Calls to Action

Increasing Abortion Training in Canadian Medical Education

March 10, 2022 /

To add your signature to Sex[M]ed’s open letter, go to this link.

Dear College of Family Physicians of Canada (CFPC), the Medical Council of Canada (MCC), the Association of Faculties of Medicine of Canada (AFMC), and each medical school in Canada

One in three people1 with uteruses in Canada have an abortion within their lifetime (1). Abortions are not only a common, safe, and medically-necessary procedure for those wishing to terminate a pregnancy but also allows the right for people with utereses to govern their own bodies when historically this has not always been the case. 

In Canada, there are no legal restrictions on abortion, however accessing this procedure has previously been very difficult for many, especially those living in more rural and remote communities (2,3). One unforeseen result of the COVID-19 pandemic has been the increasing accessibility of medical abortion care via telemedicine. With the greater recognition of mifepristone, a drug that is given for medical abortions, safe medical abortions are now being offered at higher rates by family doctors within the comfort of a patients’ own home (4). This method ultimately prevents the need for patients to travel away from their communities, towards more urban centres (4). In fact, a study looking at patients’ experiences with telemedicine abortion showed that patients prefered this method as it was more private, comfortable, and convenient (5). 

Given this context, it is now more imperative than ever to train future phyisiancs on abortion care. While abortions fall under the scope of practice of both family physicians, and obstetricians and gynecologists, family physicians are crucial to ensuring accessibility to this service as many patients do not have access to specialists. Yet, a study from 2018 demonstrated that 79% of family medicine residents “reported never observing or assisting with an abortion during training” (6). Even more so, abortion is not even included as a training objective in the Canadian College of Family Physicians curriculum (6). In the same study, 80% of family medicine residents reported receiving less than 1 hour of formal education on abortion and 25% of residents were unaware of their legal obligation regarding abortions and referrals (6). This is a failure within the medical education system. 

In Canada, the majority of medical learners support abortion rights and wish to be trained on providing abortion (7). In a study looking at abortion within Canadian medical school curriciulums, it was found than there is on average “less than one hour of education on abortion, and over one-third have no dedicated curriculum” (8). However, it is important to highlight that when given the training, medical learners feel confident and more interested in providing abortions and referring for abortion services (7,8). 

The Medical Council of Canada (MCC) and the College of Family Physicians of Canada (CFPC) are the licensing bodies for undergraduate and postgraduate medical education. Both of these do not list abortion within the medical topics required during training (9). However, the MCC does cover abortion as a “complex ethical issue” (9). Medical students, residents, and family doctors have advocated for the inclusion of this important topic in their education, yet no actions seemed to have been taken (7,9). 

This is why Sex[M]ed calls on the College of Family Physicians of Canada, the Medical Council of Canada (MCC), the Association of Faculties of Medicine of Canada, and each medical school in Canada to:

  1. Include and standardize curricular objectives regarding medical and surgical abortion both in the undergraduate and postgraduate medical education curriculum. 
  1. Establish a working group that will plan and coordinate the implementation of abortion training within curriculums. 
  1. Ensure clinical exposure in abortion care to all medical trainees. 
  1. Remain accountable throughout the process by keeping the medical community informed on their actions. 

References:

  1. Norman W. V. Induced abortion in Canada 1974-2005: trends over the first generation with legal access. J Contraception [Internet]. 2012 Feb 01 [cited 2022 Feb 22]; 85(2):185-191. Available from: https://www.contraceptionjournal.org/article/S0010-7824(11)00424-0/fulltext 
  2. Access at a Glance: Abortion Services in Canada [Internet]. Action Canada for Sexual Health & Rights. 2019 Aug [cited 2022 Feb 22]. Available from: https://www.actioncanadashr.org/resources/factsheets-guidelines/2019-09-19-access-glance-abortion-services-canada
  3. Szklarski C. Canadian clinics and hospitals performing fewer abortions, data suggests. Global News: Canada. 2020 Jan 23 [cited 2022 Feb 22]. Available from: https://globalnews.ca/news/6451914/canada-abortions-clinics-data/
  4. Ennis M., Wahl K., Jeong D., Knight K., Renner R., Munro S., Dunn S., Guilbert E., Norman W.V. The perspective of Canadian health care professionals on abortion service during the COVID-19 pandemic. Fam Practice [Internet]. 2021 Aug 23 [cited 2022 Feb 22]; 38(1):i30-i36. Available from: https://academic.oup.com/fampra/article/38/Supplement_1/i30/6358430 
  5. Boydell N., Reynolds-Wright JJ., Cameron ST., Harden J. Women’s experiences of a telemedicine abortion service (up to 12 weeks) implemented during the coronavirus (COVID-19) pandemic: a qualitative evaluation. BJOG [Internet]. 2022 Jun 17 [cited 22 Feb 2022]; 128(11):1752-1761. Available from: https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.16813
  6. Myran D.T., Bardsley J., El Hindi T., Whitehead K. Abortion education in Canadian family medicine residency programs. BMC Med Educ [Internet]. 2018 Jun 1 [cited 2022 Feb 22]; 18(1):121. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5984743/
  7. Canadian Federal of Medical Students. Abortion Training in Canadian Medical Education [Internet]. CFMS; 2020 Sep 15 [cited 2022 Feb 22]. 6. Available from: https://www.cfms.org/files/meetings/agm-2020/resolutions/abortion_training/abortion_training_pp.pdf 
  8. Lew J., Waddington A. Therapeutic abortion in undergraduate medical school curricula: a systematic review of the literature. JOGC [Internet]. 2019 May [cited 2022 Feb 22]; 41(5):723. Available from: https://www.sciencedirect.com/science/article/abs/pii/S1701216319303974 
  9. Myran D., Bardsley J. Abortion remains absent from family medicine training in Canada. Can Fam Phys [Internet]. 2018 Aug [cited 2022 Feb 22]; 64618-619. Available from: https://www.cfp.ca/content/cfp/64/8/618.full.pdf 
ENGLISH
FRANCAIS ENGLISH