1. Strategies for Teaching Residents Pregnancy Options Counseling
Strategies for Teaching Residents Pregnancy Options Counseling *Data included may not be published without authors’ permission
Vanita Kumar, M.D.
Cara Herbitter, MPH, CPH
Alison Karasz, Ph.D
Marji Gold, M.D.
STFM National 2009

2. Objectives Participants will be able to:
Identify improved options counseling skills as an educational benefit of observing abortion care.
Describe 3 strategies for teaching pregnancy options counseling.

3. Session Outline Introductions Research Presentation Group Discussion
Wrap-Up and Feedback

4. ACGME Guidelines: Pregnancy Options Counseling
All residents must be trained to competency in…options counseling for unintended pregnancy.
REFERENCE:
ACGME Board. ACGME Program Requirements for Graduate Medical Education in Family Medicine. Accessed December,

5. Research Project Background & Rationale:
A general evaluation of routine abortion training to assess its educational outcomes
How does exposure to abortion care impact to residents’ reproductive health knowledge, attitudes, and skills?

6. Methods
Site: Aspiration abortion training at a high-volume family planning clinic.
Participants: 28 residents from 2 programs who completed abortion training*
Data Collection: 30 minute semi-structured interviews
Data Analysis: Transcripts analyzed in N-Vivo using thematic codes by 3 readers.
*includes those who opted out of hands-on training
Participant training: 7/05-11/06.
Interviews conducted: 6/06-3/07.

7. Results I. Contextualizing abortion II. Familiarity with procedure
3 Major themes emerged:
I. Contextualizing abortion
II. Familiarity with procedure
III. Impact on counseling skills

8. I. Contextualizing Abortion
It's interesting just to…see where everyone's coming from…makes you more aware of how you should not have assumptions about you know, people, their stories and their lives and the choices that they make.

9. I. Contextualizing Abortion
There's the story of a woman who just had a kid eight months ago…There's the woman with eight kids who just can't afford another...There's the woman who just got engaged and really would like to have had a child, but isn’t able to care for a child at this point…There's a million and one stories...none of them less engaging than the other.

10. II. Familiarity with procedure
There's so much buildup in the media…about this procedure. And when it really breaks down to it it's just ten minutes in the office.
The ease of the technique was more surprising than anything. I thought it would be a lot harder.

11. III. Impact on Counseling Skills
Before I didn't even know what to really tell my patients…I have learned what to say to my patients.You know when you read something and you see something it's totally different? So now I feel confident about what I'm saying rather than just reading it out of a book.

12. III. Impact on Counseling Skills
I want to be an effective counselor… I realized that a diagnosis of pregnancy has different meanings for different people…And not assuming, yes this pregnancy is something that you will all want to be happy about…Making that a priority for the rest of my career will be important.

13. Conclusion
Observing and/or participating in abortions is a valuable component of teaching residents pregnancy options counseling.

14. Group Discussion

15. How is pregnancy options counseling taught at your residency program?

16. Strategies/Resources Brainstorm Notes*
Didactic sessions, precepting
Americanadoptions.com
Abortion training with values clarification first
Planned Parenthood as a resource
Role-plays to practice
Didactics on repro choices (case-based format)
Pregnancy diagnosis form
Grand rounds about: values clarification, medication abortion vs. vacuum aspiration, etc.
Miscarriage management
* These are notes from the brainstorm during the presentation at STFM National 2009.

17. Challenges Brainstorm Notes*
Range of resident attitudes
Lack of abortion training
Tension with gyn program
Lack of training on adoption
* These are notes from the brainstorm during the presentation at STFM National 2009.

18. Group Discussion
How might you incorporate some of these strategies at your residency program?

19. Wrap-Up & Feedback Summarize Discussion Participant Questions
Participant Feedback