title: Impact of partial participation in integrated family planning training on medical knowledge, patient communication and professionalism.
abstract: BACKGROUND
  Obstetrics and gynecology residency programs are required to provide access to abortion training, but residents can opt out of participating for religious or moral reasons. Quantitative data suggest that most residents who opt out of doing abortions participate and gain skills in other aspects of the family planning training. However, little is known about their experience and perspective.
  
  
  METHODS
  Between June 2010 and June 2011, we conducted semistructured interviews with current and former residents who opted out of some or all of the family planning training at ob-gyn residency programs affiliated with the Kenneth J. Ryan Residency Training Program in Abortion and Family Planning. Residents were either self-identified or were identified by their Ryan Program directors as having opted out of some training. The interviews were transcribed and coded using modified grounded theory.
  
  
  RESULTS
  Twenty-six physicians were interviewed by telephone. Interviewees were from geographically diverse programs (35% Midwest, 31% West, 19% South/Southeast and 15% North/Northeast). We identified four dominant themes about their experience: (a) skills valued in the family planning training, (b) improved patient-centered care, (c) changes in attitudes about abortion and (d) miscommunication as a source of negative feelings.
  
  
  CONCLUSIONS
  Respondents valued the ability to partially participate in the family planning training and identified specific aspects of their training which will impact future patient care. Many of the effects described in the interviews address core competencies in medical knowledge, patient care, communication and professionalism. We recommend that programs offer a spectrum of partial participation in family planning training to all residents, including residents who choose to opt out of doing some or all abortions.
  
  
  CONCLUSIONS
  Learners who morally object to abortion but participate in training in family planning and abortion, up to their level of comfort, gain clinical and professional skills. We recommend that trainers should offer a range of participation levels to maximize the educational opportunities for these learners.
authors.affiliation: The Bixby Center for Global Reproductive Health; and San Francisco General Hospital, Department of Obstetrics, Gynecology and Reproductive Sciences; University of California, San Francisco, CA, USA.
authors.forename: Jody E
authors.initials: JE
authors.lastname: Steinauer
authors.affiliation: The Bixby Center for Global Reproductive Health; and San Francisco General Hospital, Department of Obstetrics, Gynecology and Reproductive Sciences; University of California, San Francisco, CA, USA. Electronic address: turkj@obgyn.ucsf.edu.
authors.forename: Jema K
authors.initials: JK
authors.lastname: Turk
authors.affiliation: The Bixby Center for Global Reproductive Health; and San Francisco General Hospital, Department of Obstetrics, Gynecology and Reproductive Sciences; University of California, San Francisco, CA, USA.
authors.forename: Felisa
authors.initials: F
authors.lastname: Preskill
authors.affiliation: Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: Sangita
authors.initials: S
authors.lastname: Devaskar
authors.affiliation: Advancing New Standards in Reproductive Health (ANSIRH), The Bixby Center for Global Reproductive Health; Department of Obstetrics, Gynecology and Reproductive Sciences; University of California, San Francisco, CA, USA.
authors.forename: Lori
authors.initials: L
authors.lastname: Freedman
authors.affiliation: The Bixby Center for Global Reproductive Health; and San Francisco General Hospital, Department of Obstetrics, Gynecology and Reproductive Sciences; University of California, San Francisco, CA, USA.
authors.forename: Uta
authors.initials: U
authors.lastname: Landy
mesh_terms: D000028:Abortion, Induced / Q000193:education / Q000523:psychology; D000328:Adult; D001291:Attitude of Health Personnel; D003142:Communication; D005193:Family Planning Services / Q000193:education*; D005260:Female; D006801:Humans; D008297:Male; D011361:Professional Competence
keywords: Family planning; Partial participation; Professionalism; Residency education