Effects of rotating at a Catholic hospital on medical student contraceptive objective structured clinical exam scores.

OBJECTIVES: To assess the impact of rotating at a Catholic vs non-religious institution for the inpatient portion of the third-year medical school obstetrics and gynecology clerkship on medical students' contraceptive competency. STUDY DESIGN: We assigned all medical students completing an obstetrics and gynecology clerkship during the 2017-2019 academic years to a Catholic or non-religious hospital for their inpatient teaching site, where they gain much of their contraceptive counseling experience. All students attended the same didactic sessions on contraception. We compared Objective Structured Clinical Exam (OSCE) scores and clerkship grades between the two clinical sites for all medical students. We set significance at p < 0.05. RESULTS: Of 281 medical students, the 127 (45.2%) who had rotated at a Catholic hospital performed lower on the data-gathering component of the contraceptive OSCE compared with students at the non-religious hospitals (Catholic: 62.4 ± 16.5 vs non-religious: 70.2 ± 15.9, p < 0.01) and had lower total contraceptive OSCE scores (Catholic: 69.4 ± 9.3 vs non-religious: 72.0 ± 8.5, p < 0.01). Clinical reasoning and communication scores for the contraceptive OSCE, data-gathering and total scores for other OSCE scenarios, overall OSCE and clerkship grades were not different. CONCLUSION: Rotation at a Catholic hospital, with fewer opportunities for medical students to experience contraceptive counseling, was associated with poorer data-gathering skills for gynecologic and sexual history. While contraceptive knowledge can be imparted didactically, hands-on history-taking and counseling experiences are needed to build competency in contraceptive care. IMPLICATIONS: There is a disparity in medical student family planning training at a Catholic hospital compared with non-religious hospitals. Contraceptive knowledge can be attained through didactic sessions, however additional hands-on practice is needed in gynecologic and sexual history taking if clinical opportunities are limited.

Exploring the Relationship between Abortion Provision and Providers' Personal Pregnancy and Parenting Experiences.

OBJECTIVE: Support for abortion rights is often portrayed as antithetical to valuing family. With abortion provider demographics trending toward younger and female physicians, we sought to understand the influence of personal experiences with parenthood and pregnancy on abortion provision. STUDY DESIGN: We surveyed U.S. physicians who have provided abortions, recruited from listservs and online groups. We calculated descriptive statistics using Stata SE. We used an inductive editing approach in coding free-text responses to questions about the emotional and experiential interplay between pregnancy, parenthood, and abortion provision, iteratively developing and refining a codebook, and ultimately identifying common themes. RESULTS: We collected qualitative data from 227 participants, the majority of whom were under age 40 (51.1%), female (93.0%), and OB/GYN physicians (75.8%). Qualitative analysis yielded four main themes. 1) Providers feel dissonance between the societal expectation of conflict between abortion provision and parenthood and their lived experiences. 2) Abortion providers' personal experiences with pregnancy and parenthood increase compassion and stimulate a stronger therapeutic bond. 3) Pregnant abortion providers are sometimes affected by the contrast between ending one pregnancy while advancing another; however, most providers are able to contextualize their patients' need for abortion separately from their feelings about their own pregnancies and children. 4) Providers feel their abortion work positively impacts their parenting. CONCLUSIONS: Our research demonstrates multiple effects of the interplay between abortion providers' personal reproductive experiences and their abortion provision, with a mutually positive overall relationship between parenting and abortion provision. Exploring this interaction could help to decrease stigma toward both abortion and abortion providers.