Resolution: S-20-6: RECOGNIZING THE NEED TO IMPROVE OSTEOPATHIC MEDICAL STUDENTS’ EXPOSURE AND ACCESS TO ABORTION EDUCATION

[Valerie Lile]

1  WHEREAS, in 2011, nearly half (45%) of all pregnancies in the United States were unintended,¹

2  WHEREAS, approximately 862,320 abortions were performed in 2017 in the US with medication
3  abortions accounting for 39%,^2,3

4  WHEREAS, an estimated one in three women in the US will seek induced abortion services by age
5  45^3,4 and 18% of pregnancies in 2017 ended in abortion,^2,3 making it a common medical procedure,

6  WHEREAS, standard-of-care, legal abortion is also one of the safest procedures in medicine³, such that
7  childbirth has maternal mortality rate that is 14 times that of legal abortion defined as that performed
8  by a skilled provider in a hygienic setting with the appropriate equipment,⁴

9  WHEREAS, women and adolescent girls who attempt self-induced or seek unskilled abortion are at
10  increased risk of severe injury and death, self-induced abortion accounts for 1 in 8 of approximately
11  600,000 maternal deaths worldwide, and approximately 70,000 women worldwide die each year as a
12  result of complications from illegal or unsafe abortions,^5,6,7

13  WHEREAS, induced abortion and relevant counseling is widely accepted as within a family physician’s
14  scope and training in such improves patient safety by promoting continuity of care,^8,9

15  WHEREAS, exposure to thorough abortion training improves a practitioner’s ability to provide
16  comprehensive, judgement-free patient education on options for pregnant women,^8,9

17  WHEREAS, in a survey of 122 medical schools in the US and Canada, one-third of medical school
18  students reported they had received no preclinical abortion training whatsoever,¹⁰

19  WHEREAS, while roughly half of medical schools in the US and Canada offer clinical third and fourth
20  year electives in which abortion training is offered, few are able to participate and therefore few
21  students ever get exposed to medical abortions in their clinical rotations,¹⁰ be it so

22  RESOLVED,
23 on Osteopathic College Accreditation (COCA) to incorporate adequate levels of medical and surgical
24 abortion-focused education within COM curricula of didactic years. This will include discussion of pre-
25 and post-operative care and counseling patients to address the lack of education and exposure to this

26  topic that affects hundreds of thousands of women worldwide^5,6,7. This will not affect physicians right
27  to refer but will address education on how to properly educate patients on this topic.

References

1. Finer, L. B., & Zolna, M. R. (2016). Declines in Unintended Pregnancy in the United States, 2008–2011. Obstetrical & Gynecological Survey, 71(7), 408–409. doi: 10.1097/ogx.0000000000000340

2. Jones, R. K., Witwer, E., & Jerman, J. (2019). Abortion Incidence and Service Availability in the United States, 2017. doi: 10.1363/2019.30760

3. Grimes, D. A., Benson, J., Singh, S., Romero, M., Ganatra, B., Okonofua, F. E., & Shah, I. H. (2006). Unsafe abortion: the preventable pandemic. The Lancet, 368(9550), 1908–1919. doi: 10.1016/s0140-6736(06)69481-6

4. Walsh, M. D. (2012). The Comparative Safety of Legal Induced Abortion and Childbirth in the United States. Obstetrics & Gynecology, 119(6), 1271. doi: 10.1097/aog.0b013e318258c806

5. Smith, J. P. (1998). Risky choices: The dangers of teens using self-induced abortion attempts. Journal of Pediatric Health Care, 12(3), 147–151. doi: 10.1016/s0891-5245(98)90245-0

6. Murray, S., & Wooltorton, E. (2005). Fatal sepsis after medical abortion with Mifeprex misoprostol. Reactions Weekly, (1062), 2. doi: 10.2165/00128415-200510620-00002

7. Sajadi-Ernazarova, K. R., & Martinez, C. L. (2019). Abortion Complications. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK430793/

8. Women’s Health Care Physicians. (2014). Retrieved from https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Abortion-Training-and-Education?IsMobileSet=false.

9. Kumar, V., Herbitter, C., Karasz, A., & Gold, M. (2010). Being in the Room: Reflections on Pregnancy Options Counseling During Abortion Training. Society of Teachers of Family Medicine, 42(1), 41–46. Retrieved from https://www.stfm.org/FamilyMedicine/Vol42Issue1/Kumar41

10. Espey, E., Ogburn, T., Chavez, A., Qualls, C., & Leyba, M. (2005). Abortion education in medical schools: A national survey. American Journal of Obstetrics and Gynecology, 192(2), 640–643. doi: 10.1016/j.ajog.2004.09.013

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Submitted by:

Tsaina Mahlen, OMS II – Pacific Northwest University of Health Sciences COM

Victoria Sefcsik, OMS I – Pacific Northwest University of Health Sciences COM

 

Action Taken:
Date:
Effective Time Period: Ongoing

[Monica Ketchum<br>PNWU]

I, Monica Ketchum, OMS II, President of PNWU SOMA, would like to offer a suggestion to amend the wording of line 24 to delete of didactic years. Someone spoke in opposition to this phrasing because that would mean these procedures could be tested on STEP 1. I also believe that while this is important information and should be included in all COM curricula, we should allow schools to choose exactly when they introduce this into the curriculum.

[Alexander Paiva, OMS-II<br>UIWSOM]

My name is Alexander Paiva, a rising OMS-III, and I oppose this resolution. As a medical student at a faith-based institution, having a universal requirement of COMs incorporating the education around abortion and the processes it entails would be a direct violation of religious institution exemptions as well as personal consciences. The topic of abortion is controversial, with people existing on both sides, and while I’m not naive to the fact of its availability, and agree that a physician should have competence in performing such a procedure, I do not think that it is a topic to be discussed during pre-clinical years of medical school, or even in the clinical years, because of its complexities and the details required. The details of other surgical procedures are not fully delved into during the pre-clinical years, but only the basics that are testable material. Only a select few future physicians have a desire to become an abortion provider, and mostly via the OB-Gyn pathway. The details surrounding the education of abortions and associated procedures should be a part of an OB-GYN residency program elective, which is still a part of the education training of physicians. That way a physician who wishes to pursue that career and training can still learn and be a competent physician to perform the abortive procedures, while simultaneously not requiring a universal requirement of all physicians to learn about it, especially when many physicians will not pursue that line of training or line of work. Thank you for your consideration.

[Daniel Nurse<br>University of the Incarnate Word]

I am a rising OMS-III and member of SOMA, and I oppose this resolution for the reasons stated above. Abortion-focused education should not be included in didactic years. It should remain an elective, as it is not only a specialized procedure, but also an ethically complex topic to which many institutions and students have moral objections.

[Alyson Randall<br>UIWSOM]

As a rising OMS-IV, I oppose this resolution and strongly urge a reconsideration toward more humanistic education to help patients suffering through pregnancy loss but not a medical & surgical abortion-focused education during the didactic years, as stated. The resolution fails to distinguish between spontaneous abortions, missed abortions, and elective abortions, all of which are subject to medical and surgical management. As noted above, these can appropriately be addressed at the OBGYN residency level. Instead, a didactic focus during medical school could be on a humanistic approach toward women and families experiencing pregnancy loss. As someone who has suffered through missed abortions and both undergone the medical and surgical management of these, it is my opinion that physicians are not well-trained enough to emotionally support patients experiencing these painful events. Additionally, there may be opportunities during OBGYN clerkship to discuss this topic with preceptors on an individual basis instead of making it an entire class experience. Thank you for considering my statement.

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