive and negative aspects of their use. There are also groups of women for whom intrauterine contraception is the method of choice for birth control. The indications for the extraction of an intrauterine contraceptive are described. Among them, there are menstrual disorders of the type of hypermenorrhea lasting more than 6 months in the absence of the effect of the use of non-steroidal anti-inflammatory drugs, the end of the period of use of an intrauterine contraceptive, the desire and need of a woman, the desired pregnancy, expulsions, the postmenopausal period. Knowledge of all aspects of intrauterine contraception allows the obstetrician-gynecologist to correctly select a certain type of IUD, to explain to the woman all the risks of its use, to diagnose and correct complications in a timely manner.

The integration of abortion into obstetrician-gynecologists’ practice after comprehensive family planning resident training

ObjectivesTo explore the impacts of routine family planning and abortion training during residency on abortion practice between three and ten years after residency. Study DesignIn 2018, we surveyed 771 graduated obstetrician-gynecologists at least three years after residency about their current abortion practice. Respondents consented to join a prospective cohort as part of routine, post-rotation evaluation of the Kenneth J. Ryan Residency Training Program in Abortion and Family Planning. We matched and then de-identified post-rotation and post-residency surveys, and conducted bivariate and multivariable analyses. ResultsOf 463 respondents (60% response rate), 188 (41%) reported that they provide abortions (median of eight abortions per month) in their current practice. Eighty-eight (19%) do not provide abortions but would if not restricted by their practice. One hundred-fifty respondents (32%) reported abortions are out of their practice scope or that someone else in their practice provides abortions, and 38 (8%) do not desire to provide abortion care. Two hundred twenty-six (54%) reported practice or hospital group restrictions to abortion care. In multivariable analyses controlling for demographics, training, attitude and practice factors; geographic location, practice restrictions and logistical barriers, among other variables, correlated with abortion practice (practice in the West: odds ratio (OR) 2.3; 95% confidence interval [CI], 1.3-4.2; p = 0.01; logistical barriers: OR 0.3, CI 0.1 to 0.7, p = 0.01; and practice restrictions OR 0.5, CI 0.3 to 0.8, p = 0.01). ConclusionsNearly half of Ryan Program-trained obstetrician-gynecologists provide abortions. However, many barriers prevent the integration of abortion into practice. Healthcare providers and leaders should work to eliminate barriers to the provision of abortion care. ImplicationsRegardless of their intentions at the time of training, nearly half of Ryan Program-trained obstetrician-gynecologists provide abortions in practice, and another 19% would if not restricted by their practice. Integrated training is critical to abortion care, and efforts to overcome practice barriers could improve access to comprehensive health care.

Attitudes and Practices of Healthcare Professionals and Clinical Medical Students on Contraception: A Cross-Sectional Study in Cape Coast, Ghana.

Background Healthcare providers play a major role in the implementation of family planning policies. In Ghana, there has been a conscious effort to improve the knowledge of preservice and practicing health professionals on family planning. However, there have been concerns about the appropriateness of the attitudes and practices of these health cadres and, hence, their propensity to become barriers to the uptake of contraception in the general population. This study is aimed at assessing the attitudes and practices of healthcare workers and clinical-year medical students in contraceptives use, advocacy, and service provision. Methods A cross-sectional survey was conducted among health workers and clinical-year medical students from January 1 to June 30, 2018. Variables assessed included sexual activity status, previous and current contraceptive use, and satisfaction with contraceptive use among others. Data from 400 self-administered, structured questionnaires comprising close- and open-ended questions was entered in SPSS version 22 and analysed using same. The variables assessed were presented as means, frequencies, and percentages. Results About 58% of the respondents were sexually active. Half of the participants (50.2%) had used a form of contraception before, with condoms and other barrier methods being the most preferred (67.7%). However, only 18% of respondents were on a form of contraceptive at the time of the survey. Four out of five (82.6%) of the users of these contraceptives were satisfied with their past use. A little over half of the participants had discussed contraception with their partners. Over four-fifths of participants thought family planning was beneficial and were willing to encourage others to use a method of family planning. Majority (63.7%) of the participants had had formal training in family planning, but only 72 (18%) were actively involved in the provision of family planning services. Conclusions Although the attitudes of the health workers and trainees toward family planning were excellent generally, only a few were using a method of contraception at the time of the survey despite the fact that most of them were sexually active. There is a need to intensify communication on behaviour change towards contraception among health professionals and clinical-year medical students in order to strengthen their role as change agents in an effort to improve community uptake.

Twenty years of the Ryan Residency Training Program

This issue of Contraception includes an analysis of the Ryan Residency Training Program's 20 years promoting residency training in abortion and family planning in departments of obstetrics and gynecology throughout the United States and Canada.

Benefits of Routine, Opt-Out Abortion and Family Planning Training: 20 Years of the Ryan Program [02J

INTRODUCTION: To describe the effects of routine, opt-out abortion and family planning training on clinical exposure to uterine evacuation skills and intentions to provide abortion post-residency. METHODS: Data from the first 20 years of the Ryan Residency Training Program in Abortion and Family Planning (RP) were analyzed. Post-rotation surveys assessed residents’ experiences with abortion and intentions to provide abortions post-residency. The 2019 residency program director survey assessed benefits of training from the educators’ perspective. This study is considered exempt by the University of California San Francisco IRB. RESULTS: A total of 3,197 residents completed post-rotation surveys, for an overall response rate of 80.1%. During the rotation, residents, including those who partially participated, gained significant exposure to all methods of first- and second-trimester termination, with an average of 7.4 medication abortions, 11.8 manual uterine aspirations, 15.6 electric uterine aspirations and 5.8 second-trimester dilation and evacuations (D&amp;E). Residents reported feeling competent to do aspiration procedures independently up to an average of 12.8 weeks. Eighty-one percent of residents intend to do abortions for medical reasons after residency and sixty-one percent for all reasons. Ninety-six percent of directors reported increased clinical competence in abortion and contraception among all residents after the rotation, and 68% reported the RP training helped improve continuity of care for patients. CONCLUSION: Routine, opt-out training in abortion and family planning gives OB-GYN residents an opportunity to gain the clinical skills necessary to integrate abortion into their patient care after residency.

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

(Abstracted from Am J Obstet Gynecol 2019; DOI: 10.1016/j.ajog.2019.09.012) 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.

Family Planning Training at Catholic and Other Faith-Based Obstetrics and Gynecology Programs

PURPOSE: To evaluate family planning training at obstetrics and gynecology (OB-GYN) residency programs that primarily train at restrictive religious hospitals. BACKGROUND: Catholic and other religious hospitals face institutional family planning care restrictions, which are in conflict with the training requirements set forth by the Accreditation Council for Graduate Medical Education (ACGME). METHODS: We identified 30 ACGME accredited OB-GYN residency programs in which at least 70% of resident time is in restrictive, faith-based hospitals. We queried program representatives about training using an online survey and follow-up telephone interview. RESULTS: We had an 80% survey response rate. The majorities were program directors (83%), represented Catholic hospitals (75%), and completed telephone interviews (71%). Programs often relied on other sites to accomplish contraceptive (33%), sterilization (71%), and abortion (88%) training. All programs reported adequate training in reversible contraception. 58% reported inadequate sterilization training, most commonly in postpartum and hysteroscopic sterilizations. 67% reported inadequate abortion training, most commonly in D&E. Approximately half (54%) offered “routine” and 13% did not offer any abortion training. Eight programs (33%) received a total of ten Residency Review Committee citations due to insufficient family planning training, and most of these programs (71%) reported using these citations to gain institutional support for off-site training. DISCUSSION: While Catholic and other faith-based OB-GYN residency training programs have developed strategies in response to institutional restrictions, many report ongoing deficiencies and half remain noncompliant with abortion training requirements. Residency Review Committee citations, however, provided an opportunity for programs to leverage support for comprehensive training.

Family planning training at Catholic and other religious hospitals: a national survey

Catholic and other faith-based hospitals often restrict family planning service provision based on institutional doctrine. Approximately 11% of US accredited obstetrics and gynecology residency programs occur at such hospitals, creating a challenge to educational leaders who must ensure comprehensive family planning training. To evaluate and summarize family planning training at obstetrics and gynecology residency programs that are affiliated with Catholic and other faith-based hospitals that restrict reproductive services. Using an online database search and survey screening questions, we identified 30 of 278 accredited 2017-2018 programs in which at least 70% of resident time is spent in faith-based hospitals that restrict family planning services; Jewish programs were excluded. We queried program leaders between March 2017 and April 2018 about education and training using an online or paper survey, and asked them to report on training settings, provision of family planning services in such settings, and to rate aspects of training as "poor," "adequate," or "strong." We compared responses at Catholic versus other faith-based programs using Fisher exact tests, χ2 analyses, and median tests. Among 30 programs, 25 responded (83%); the majority of respondents were program directors (88%) and represented Catholic hospitals (76%). All reported adequate contraceptive training, with 47% of Catholic programs relying on off-site locations. The majority of Catholic sites (84%) relied on off-site sterilization training sites. Survey respondents from Catholic programs most commonly endorsed concerns for inadequate training in postpartum tubal ligations (53% of Catholic respondents versus 0% of other faith-based program respondents, P= .05). Approximately one-half (56%) offered abortion training as part of the curriculum ("routine"), 32% offered residents the opportunity to arrange training ("elective"), and 12% did not offer; the majority (84%) relied on off-site collaborations. Catholic sites were more likely than other religious programs to report poor abortion training (47% versus 0%, P= .04). Five Catholic programs (26% of Catholic programs) reported that their residents did not meet the graduate training requirement for completion of 20 dilation and curettage procedures. One-third reported a prior Residency Review Committee family planning citation(s), and many commented that these citations helped provide leverage for improved training. Although Catholic and other restrictive, faith-based obstetrics and gynecology residency training programs have developed strategies in response to institutional restrictions, many report ongoing deficiencies, and almost one-half reported they were noncompliant with abortion training requirements. Programs with deficient trainings may benefit from strategic approaches, including enhanced onsite education and collaborations with off-site facilities.

Impact of the Ryan Program on Resident Clinical Experience and Intentions to Include Abortion in Future Practice [6N

INTRODUCTION: This study assessed the impact of formal, opt-out family planning training on the clinical experience and intentions to include abortion care after residency among obstetrics and gynecology (ob-gyn) residents at currently funded Ryan Programs. METHODS: The Ryan Program (RP) has supported 99 US and Canadian ob-gyn residency programs to establish routine opt-out training in family planning and abortion. In this analysis we report on clinical experience and post-residency plans reported by residents after the family planning training at RPs in the last five years. Data were collected using Key Survey and descriptive analyses were conducted with STATA. This study was approved by the Institutional Review Board of the University of California San Francisco. RESULTS: Between September 2013 and 2018, 1,254 post-rotation surveys were completed by residents for a response rate of 70%. Residents did an average of 38 abortions on the rotation, including the 18% who opted out of portions of the training: 8 medication abortions, 11 manual uterine aspirations, 14 electric uterine aspirations, and 6 dilation and evacuations. When asked about their post-residency plans, 82% intend to do abortions for medical reasons and 59% for all reasons. CONCLUSION: Participation in a formal, opt-out family planning rotation resulted in significant clinical exposure to abortion procedures and plans to provide abortions after residency. Studies of ob-gyn residents between 1996 and 2014 have found that 30-40% planned to provide abortions after residency, suggesting that routine training is associated with plans to integrate abortion into obstetrics and gynecology practice.

Exploring How Targeted Regulations of Abortion Providers Affect Training and Practice Location [4A

INTRODUCTION: Targeted Regulations of Abortion Providers (TRAP laws) create variable abortion accessibility by state. We explored how TRAP laws affect where physicians choose to receive family planning training and practice. METHODS: We conducted semi-structured telephone interviews with 25 physicians who provide abortion care across the United States and asked them about their experiences providing care in the recent political climate. Using an iterative qualitative coding process, we detected themes around how political climate and state laws around abortion affected personal preference in location of family planning training and practice. RESULTS: State laws surrounding abortion provision often influenced where providers chose to receive family planning training and practice. Reasons for choosing to train in liberal areas with few TRAP laws include a higher patient load and more opportunity to gain procedural skills. Some providers chose to train in restrictive areas for experience in navigating state laws that limit abortion access. When choosing location of practice, those that chose a hostile environment cited a greater need for abortion providers in restrictive areas. Those who practice in liberal areas often had personal reasons, including safety concern for themselves and their families as well as a desire to work in an environment where state laws do not force providers into practicing substandard care. CONCLUSION: Understanding how state TRAP laws affect location of training and practice of abortion providers creates an opportunity to further analyze what training, supports, and resources can be provided to encourage physicians to practice in underserved areas with restrictive abortion policies.

Urology training in Germany: international comparison of educational concepts and satisfaction

The training of residents in urology is challenged by global trends in surgical education, increasing technological developments, subspecialization of the field and working hour regulations for physicians. Currently, there is no standardized curriculum in Europe and significant international differences exist in the education of residents. We aimed to comprehensively map the state of urological training in an international comparison. Aselective literature review was conducted using the following keywords: "urology, training, residents". Recent surveys have shown that urology training in Germany is subject to relatively few regulations on content, time and space when compared to other countries. Alack of astructured curriculum is considered as the main factor leading to dissatisfaction of the residents. Increasing work load, lack of surgical training and limited flexibility in family or research planning have been mentioned as barriers for successful training. Structured and validated competence assessments and not "minimum numbers of operations" may help improve surgical training. An objective nationwide examination at the end of residency may be useful for international benchmarking.