Abortion remains absent from family medicine training in Canada

Concerning state of abortion education

Among these challenges, one of the biggest threats to accessing abortion might be its striking absence from medical education. In 2016, concerned about the dearth of abortion training in our own medical education, we sent out a survey to 8 family medicine programs across the country to examine the amount and kind of education Canadian family medicine residents received on abortion. Our results were published in BMC Medical Education⁴ and paint a concerning picture of the state of abortion education across Canada.

Overall, 57% of residents who responded to our survey reported receiving no school-organized education on abortion during their training, and more than 80% received less than 1 hour of instruction. More than three-quarters of all residents in our survey reported graduating without having counseled a patient on or assisted with an abortion. Perhaps most concerning is that when we presented residents who were in training programs in Ontario with a case involving a woman seeking an elective abortion, 35.7% of residents incorrectly believed they had no legal or professional obligation to refer the patient to another provider if they themselves did not provide abortions.

Should we be surprised by these results? As Phillips and Swift pointed out in their 2016 opinion piece, “Therapeutic abortion counseling and provision. Are Canadian family physicians opting out?”⁵ the 2 licensing bodies in charge of undergraduate and postgraduate medical education for family physicians, the Medical Council of Canada (MCC) and the College of Family Physicians of Canada (CFPC), did not include abortion as a medical topic to be covered during training. The MCC covered abortion only in the context of its being a complex ethical issue under section 6.7.⁵

Training is well received

The good news is that the training residents do receive seems to work. In our survey, residents who did report counseling patients on or assisting with an abortion during training were twice as likely to feel competent to counsel a woman seeking an abortion. Furthermore, these residents were almost twice as likely to intend to provide medical abortions during their careers. Two additional findings point to the probable success of increasing education and exposure to abortion during residency. First, residents in our study held largely positive attitudes toward abortion and inclusion of abortion in their residency curricula. Second, the positive association between exposure to abortion and self-reported competency and intention to provide abortion was consistent among residents who were exposed to abortion during both core rotations and electives. We propose these findings suggest that including abortion education in postgraduate training would be well received by residents and could result in global increases in resident competency.

We believe that Canadian women seeking abortion care at a potentially vulnerable, stigmatized, and uncertain moment in their lives should be received by a competent and capable provider. If a woman walking into the office of a newly graduated family physician could easily encounter a provider who has never counseled or referred a woman for an abortion, this standard might not be met.

Future directions

In July 2015, mifepristone, a drug included on the World Health Organization list of essential medicines, and the international “gold standard” medication for medical abortion,¹¹ was approved in Canada.¹² Since that time ongoing advocacy for women’s reproductive rights has removed many of the initial logistic limitations that prevented its widespread use. The degree to which mifepristone will improve access to abortion in Canada will in part depend on whether new providers begin prescribing it. We urge departments of family medicine to offer formal education and opt-out clinical experiences related to abortion provision. The CFPC should consider adding abortion as a core topic to be covered during residency with an emphasis on competency to counsel on abortion and provide a medical abortion if willing. As physicians who were born the year of the Morgentaler decision, we feel like it is about time.