August 25, 2017

By Rachel Burch



Testing Medical Student Knowledge

A recent study published in the Journal of Frontiers in Medicine highlights how medical students and physicians lack adequate knowledge when it comes to fertility awareness based methods (FABMs) for family planning. Because most medical schools don’t include a specified curriculum and/or advanced discussion about fertility awareness, medical students are un- or under-aware of FABMs and have little to no clinical opportunity to expand their knowledge on the subject.


Researchers designed a study that would analyze third-year medical students’ in two areas – their basic knowledge of FABMs and their level of confidence in utilizing FABM knowledge in patient care. The study sought ways to deliver focused education on the subject to see if knowledge and confidence ultimately improved.

Third-year medical students were given a 10-question assessment at the start of their OB-GYN rotation and the opportunity to attend two lectures about FABMs during their rotation. The first lecture reviewed normal reproductive physiology, the science behind FABMs, and realistic applications of FABMs in family planning. The second lecture focused on the use of FABM charting in the diagnosis and treatment of gynecological conditions, such as endometriosis and infertility. Students were also provided access to additional online resources with more detailed FABM information. At the completion of their rotation, students were given a posttest with the same 10 questions posed on the pretest.

The posttest results indicated that most medical students’ knowledge and application of FABMs did change and overall there was a positive effect on student intelligence and confidence. A total of 277 students completed the pretest and 196 students completed the posttest. The initial pretest results showed a test score of 38.99% and the posttest results showed a 14.58% increase to an average score of 53.57%. Confidence in sharing FABM information with patients also grew from a pretest level of 1.51 (on a scale of 0 to 5, with 0 being least confident and 5 being very comfortable) to a 3.0; and the confidence in utilizing FABMs to diagnose gynecologic and reproductive problems grew from 1.01 to 3.15.

Confidence scores in educating about FABMs increased from the pre to posttest

Confidence scores in educating about FABMs increased from the pre to posttest


Medical students have limited knowledge and comfort discussing FABMs, which are also referred to as natural family planning. Medical institutions may not routinely educate students about these methods due to common misconceptions about the role and effectiveness of FABMs. There is an inherent bias that the only effective way to diagnose and treat patients for gynecologic and reproductive complications is through hormonal birth control as medicine. And current research data on the effectiveness of FABMs isn’t current at all – with limitations to its application. When referring to FABM effectiveness rates, the most commonly cited study asked women to recall which family planning method they were using at the time of conception. Data for all FABMs were then pooled, including the older and outdated rhythm method, (which is not really an FABM as it requires no awareness of fertility at all). Combining data from lower quality retrospective surveys for all FABMs, including outdated methods, has led to a misunderstanding of effectiveness of the newer, modern FABMs. Therefore, it is essential to educate medical students about the evidence-based, modern FABMs, which include cervical fluid based, sympto-thermal and the sympto-hormonal methods, especially since their effectiveness rates compare to other commonly used forms of birth control

There were some flaws in the study, such as a lack of accuracy due to incomplete testing from individuals on the pre- and posttest, and an absence of an outlined curriculum with long-term objectives. Despite some of the limitations, however, it is apparent that a general lack understanding of fertility awareness in medical curriculum currently exists. Learning how charting biomarkers can reflect physiology and treatment can enable medical students to be a resource of information to patients and to give them additional tools to effectively address reproductive health problems. If woven into curriculum earlier, perhaps during the preclinical coursework on hormonal and reproductive physiology, this knowledge would allow students to recognize and apply this information to better assist patients that they will see in clinical years.


A brief FABMs course offered to medical students is shown to be both positive and useful in increasing knowledge and familiarity with FABMs. There are several ways to offer this information to medical students, whether that is via online learning, in a professional setting or through peer-to-peer instruction with another trained physician. FACTS currently offers educational programming through an online CME approved course and in-person speaking events, as well as a growing preceptorship program. Please visit follow those links for more information about these opportunities or to request a speaker.

This Featured Research article is a review of the paper originally published in Frontiers in Medicine, Population, Reproductive and Sexual Health: Danis PG, Kurz SA and Covert LM (2017) Medical Students’ Knowledge of Fertility Awareness-Based Methods of Family Planning. Front. Med. 4:65. doi: 10.3389/fmed.2017.00065

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