Abortion and Contraception in Medical School Curricula: A Survey of North American Family Medicine Clinical Curriculum Directors

Abstract

Phenomenon: Contraception and abortion care are commonly accessed health services, and physicians in training will encounter patients seeking this care. Curricula that teach contraception and abortion provision during medical school equip medical students with valuable skills and may influence their intention to provide these services during their careers. Family planning is nevertheless understood to be underrepresented in most medical curricula, including in North American medical schools where the laws on providing contraception and abortion have been consequentially changing. This study investigated the prevalence and predictors of contraception and abortion education in North American medical curricula in 2021.

Approach: We asked family medicine clerkship directors from Canada and the United States (US) to report about contraception and abortion teaching in their clinical curricula and their school’s whole curriculum and to report on associated factors. Survey questions were included in the 2021 Council of Academic Family Medicine’s Educational Research Alliance (CERA) survey of Family Medicine Clerkship Directors at accredited North American medical schools. Surveys were distributed between April 29 and May 28, 2021, to the 160 clerkship directors listed in the CERA organization database.

Findings: Seventy-eight directors responded to the survey (78/160, 48%). 47% of responding directors reported no contraception teaching in the family medicine clerkship. 81.7% of responding directors reported no abortion teaching in the clerkship, and 66% indicated abortion was not being taught in their school’s whole curriculum. Medical school region correlated with the presence of abortion curricula, and schools with high graduation rates into the family medicine specialty reported abortion teaching more frequently. Fewer than 40% of responding directors had received training on both contraception and abortion care themselves.

Insights: Contraception and abortion are both underrepresented in North American medical curricula. Formal abortion education may be absent from most family medicine clerkships and whole program curricula. To enhance family planning teaching in North American medical schools, we recommend that national curriculum resources be revised to include specific contraception and abortion learning objectives and for increased development and support for clinical curricula directors to universally include family planning teaching in whole program and family medicine clerkship curricula.

Keywords:

• Contraception
• Abortion
• Medical education
• Undergraduate medical education
• Family medicine clerkship

Author contributions

Laurel Witt, MD, MPhil: Conceptualization, Methodology, Formal Analysis, Investigation, Resources, Data Curation, Writing – Original Draft Preparation, Writing – Review & Editing, Supervision, Project Administration.

Sharon Wolff, MPH: Methodology, Software, Validation, Formal Analysis, Investigation, Resources, Writing – Review & Editing

Grace Shih, MD, MAS: Methodology, Resources, Data Curation, Writing – Review & Editing, Supervision

Valerie French, MD, MAS: Conceptualization, Methodology, Formal Analysis, Investigation, Resources, Data Curation, Writing – Original Draft Preparation, Writing – Review & Editing, Supervision, Project Administration

Disclosure statement

No potential conflict of interest was reported by the author(s).

Institutional review board statement

The American Academy of Family Physicians Institutional Review Board in April 2021 approved this study.

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Appendix Abortion and contraception in medical school curricula: a survey of North American family medicine clinical curriculum directors

Survey questions

1. During their preclinical years, do medical students at your school have formal education (e.g., dedicated lectures, flipped classrooms, small groups, or other) on the following topics:

   1. Contraception

   2. Abortion care

   3. Both

   4. Neither

   5. I don’t know

2. During the family medicine clerkship, do medical students at your school have formal education (e.g., dedicated lectures, flipped classrooms, small groups, or other) on the following topics:

   1. Contraception

   2. Abortion care

   3. Both

   4. Neither

   5. I don’t know

3. In your opinion, is it important to teach medical students about CONTRACEPTION?

   1. Yes, during the family medicine clerkship

   2. Yes, but not in the family medicine clerkship; rather, in other areas of the formal curriculum

   3. Yes, in both the family medicine clerkship and in other areas of the formal curriculum

   4. No, not important

4. In your opinion, is it important to teach medical students about ABORTION CARE?

   1. Yes, during the family medicine clerkship only

   2. Yes, but not in the family medicine clerkship; rather, in other areas of the formal curriculum

   3. Yes, in both the family medicine clerkship and in other areas of the formal curriculum

   4. No, not important

5. In your opinion, does the current teaching about CONTRACEPTION at your medical school meet the needs of the typical medical student?

   1. Yes, teaching is definitely adequate

   2. Yes, teaching is probably adequate

   3. No, teaching is probably NOT adequate

   4. No, teaching is definitely NOT adequate

   5. I don’t know

6. In your opinion, does the current teaching about ABORTION CARE at your medical school meet the needs of the typical medical student?

   1. Yes, teaching is definitely adequate

   2. Yes, teaching is probably adequate

   3. No, teaching is probably NOT adequate

   4. No, teaching is definitely NOT adequate

   5. I don’t know

7. In my own training (medical school and beyond), I received a formal curriculum on:

   1. Contraception only

   2. Abortion care only

   3. Both contraception and abortion care

   4. Neither

   5. I don’t remember

8. Is there a clinical educator available to teach CONTRACEPTION for your students?

   1. Yes, and they are easily accessible

   2. Yes, but they are challenging to access

   3. No clinical educator is available to teach contraception

9. Is there a clinical educator available to teach ABORTION CARE to your students?

   1. Yes, and they are easily accessible

   2. Yes, but they are challenging to access

   3. No clinical educator is available to teach abortion care

10. Do you feel that the organizational culture at the medical school is supportive of contraception and abortion care education?

    1. Yes, the school culture is supportive of both contraception and abortion care education

    2. Yes, but only contraception education

    3. Yes, but only abortion care education

    4. No, I do not feel the school culture is supportive of either topic