A version of this piece can be found in the May 2016 Issue of Medical Forum WA.
There are many things that medical students have to know and a limited amount of time in which to learn them (especially now that most universities offer condensed four-year postgraduate degrees). The upshot of this is that there are always going to be topics that aren’t covered as well as they could be, and I’m okay with this so long as there is a sensible reason why. It makes sense, for example, that we learn the details of surgeries and cosmetic medicine after we have mastered the basics. But I don’t believe that medical and surgical abortion, a topic I learned almost nothing about in medical school, falls into this category.
A medical course that ignores abortion seems a tad irresponsible to me considering that one in three Australian women will have one in their lifetime. I can guarantee that abortion will have touched more lives than Fanconi Syndrome, a rare disease I spent a week learning about in Problem Based Learning. Doctors should at least have a basic understanding of how abortions are performed, where they can be done, their pros and cons and how to counsel people appropriately. Without this, a large chunk of the population may receive suboptimal care at a sensitive time of their life.
This is not a phenomenon limited to Western Australia, or even to Catholic universities. An article in the Student BMJ refers to abortion as ‘the forgotten rotation’. In her piece for the Sydney Morning Herald entitled ‘How Medical Schools are Failing to Educate Doctors in Abortion Care’, Jenna Price describes how many students get no instruction about abortions, and that this could contribute to doctors lacking the necessary understanding to provide this common procedure.
Like abortion, contraception is another common presenting complaint that medical students should be taught more about. I’m often surprised and disappointed by the number of people who are not aware of the wide variety of contraceptives available, or have little understanding of how they work. This is especially evident when it comes to Long Acting Reversible Contraceptives (LARCs); despite being highly effective and affordable, less than 7% of women in Australia use LARCs and discussions about them occur in only 15.4% of GP contraception consultations. This latter statistic is particularly concerning: with variable quality school-based sexual education, many people in our community will learn about contraceptive methods from medical professionals. Unless we as doctors have a comprehensive understanding about contraception (i.e. more than a one hour lecture at medical school), we are at risk of perpetuating misinformation and not providing out patient’s with the best care possible.
I can appreciate that creating medical courses is a difficult business, and that there are places where interested types can learn more (thank goodness for Sexual and Reproductive Health WA). However, because the majority of the community is having sex, shouldn’t we make sure that all future doctors are learning enough about it?
You are an amazing writer. I love reading your articles, they are full of life, laughter and always thought provoking.
This article, is of course a well written piece, however I find myself disagreeing, as I believe that there are bigger fish for the curriculum to fry.
With our degree being only four years, and rumours circulating that one WA university is considering shortening theirs to less than four years, every lecture slot must be carefully thought through as to what will deliver the best bang for their buck in their goal of delivering hospital ready interns to Australia, who will be knowledgeable, safe & thoughtful doctors.
Abortions are a specialised procedure that I don’t believe every medical student should be involved in during their training. What do I suggest the slots to be taken up by if they were to cull some of the ‘dud’ lectures? Anatomy, Microbiology and clinical pharmacology. Of course we do get teaching in these areas, however I believe that it falls short of what we need. I have felt for a while now that I am underprepared in these areas, and after speaking to other final year medical students have found that it not just me. These are fundamental areas that will assist junior doctors in their day to day role within the hospitals. Surely in terms of reducing mortality and morbidity across the population these areas should be given extra time and focus in medical school.
With regards to sexuality, and the diversity that exists in our society, I also feel underprepared from what I have been taught throughout my degree. I will be relying solely on my life skills to sensitively and appropriately approach situations with patients such as fluidity of sexuality, homosexuality, bisexuality, transgender ect.
I am not proposing that we ignore contraception and abortion, they are important topics, and as a society we should be aiming towards eliminating the practice of abortion by much better prevention strategies. Prevention is always better than cure in all areas of medicine. The cost of abortions in money terms to our health system are surely remarkably higher than the cost of any of the contraception options. Not to mention the human cost of post abortion psychological problems that stalk some women for many years.
I, like you am equally outraged by the figures you quoted regarding the information that the public is given by their GPs regarding contraceptive options. This is not what I have witnessed while on placement with various GPs while being a medical student, however I understand that we are more likely to be placed with GPs who have a sound knowledge base and are keen to teach both us and patients. I would love to see the study that the figures came from, and maybe it would be worth passing it onto RACGP and ACRRM?
(OK, time for me to stop procrastinating and get back to the books x)
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Thanks so much for taking the time to write a comment. I really appreciate it and I think you’ve raised some excellent points.
I definitely agree with you that we need to learn more about fundamental topics such as anatomy and pharmacology. However, the fact that we learn practically nothing about something one in three women will have I find unacceptable. Students wouldn’t necessarily have to learn about how a surgical abortion is undertaken (that can be left until after medical school). However, what all medical students should know is the difference between a medical and surgical abortion, where patients can access services, and also the information that we as doctors need to provide to patients (such as the opportunities for counselling and the pros of cons of abortion and continuing pregnancy). I have needed this knowledge as a junior doctor in the ED, and am so grateful that I learned it during my elective.
I think we are very fortunate that the GPs we do placements with are generally very knowledgeable about contraceptives. However, as both a patient and while completing by Doctors Certificate in Sexual Health I have seen that many GPs are still promoting the pill only.
The statistic about LARCs came from this 2014 MJA paper: https://www.mja.com.au/journal/2014/201/7/factors-predicting-uptake-long-acting-reversible-methods-contraception-among#10. They in turn reference a 2012 MJA article that analyses the BEACH data.
Thanks again, and best of luck with your study xxx
I couldn’t agree more. I’m not sure where you did your medical training, but it seems strange that in this so-called enlightened age, such a huge and important part of human interaction has been left out.
Every human is sexual, even if they’ve made the decision to be celibate. We’re put here to reproduce, and the sexual drive is as close to our core as eating and excreting.
Male and female doctors need to be educated about sex and sexuality (in all its forms), contraception, and abortion, and if someone has an issue talking about any of those subjects, they need to ask themselves, What is it about this I’m frightened of? And address their own issues with it.
It sounds as if the powers-that-be have omitted it from the curriculum because it’s contentious and upsetting for some, so they’ve decided to ignore the elephant in the room. Some of these topics and issues might be unsavoury and not what we’d discuss in polite company, but medical students are going to be doctors—they’ll have to face these more sensitive issues with their patients and they’ll need to be able to talk about them openly. They need to be aware of their own values and where they might clash with their patients, because to be a good doctor, they’ll need to treat their patients with care and acceptance and without judgement.
I write this as a former doctor, educated in the Catholic system like you, who found it difficult to talk about sex with my patients. I’m sure my patients felt my discomfort, and I wish I’d addressed my own issues with the subject much earlier than I did.
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Thank you so much for your comment Louise. Completely agree with everything you have written, and I’m always glad to hear there are other doctors out there who believe we can and should do better!
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