UK medical students should be taught how to manage unwanted pregnancyBMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3800 (Published 07 September 2018) Cite this as: BMJ 2018;362:k3800
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Ms Burton addresses a very interesting and truthful argument regarding the weaknesses in current undergraduate medical education (1). As a medical student who has completed my Obstetrics and Gynaecology and General Practice placement, my experience with abortion services has been extremely slim. I believe this is the same for many of my peers. It concerns me that such a large proportion of my peers with one day work in these fields but may not be equipped with the skills needed for such important, and often life-changing discussions.
I believe that this is consequence of the change in organisational structure of abortion care within the NHS rather than efforts from universities and the medical education curriculum. In the UK, much abortion care is provided by independent specialised non-profit abortion clinics (2). Therefore, as medical students, it is now rare for us to have the opportunity to witness abortion-counselling and we are missing out on valuable learning opportunities. These opportunities would be useful not only to help with practical examinations in early pregnancy care but also for practical application of medical law and ethics in what would be very complex discussions.
Another problem that has arisen from outsourcing of abortion care is that trainees now have less exposure and access to services and less are training in this area as a result. (3) In 2016, only 1% of trainees completed the abortion training set out by the Royal College of Obstetrics and Gynaecologists (2). Again, because of lack of trainees, we as medical students suffer from lack of exposure to this part of our curriculum.
1) Burton, R. UK medical students should be taught how to manage unwanted pregnancy. BMJ Online [eLetter] 7 September 2018
2) Goldbeck-Wood S. Reforming abortion services in the UK: less hypocrisy, more acknowledgment of complexity. J Fam Reprod Health Care 2017;43:3-4
3) Abortion Care Study Day, 28 April 2008 – consensus statement. [accessed 22 December 2018]. Avaliable from: https://www.fsrh.org/documents/general-training-abortion-consensus-oct-2...
Competing interests: No competing interests
We are grateful to Ms Burton for her letter highlighting the failings of the current British undergraduate medical curriculum regarding teaching on how to manage an unwanted pregnancy.
As fellow medical students, we are concerned that many aspects of reproductive health are covered in so little detail in curricula, and that many students complete medical school without having had any professional exposure to reproductive health clinics, counselling on unwanted pregnancy or practical safeguarding.
One of the key reasons for the early integration of clinical exposure in modern medical teaching is to bridge the gap between the understanding of a clinical process and the presentation of actual patients. This allows the student to experience the complexities of these situations and prepares them for the day that they become the doctor responsible for such a patient.
With a combination of a curriculum which does not appear to lend weight to the importance of understanding and managing reproductive health and pregnancy, along with the amalgamation of sexual health clinics in the UK, leading to fewer opportunities for medical students to spend time shadowing, there is a risk that we are leaving new doctors with poor exposure to this important field and de-skilling the workforce.
It is important to remember that reproductive health clinics are significant centres for joined up care with local social services that support the most at risk and vulnerable people. These centres have long had a recognised role in safeguarding children, the practicalities of which are essential for new doctors to have experienced prior to beginning their practice. We feel that in many medical schools, a lack of practical exposure to this part of the curriculum poorly equips students for their future responsibilities in this area.
In a time where one in three women in the UK will have an abortion in their lifetime and where we are seeing an increase in resistant sexually transmitted infections, it seems bizarre that some students will complete their entire medical education without ever having seen a doctor counsel a patient on these topics.
1 Burton, R. UK medical students should be taught how to manage unwanted pregnancy. BMJ Online [eLetter] 7 September 2018. https://doi.org/10.1136/bmj.k3800
2 Royal College of Physicians. Developing services; Genitourinary medicine services; GUM services. 2018. http://www.rcpmedicalcare.org.uk/designing-services/specialties/genitour... [Accessed 16 September 2018].
3 NHS. Abortion overview. 2016. https://www.nhs.uk/conditions/abortion [Accessed 16 September 2018].
Competing interests: No competing interests