Carla Lupi

Four Residents' Narratives on Abortion Training: A Residency Climate of Reflection, Support, and Mutual Respect.

We read Janet Singer’s article with a mix of gratitude and frustration. We were dismayed by how this commentary misrepresents the experiences and voices of obstetrics and gynecology residents across the country. Of the four narratives, three are written by men, although men make up less than 25% of obstetrics and gynecology residents nationally and at Brown University. Two of the four narratives are written by residents who opted out of abortion training, despite the fact that, at Brown (as at most residency programs), “a large majority” of residents participate in abortion training. Even more troubling: of the two narratives from residents who have chosen to receive abortion training, one says he or she will not be providing abortions after residency and the other remains noncommittal, stating only that his or her decisions about future practice will be shaped by “broader societal issues.” In a commentary that purports to represent a “diversity” of experiences and opinions among obstetrics and gynecology residents, not a single resident declares himself or herself committed to providing abortions after residency. Where are the voices of the steadfast, dedicated abortion providers? Why were they not asked to contribute to this commentary? We wholeheartedly agree with the authors that residency programs should provide a formal support system for discussing abortion and the deep personal responses it can evoke in providers. We also applaud their use of personal narrative—a powerful and underutilized format in the medical literature—to frame a rich discussion. However, even in an environment where “reasonable providers can disagree fundamentally and still work effectively with one another,” it seems that the voices of the staunch and steadfast abortion providers still make too many people uncomfortable. How will physicians help to shape the national dialogue if we do not engage with its full spectrum of voices?

Non-Directive Pregnancy Options Counseling: Online Instructional Module, Objective Structured Clinical Exam, and Rater and Standardized Patient Training Materials

Introduction Many patients receiving news of an unplanned pregnancy need not only a test result, but also the initiation of pregnancy options counseling. Thus, this online instructional module and objective structured clinical examination (OSCE) aim to provide foundational training for medical students in nondirective pregnancy options counseling. Methods To further the validity of a previously published OSCE, we reconsidered content, revised the checklist, and produced videos for rater training. We also developed a 30-minute preparatory module outlining a stepwise approach and providing a structured opportunity for values clarification. The 10-minute OSCE scenario involves a 24-year-old woman presenting to an urgent care center with persistent nausea who receives the diagnosis of an early, unplanned pregnancy. She responds to the news with shock and emotional silence, asking for guidance. We conducted the OSCE with 46 third-year medical students on the family medicine clerkship. Immediately after the OSCE, students completed a survey and self-assessment, followed by an individualized feedback session with a faculty member. Results In the self-assessment phase, students reflected on how successfully they utilized methods in the online module for handling emotional silence and presenting options. Student self-identified areas for improvement highlighted use of terminology and their response to difficult emotional encounters in the future. Discussion This online module and validated OSCE provide a valued opportunity for learners to practice nondirective pregnancy options counseling skills, including screening for intimate partner violence and reproductive coercion, engagement in self-assessment and receiving feedback, and engaging in personal values clarification.

Furthering the Validity of a Tool to Assess Simulated Pregnancy Options Counseling Skills.

OBJECTIVE: To further the validity of a tool to assess nondirective pregnancy options counseling skills. METHODS: Using a cross-sectional design, we explored four sources of construct validity evidence for an objective structured clinical examination for training and assessment of nondirective pregnancy options counseling: content, response process, internal structure, and relations to other variables. Content of the previously developed tool was enhanced through input from five family medicine educators. The objective structured clinical examination was implemented in a family medicine clerkship with third-year medical students from 2014 to 2015 using trained raters. Response process was addressed after a pilot round. Three new raters evaluated videotapes of 46 performances. Cronbachs alpha, intraclass correlation coefficients, and Spearmans rho were estimated with 95% confidence intervals. RESULTS: The content validity was affirmed. Cronbachs alpha was 0.71. According to Landis and Kochs criteria, all but two items unique to the clinical situation of pregnancy options counseling generated substantial to perfect agreement (0.62–1.00). Relations to other variables within the checklist were strong, ranging from 0.66 to 0.87. DISCUSSION: This tool for assessing pregnancy options counseling skills has excellent content and strong internal structure. Further work to improve the Global Rating Scale may be necessary for summative use.