Guiahi Maryam, Wilson Carrie, Claymore Emily, Simonson Kristin, Steinauer Jody
University of Colorado Anschutz Medical School, Department of Obstetrics and Gynecology, 12631 E. 17 Ave Aurora CO, 80045, USA.
University of California San Francisco, Kenneth J. Ryan Residency Training Program, San Francisco, CA, USA.
Contracept X. 2021 Jan 20;3:100054. doi: 10.1016/j.conx.2021.100054. eCollection 2021.
To evaluate if a values clarification workshop conducted at Catholic hospital training programs influenced obstetrics and gynecology residents' abortion attitudes.
Between 2018 and 2019, we provided a values clarification workshop focused on abortion care to 47 obstetrics and gynecology residents at five Catholic programs that do not provide abortion training. Participants received a pre-survey eliciting participant characteristics, and training experiences. On pre- and post-surveys, we asked participants to respond to abortion scenarios using a five-point Likert scales (1 = strongly disagree, 2 = somewhat disagree 3 = neither agree nor disagree, 4 = somewhat agree, 5 = strongly agree). We calculated descriptive frequencies, report the proportions agreeing with the statements (Likert ≥ 4) before and after the workshop, and compared median Likert responses using Wilcoxon matched pair test.
Forty-one participants (87%) completed both surveys. Twelve (29%) reported Catholic religion, six (15%) reported their personal reproductive care views were in line with their institution, and five (12%) selected their program based on its religious affiliation. Three (9%) had experience with first-trimester abortion for nonmedical reasons, and 20 (49%) planned to provide such care after graduation. Both before and after the workshop, all participants could think of a justification why a patient with an undesired pregnancy would choose abortion. After the workshop, more residents were able to think of a justifiable reason for the following abortion-related scenarios: (1) patients declining post-abortal contraception (51% vs. 78%, p < 0.001), (2) patients presenting for subsequent abortion (93% vs 95%, p = 0.01), and (3) patients presenting for second-trimester abortion (93% vs. 100%, p = 0.001). Many participants increased their Likert score when asked about acceptability of patients declining post-abortal contraception (n = 24, 59%), patients seeking a subsequent abortion (n = 15, 37%), and patients obtaining a second trimester abortion contraception (n = 11, 27%). Emotional and professional reactions to these scenarios were unchanged. After the workshop, residents were more likely to consider either financial inability (73% vs. 83%, p < 0.01) or disruption to career or education (71% vs 80%, p < 0.01) as morally acceptable reasons for requesting an abortion. For abortion for a patient who is financially unable to support their child, 12 (29%) increased their Likert score, 1 (2%) had a lower score and the remaining 28 (68%) had no change. For abortion for a patient whose career or education would be disrupted 13 (32%) increased their Likert score, one (2%) had a lower score and the remaining 27 (66%) had no change.
Our values clarification workshop resulted in more residents at Catholic training programs endorsing accepting attitudes toward abortion patient scenarios. Values clarification exercises can be a useful tool for residents to discuss abortion care, especially when training is insufficient.
Most obstetrics and gynecology residents at Catholic hospitals experience limited training in abortion care. A values clarification workshop conducted at such programs may result in increasing resident acceptance of abortion-related patient care scenarios and may help reduce abortion stigma.
评估在天主教医院培训项目中开展的价值观澄清研讨会是否会影响妇产科住院医师对堕胎的态度。
在2018年至2019年期间，我们为五个不提供堕胎培训的天主教项目中的47名妇产科住院医师提供了一次聚焦于堕胎护理的价值观澄清研讨会。参与者接受了一项预调查，以了解其个人特征和培训经历。在预调查和后调查中，我们要求参与者使用五点李克特量表（1 = 强烈反对，2 = 有些反对，3 = 既不同意也不反对，4 = 有些同意，5 = 强烈同意）对堕胎情景做出回应。我们计算了描述性频率，报告了研讨会前后同意这些陈述（李克特量表≥4）的比例，并使用威尔科克森配对检验比较了李克特回应的中位数。
41名参与者（87%）完成了两项调查。12人（29%）报告信仰天主教，6人（15%）报告其个人生殖护理观点与所在机构一致，5人（12%）根据项目的宗教背景选择了该项目。3人（9%）有非医学原因的孕早期堕胎经历，20人（49%）计划毕业后提供此类护理。在研讨会前后，所有参与者都能想出一个理由来说明意外怀孕的患者为何会选择堕胎。研讨会后，更多住院医师能够为以下与堕胎相关的情景想出合理理由：（1）患者拒绝堕胎后避孕（51%对78%，p < 0.001），（2）患者前来进行后续堕胎（93%对95%，p = 0.01），以及（3）患者前来进行孕中期堕胎（93%对100%，p = 0.001）。当被问及患者拒绝堕胎后避孕、寻求后续堕胎以及进行孕中期堕胎避孕的可接受性时，许多参与者提高了他们的李克特分数（分别为n = 24，59%；n = 15，37%；n = 11，27%）。对这些情景的情感和专业反应没有变化。研讨会后，住院医师更有可能将经济困难（73%对83%，p < 0.01）或对职业或教育的干扰（71%对80%，p < 0.01）视为请求堕胎的道德可接受理由。对于因经济无法抚养孩子而堕胎的情况，12人（29%）提高了李克特分数，1人（2%）分数降低，其余28人（68%）没有变化。对于因职业或教育会受到干扰而堕胎的情况，13人（32%）提高了李克特分数，1人（2%）分数降低，其余27人（66%）没有变化。
我们的价值观澄清研讨会使天主教培训项目中有更多住院医师认可对堕胎患者情景的接受态度。价值观澄清练习可以成为住院医师讨论堕胎护理的有用工具，尤其是在培训不足时。
大多数天主教医院的妇产科住院医师在堕胎护理方面接受的培训有限。在此类项目中开展的价值观澄清研讨会可能会提高住院医师对与堕胎相关的患者护理情景的接受度，并可能有助于减少对堕胎的污名化。
