项目层面的堕胎培训与毕业生在生殖保健方面的准备及提供之间的关联。

Weidner Amanda, Stevens Nancy, Shih Grace

Association of Departments of Family Medicine, Leawood, KS, and University of Washington School of Medicine, Family Medicine Residency Network.

Department of Family Medicine, University of Washington, Seattle, WA.

Fam Med. 2019 Oct;51(9):750-755. doi: 10.22454/FamMed.2019.219951.

BACKGROUND AND OBJECTIVES

The role of training in the declining rate of family physicians' provision of women's reproductive health care is unclear. No requirements for abortion training exist, and curricula vary widely. This study assessed the impact of program-level abortion training availability on graduates' feelings of training adequacy and their postgraduate practice in reproductive health.

METHODS

We conducted secondary analysis of graduate survey data from 18 family medicine residency programs in the Northwest categorized by whether or not their program routinely offered abortion training (opt out or elective rotation). We used bivariate analyses and logistic regression to compare groups on preparation for training and current clinical practice of women's health procedures.

RESULTS

Six of 18 programs included in the study had routinely available abortion training for graduates (N=408). In bivariate analysis, these programs with routine abortion training had significantly more graduates who report feeling prepared to perform abortions (19% vs 10%; P=.01), but no difference in likelihood to provide abortion care postresidency compared to programs without routine abortion training. In adjusted analyses, graduates of programs with routine abortion training were significantly less likely to feel prepared for performing colposcopies (OR=0.45, 95% CI, 0.26-0.78; P<.01) and to actually perform them in practice (OR=0.32, 95% CI, 0.18-0.57; P<.001); all other differences are attenuated.

CONCLUSIONS

Program-level abortion training alone is not enough to overcome the systems- and individual-level barriers to increasing the numbers of trained family medicine residency graduates who provide abortion care and other reproductive care in practice. More must be done to create opportunities for family physicians interested in providing full-spectrum care in their postgraduate practices to be able to do so.

背景与目的

培训在家庭医生提供女性生殖健康护理比例下降中所起的作用尚不清楚。目前不存在堕胎培训要求，课程差异也很大。本研究评估了项目层面堕胎培训的可用性对毕业生培训充足感及其毕业后生殖健康实践的影响。

方法

我们对来自西北部18个家庭医学住院医师培训项目的毕业生调查数据进行了二次分析，这些项目根据其是否常规提供堕胎培训（退出或选修轮转）进行分类。我们使用双变量分析和逻辑回归来比较各组在女性健康程序培训准备情况和当前临床实践方面的差异。

结果

纳入研究的18个项目中有6个为毕业生常规提供堕胎培训（N = 408）。在双变量分析中，这些提供常规堕胎培训的项目中有更多毕业生报告感觉自己为进行堕胎做好了准备（19%对10%；P = 0.01），但与未提供常规堕胎培训的项目相比，毕业后提供堕胎护理的可能性没有差异。在调整分析中，接受常规堕胎培训项目的毕业生进行阴道镜检查的准备感显著降低（OR = 0.45，95% CI，0.26 - 0.78；P < 0.01）以及在实际操作中进行阴道镜检查的可能性显著降低（OR = 0.32，95% CI，0.18 - 0.57；P < 0.001）；所有其他差异均减弱。