Turning Rage Into Action: Abortion Care and Residency Training in the United States
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ABSTRACT:
SUBMITTER: Bauer C
PROVIDER: S-EPMC10286934 | biostudies-literature | 2023 Jun
REPOSITORIES: biostudies-literature
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Project description:BackgroundPoint-of-care ultrasound (POCUS) use has become ubiquitous in the field of anesthesiology. However, POCUS training curriculum in anesthesiology residencies vary widely. We performed a survey study to better understand the structure of existing POCUS training and identify barriers to instituting a POCUS curriculum for anesthesiology trainees.
| S-EPMC11863924 | biostudies-literature
Project description:Study objectivesTo understand the sleep medicine educational exposure among parent specialties of sleep medicine fellowships, we conducted an online survey among Accreditation Council of Graduate Medical Education-approved training programs.MethodsTarget respondents were program directors of family medicine, otolaryngology, psychiatry, neurology, pediatrics, and pulmonary and critical care training programs in the United States. The survey was based on the Sleep Education Survey, a peer-reviewed, published survey created by the American Academy of Neurology Sleep Section. The modified 18-question survey was emailed via Survey Monkey per published methods totaling 3 requests approximately 1 week apart in January 2017.ResultsA total of 1228 programs were contacted, and 479 responses were received for an overall response rate of 39%. Some programs in every specialty group offered a sleep medicine elective or a required rotation to trainees. Pulmonary and critical care and neurology reported the highest percentages of sleep medicine rotation as an option for housestaff (85.7% and 90.8%, respectively), and pulmonary and critical care had the highest portion of programs indicating a rotation requirement (75.4%). Teaching format was a mixture of didactic lectures, sleep center/laboratory exposure, and case reports, with lectures being the most common format. Didactics averaged 4.75 h/y. Few programs reported trainees subsequently pursuing sleep medicine fellowship (<10% produced a fellow over 5 years), and even fewer reported having a trainee who pursued grant funding for sleep-related research over 5 years.ConclusionsThere is wide variability and overall low exposure to sleep medicine education among United States "parent" Accreditation Council of Graduate Medical Education training programs whose medical boards offer sleep medicine certification.
| S-EPMC8020704 | biostudies-literature
Project description:AbstractAlthough the physiatric community increasingly embraces evidence-based medicine (EBM), the current state of EBM training for trainees in physiatry is unclear. The purposes of this article are to report the results of the Association of Academic Physiatrists' surveys of physiatry residency programs in the United States, to discuss the implications of their findings, and to better delineate the "baseline" upon which sound and clear recommendations for systematic EBM training can be made. The two Association of Academic Physiatrists surveys of US physiatry residency programs reveal that most survey respondents report that they include EBM training in their programs that covers the five recommended steps of EBM core competencies. However, although most respondents reported using traditional pedagogic methods of training such as journal club, very few reported that their EBM training used a structured and systematic approach. Future work is needed to support and facilitate physiatry residency programs interested in adopting structured EBM training curricula that include recommended EBM core competencies and the evaluation of their impact.
| S-EPMC9444380 | biostudies-literature
Project description:ObjectiveMedication abortions now make up the majority of abortions in the US, with new service delivery models such as telehealth; however, it is unclear how this may impact patient experiences. The objective of the study is to adapt and validate a person-centered abortion care (PCAC) scale for medication abortions that was developed in a global South context (Kenya) for use in the United States.Study designThis study includes medication abortion patients from a hospital-based clinic who had one of two modes of service delivery: (1) telemedicine with no physical exam or ultrasound; or (2) in-person with clinic-based exams and ultrasounds. We conducted a sequential approach to scale development including: (1) defining constructs and item generation; (2) expert reviews; (3) cognitive interviews (n = 12); (4) survey development and online survey data collection (N = 182, including 45 telemedicine patients and 137 in-person patients); and (5) psychometric analyses.ResultsExploratory factor analyses identified 29-items for the US-PCAC scale with three subscales: (1) Respect and Dignity (10 items), (2) Responsive and Supportive Care (nine items for the full scale, one additional mode-specific item each for in-person and telemedicine), and (3) Communication and Autonomy (10 items for the full scale, one additional item for telemedicine). The US-PCAC had high content, construct, and criterion validity. It also had high reliability, with a standardized alpha for the full 29-item US-PCAC scale of 0.95. The US-PCAC score was associated with overall satisfaction.ConclusionThis study found high validity and reliability of a newly-developed person-centered abortion care scale for use in the US. As medication abortion provision expands, this scale can be used in quality improvement efforts.ImplicationsThis study found high validity and reliability of a newly-developed person-centered care scale for use in the United States for in-person and telemedicine medication abortion.
| S-EPMC11849315 | biostudies-literature
Project description:BACKGROUND:There is a high level of interest in international experiences during United States (U.S.) ophthalmology residency training among both program directors and trainees. METHODS:An electronic invitation to a 26-question survey was sent to all 114 U.S. ophthalmology residency program directors. The invitation requested that the survey be completed by the one faculty member who was most involved in overseeing the international experiences for the residents. The survey consisted of multiple choice and Likert-type scale questions. The Mann-Whitney U test was used for analysis of demographic data and Friedman's test and Wilcoxon-Signed Rank test were used to analyze ranked responses. RESULTS:Responses were obtained from 70 faculty mentors representing unique programs, yielding a response rate of 61.4%. The majority of programs that responded (88.6%, n = 62) either offered international ophthalmology experiences for residents or supported residents finding their own experiences to go abroad. International experience participation rate among residents correlated with the number of years the experiences had been offered by the programs (p = 0.001). More than half of the respondents (55.0%, n = 33) felt that the residents benefited more than the hosts during these international experiences. Approximately half of the respondents (51.6%, n = 32) believed that additional training beyond what is covered in the standard curriculum to practice ophthalmology in the U.S. is necessary for practicing ophthalmology in an international setting. CONCLUSIONS:There is high interest and participation in international experiences within U.S. ophthalmology residency programs. This high participation warrants further investigation into the long-term impact of these international experiences and how U.S. residency programs can structure these experiences to maximize the benefits to both the residents and the international host communities.
| S-EPMC6879160 | biostudies-literature
Project description:BackgroundIn the United States, abortion access is often more limited for people who live in states with few abortion facilities and restrictive abortion legislation. Pregnant people seeking an abortion thus often travel to access care.MethodsWe calculated state-specific abortion rate (number of abortions per thousand women ages 15 to 44) and percentage of patients leaving for abortion care using CDC 2017 Abortion Surveillance data, the Guttmacher Institute's Abortion Provider Census and Pregnancies, Births and Abortions in the United States report, and US Census data. We categorized percent leaving by abortion policy landscape using the Guttmacher Institute's classification of state abortion laws, and by facility density (number of abortion facilities per million women ages 15 to 44), calculated using Census and Guttmacher data. We ran correlational tests between each of our variables (percent leaving, facility density, and policy environment), as well as between percent leaving and facility density within policy environment.FindingsIn 2017, an average of 8% of US patients left their state of residence for abortion care. Percent leaving varied widely by state: 74% left Wyoming, 57% left South Carolina, and 56% left Missouri, while 13 states had fewer than 4% of patients leaving. States with more restrictive laws averaged 12% of patients leaving, while states with middle ground or supportive laws averaged 10% and 3% leaving, respectively. Pairwise correlations between percent leaving, facility density, and policy score were all statistically significant, though correlations between percent leaving and facility density within policy environment were not.InterpretationMany patients travel across state lines for abortion care. While patients may leave for a range of reasons, restrictive state-level abortion policy and facility scarcity are associated with patients leaving their state of residence.FundingThis study was supported by a philanthropic foundation that makes grants anonymously.
| S-EPMC9903901 | biostudies-literature
Project description:BackgroundInternational medical graduates (IMGs) have significant exposure to clinical training in their home country, which provides opportunity for international comparison of training experiences. One relevant IMG population is Japanese physicians who have completed some training before entering residency programs in the United States and desire to improve medical education in Japan.ObjectiveWe examined Japanese IMGs' perceptions of the respective attributes of residency in the United States and Japan.MethodsIndividual semistructured interviews were conducted with 33 purposively sampled Japanese IMGs who had completed training. We used exploratory thematic analysis, iterative data collection, and thematic analyses with constant comparison.ResultsComments were organized into 3 categories: (1) attributes of US residency preferable to Japanese residency; (2) attributes of residency training with no clear preference for the US or Japanese systems; and (3) attributes of Japanese residency preferable to US residency. Within each category, we matched themes to residency program requirements or culture of medical training. Main themes include high regard for Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirements, with emphasis on efficient achievement of clinical competency through graded responsibility, contrasted with preference expressed for a Japanese training culture of increased professional commitment facilitated by a lack of work hour limits and development of broad clinician skills, including bedside procedures and radiology interpretation.ConclusionsJapanese training culture contrasts with a US model that is increasingly focused on work-life balance and associated compartmentalization of patient care. These findings enhance our understanding of the global medical education landscape and challenges to international standardization of training.
| S-EPMC6697274 | biostudies-literature
Project description:ObjectiveTo survey practice patterns designed to increase access to infertility care and evaluate the exposure of obstetrics and gynecology residents to infertility care for the underserved.DesignCross-sectional.SettingReproductive endocrinology and infertility (REI) practices associated with Accreditation Council for Graduate Medical Education-accredited obstetrics and gynecology residency training programs.PatientsNone.InterventionsQuestionnaire survey.Main outcome measuresPresence of clinical programs designed to improve access to REI care, resident involvement in such programs, and perceived barriers to expanding access to care.ResultsClinical initiatives to expand access included discounted infertility services (38%, n = 30), utilization of a low-cost in vitro fertilization (IVF) program (28%, n = 22), and utilization of a resident- and/or fellow-staffed clinic to provide infertility care (39%, n = 31). The most commonly discounted infertility services were IVF (73%, n = 22), clinical consultation (70%, n = 21), and intrauterine insemination (53%, n = 16). The provision of discounted prices was correlated with the increasing practice size (odds ratio [OR], 2.29; 95% confidence interval [CI], 1.23-4.24) and number of assisted reproductive technology cycles performed annually (OR, 3.65; 95% CI, 1.48-9.02). Academic REI practices (OR, 3.6; 95% CI, 0.98-13.25) were more likely to have a low-cost IVF program. Less than half of obstetrics and gynecology residency programs (39%, n = 31) had an associated REI clinic in which obstetrics and gynecology residents provide direct infertility care to the medically underserved. Frequency and services offered in trainee clinics varied. Multiple barriers to expanding access to care were reported.ConclusionsReproductive endocrinology and infertility practices associated with obstetrics and gynecology residency programs utilize a diverse range of approaches to provide infertility care to the underserved in the backdrop of considerable challenges and barriers, but significant gaps persist.
| S-EPMC9349242 | biostudies-literature
Project description:BackgroundInternal medicine residents are responsible for providing much of the direct care for palliative and terminally ill patients in teaching hospitals in the United Arab Emirates (UAE). To date, little systematic information is available on the prevalence of palliative care (PC) programs or faculty in UAE academic hospitals, or on the nature of PC education in internal medicine residency programs in the country.MethodsSemi-structured interviews were conducted with program directors of all 7 internal medicine residency programs in the UAE. Qualitative content analysis was conducted to identify recurring themes.ResultsAll program directors agreed that PC knowledge and skills are an essential component of training for internal medicine residents, but have had variable success in implementing the components. Three themes emerged, namely lack of structured PC training, perceptions of resident preparedness, and barriers to implementing a PC curriculum.ConclusionInternal medicine residency programs in the UAE currently lack structured, mandatory PC curricula and have limited opportunities for formal teaching and assessment of PC knowledge and skills. The planned development of comprehensive oncology and palliative care centers and ongoing curricular reform in teaching hospitals in the country will provide important opportunities to train a cadre of competent health professionals to provide high quality palliative and end-of-life care to UAE patients and their families.
| S-EPMC8973813 | biostudies-literature
Project description:ContextNational and state-level information about abortion incidence can help inform policies and programs intended to reduce levels of unintended pregnancy.MethodsIn 2015-2016, all U.S. facilities known or expected to have provided abortion services in 2013 or 2014 were surveyed. Data on the number of abortions were combined with population data to estimate national and state-level abortion rates. The number of abortion-providing facilities and changes since a similar 2011 survey were also assessed. The number and type of new abortion restrictions were examined in the states that had experienced the largest proportionate changes in clinics providing abortion services.ResultsIn 2014, an estimated 926,200 abortions were performed in the United States, 12% fewer than in 2011; the 2014 abortion rate was 14.6 abortions per 1,000 women aged 15-44, representing a 14% decline over this period. The number of clinics providing abortions declined 6% between 2011 and 2014, and declines were steepest in the Midwest (22%) and the South (13%). Early medication abortions accounted for 31% of nonhospital abortions, up from 24% in 2011. Most states that experienced the largest proportionate declines in the number of clinics providing abortions had enacted one or more new restrictions during the study period, but reductions were not always associated with declines in abortion incidence.ConclusionsThe relationship between abortion access, as measured by the number of clinics, and abortion rates is not straightforward. Further research is needed to understand the decline in abortion incidence.
| S-EPMC5487028 | biostudies-literature