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Contraception Corner

Reproductive Health Care: Teaching Future Providers

Cathy J. Lazarus, MD; Shana Brown, MPH

Many women rely on their physicians for accurate information about reproductive health care. But are these providers being trained to deliver the goods?

Women often report that physicians are their primary source of health-related information. Providers are therefore in a unique position to help patients select the contraceptive method that best meets their needs.1 Women are more likely to be satisfied with their chosen contraceptive method when they discuss all of their options with their physicians, and satisfaction is a strong predictor of correct and consistent use.2-5

However, many physicians do not routinely discuss reproductive health issues during patient visits.6 Indeed, they may never obtain a sexual history—a critical step in helping patients determine their reproductive health goals and contraceptive choices.7 This is a significant concern because patients who do not receive appropriate information from their physicians about contraception tend to use a less effective method or no contraception at all.8

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CURRENT TRAINING PICTURE


–Lack of training” is the main reason physicians give for omitting the sexual history and other reproductive health concerns during visits.9 Accordingly, physicians are more likely to raise these issues when they are specifically trained in how to do so.10,11 To be most effective, such training should be included in the curricula at all US medical schools and advanced practice programs.12

However, comprehensive reproductive health training is neglected in many curricula.13-15 Reasons include a heavy burden of existing course requirements, a lack of qualified faculty and appropriate sites, and the belief that other subjects are more important.16,17 These are formidable barriers, but they are not insurmountable.

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A BETTER APPROACH

It will take novel strategies, an authentically collaborative approach, and time to effect the appropriate curricula changes for reproductive health education. As rigid curricula are hard to sustain and replicate, content must be adaptable to meet the educational needs of different institutions. And when national organizations guide and support these efforts, program sustainability and generalizability are greatly enhanced.18

These tenets form the framework of the Curricula Organizer for Reproductive Health Education (CORE), a new educational tool from the Association of Reproductive Health Professionals (ARHP).

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CONCLUSION

Through CORE, ARHP is helping to improve the way reproductive health information is taught to future providers. Other national organizations offer student competencies and frameworks for developing curricula that address reproductive health topics.19,20 These are critical elements in the movement to strengthen clinical education in reproductive health. Today, CORE provides the adaptable, evidence-based content that can help make these recommendations a reality.

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Cathy J. Lazarus, MD, is senior associate dean, Student Affairs and Medical Education, Chicago Medical School, Rosalind Franklin University of Medicine and Science, Illinois. Shana Brown, MPH, is program manager, Association of Reproductive Health Professionals, Washington, DC.

References

1. Shulman LP. New recommendations for the periodic well-woman visit: impact on counseling. Contraception. 2006;73(4):319-324.
2. Halpern V, Grimes DA, Lopez L, Gallo MF. Strategies to improve adherence and acceptability of hormonal methods for contraception. Cochrane Database Syst Rev. 2006;(1):CD004317.
3. Lamvu G, Steiner MJ, Condon S, Hartmann K. Consistency between most important reasons for using contraception and current method used: the influence of health care providers. Contraception. 2006;73(4):399-403.
4. Freeman S. Nondaily hormonal contraception: considerations in contraceptive choice and patient counseling. J Am Acad Nurse Pract. 2004;16(6):226-238.
5. Weisman CS, Maccannon DS, Henderson JT, Shortridge E, Orso CL. Contraceptive counseling in managed care: preventing unintended pregnancy in adults. Womens Health Issues. 2002;12(2):79-95.
6. Salganicoff A, Ranji UR, Wyn R. Women and Health Care: A National Profile. Key Findings from the Kaiser Womenês Health Survey. Menlo Park, Calif: Kaiser Family Foundation; 2005:36. Available at: http://www.kff.org/womenshealth/upload/Women-and-Health-Care-A-National-Profile-Key-Findings-from-the-Kaiser-Women-s-Health-Survey.pdf. Accessed December 19, 2006.
7. Ferrara E, Pugnaire MP, Jonassen JA, et al. Sexual health innovations in undergraduate medical education. Int J Impot Res. 2003;15(suppl 5):S46-S50.
8. Isaacs JN, Creinin MD. Miscommunication between healthcare providers and patients may result in unplanned pregnancies small star, filled. Contraception. 2003;68(5):373-376.
9. Nusbaum MR, Hamilton CD. The proactive sexual health history. Am Fam Physician. 2002;66(9): 1705-1712.
10. Tsimtsiou Z, Hatzimouratidis K, Nakopoulou E, Kyrana E, Salpigidis G, Hatzichristou D. Predictors of physiciansê involvement in addressing sexual health issues. J Sex Med. 2006;3(4):583-588.
11. Magnan MA, Reynolds KE, Galvin EA. Barriers to addressing patient sexuality in nursing practice. Medsurg Nurs. 2005;14(5):282-289.
12. Reproductive Health Online (Reproline) Web site. Strengthening preservice education: a systematic approach and lessons learned. 2003. JHPIEGO TrainerNews. Available at: http://www.reproline.jhu.edu/english/6read/6issues/6jtn/v6/tn0302trng.htm. Accessed December 19, 2006.
13. Espey E, Ogburn T, Chavez A, Qualls C, Leyba M. Abortion education in medical schools: a national survey. Am J Obstet Gynecol. 2005;192(2):640-643.
14. Foster AM, Polis C, Allee MK, Simmonds K, Zurek M, Brown A. Abortion education in nurse practitioner, physician assistant and certified nurse-midwifery programs: a national survey. Contraception. 2006;73(4):408-414.
15. Solursh DS, Ernst JL, Lewis RW, et al. The human sexuality education of physicians in North American medical schools. Int J Impot Res. 2003;15(suppl 5):S41-S45.
16. Weiss LB, Lee S, Levison SP. Barriers and solutions to implementing a new curriculum: lessons from the womenês health education program at MCP Hahnemann School of Medicine. J Womens Health Gend Based Med. 2000;9(2):153-160.
17. Bennett I, Aguirre AC, Burg J, et al. Initiating abortion training in residency programs: issues and obstacles. Fam Med. 2006;38(5):330-335.
18. Wartman S, Davis A, Wilson M, Kahn N, Sherwood R, Nowalk A. Curricular change: recommendations from a national perspective. Acad Med. 2001;76(suppl 4):S140-S145.
19. Womenês Health Care Competencies for Medical Students: Taking Steps to Include Sex and Gender Differences in the Curriculum. Association of Professors of Gynecology and Obstetrics Web site. Crofton, Md: 2005;1-106. Available at: http://www.apgo.org/binary/1959_APGO.pdf. Accessed December 19, 2006.
20. Nurse Practitioner Primary Care Competencies in Specialty Areas: Adult, Family, Gerontological, Pediatric, and Womenês Health. The National Organization of Nurse Practitioner Faculties Web site. Rockville, Md: 2002;1-84. Available at: http://www.nonpf.com/finalaug 2002.pdf. Accessed December 19, 2006.

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