Medical Student Reproductive Health Education: A Research Review
By: Jennifer Pires, DO
Director’s Note: As we kick off the 6th year of our elective in Family Planning and Women’s Health, we highlight research authored by our executive director, Dr. Marguerite Duane, examining what reproductive health topics students learn about in medical schools. The study, summarized by former FACTS elective student, Jennifer Pires, DO, was inspired by Grace Carson, MD, a FACTS ambassador. Titled, “An Evaluation of US Medical Schools’ Reproductive Health and Family Planning Curricula,”  the study by Duane et al represents a collaborative effort that involved a number of student ambassadors from various schools across the United States. Through the FACTS elective and our student and resident ambassador programs, we hope to train the next generation of physicians to fully appreciate the value of charting the female cycle with fertility awareness-based methods (FABMs). There is still space available in our FACTS medical elective, so sign up today!
Reproductive health is an important topic that is being discussed more frequently in the United States. Approximately 45% of pregnancies are unintended and, in recent years, the rate of elective termination has decreased.  However, as culture changes and women attempt to conceive later in life, the rate of infertility is increasing. Alongside these trends, it has been noted that 40% of women are not knowledgeable about the ovulatory cycle, and one third are unaware of infertility risk factors. 
The authors of the 2022 article  summarized below focused on what medical students are learning in their reproductive health curricula. To the authors’ knowledge, previous studies have relied on student perceptions rather than assessing the specific reproductive health curriculum used in different medical schools.
The goal of this study was to collect information from a diverse group of medical schools, and students from 91 U.S. medical schools were contacted. Twenty schools provided the requested information about reproductive health-related courses for the first three years of their medical school curriculum from the 2016-19 academic year. The material received included written syllabi, lecture notes, and formal curriculum material from the family medicine and obstetrics and gynecology clerkships. Informal presentations, discussion notes, textbooks, and optional online modules were not included.
The researchers followed a standardized protocol to analyze the material collected. Sixty-nine terms related to reproductive health and family planning were selected and searched in the documents collected by using the “control F” feature as well as visual inspection of graphs and tables. The number of terms mentioned in the course material were totaled and analyzed.
The curriculum data was collected from 20 schools, 16 allopathic and 4 osteopathic, which represented 10.5% of the accredited U.S. medical schools. There were 10 public and 10 private schools, with 3 schools having an affiliation with Catholic universities. Forty-five percent of the schools were from the Midwest, 25% were from the Northeast and South, and 5% from the West. There was a total of 9,308 mentions of the 69 pre-determined reproductive health terms.
Of the terms mentioned, 43% were related to specific types of family planning, 28% were generic terms in reproductive health, 10.4% pertained to elective abortion procedures, and 9.5% were about infertility and its treatment. Other topics identified included 5.8% of terms about counseling on reproductive health options and 3.5% on ectopic pregnancies.
“Of the terms mentioned, 43% were related to specific types of family planning, 28% were generic terms in reproductive health, 10.4% pertained to elective abortion procedures, and 9.5% were about infertility and its treatment.”
Of the family planning methods discussed, hormonal birth control was mentioned most frequently (41.5%) followed by long-acting reversible contraceptives (26.7%), barrier methods (15.7%), and fertility awareness-based methods (4%). The authors noted FABMs were generally referenced or explained using outdated terms and methods, such as the rhythm method, rather than modern, evidence-based methods.
This article is the first of its kind to objectively evaluate what is taught in medical school in the female reproductive health curriculum. This study creates a baseline that can lead to further research into medical education about reproductive health, and has the potential to improve curricula by promoting a broader approach to women’s health.
The study shows the current medical school curriculum places a large emphasis on pharmacological methods of birth control with less emphasis on education about infertility or alternative methods of family planning, including FABMs. The authors compare their findings to a survey of ‘Medical Students for Choice’ groups which reported similar results.
“The current medical school curriculum places a large emphasis on pharmacological methods of birth control with less emphasis on education about infertility or alternative methods of family planning, including FABMs.”
The findings also reveal that counseling was not mentioned in over 50% of the schools evaluated. The authors suggest that this deficiency in education means these medical students may not be able to provide patients with adequate information to obtain true informed consent. Informed consent includes explanations to a patient about alternatives, risks, benefits, and how a treatment works.  If students do not receive lessons on how to counsel patients on all available family planning options, they cannot properly consent patients to treatment. Despite FABMs being a less commonly used method for family planning, when offered information about them, 22-61% of women express interest in using them. 
“This deficiency in education means these medical students may not be able to provide patients with adequate information to obtain true informed consent.”
Although this study evaluates curricula content via an objective review of course materials, it does have limitations. It has a small sample size, with material only reviewed from 20 out of the 190 accredited U.S. medical schools, and almost half of them located in the Midwest. Also, collecting data by using the “control F” feature with visual inspection of graphs and charts to identify terms may miss some mentions. The written material from the schools may contain spelling errors, other phrases instead of the 69 specifically chosen terms, and the written curriculum may not accurately represent conversations that occur during live lectures and clinical encounters. Though generally standardized, medical schools use different curricula. Some utilize the traditional lecture-based format while others use problem-based learning, which could not be evaluated by the methods of this study. Despite these limitations, the study was able to provide quantitative and objective analysis of reproductive health curricula in twenty U.S. medical schools.
This study used data from the 2016-19 academic years and was published in 2022. Since then, there have been changes to state laws that dictate what care female patients can receive. These recent changes have placed a spotlight on the care and treatment options available to women. This study represents a valuable baseline for research to evaluate the education medical students receive. Further research into all methods of family planning, including FABMs, is crucial to obtain the most positive outcomes for all women regardless of their geographic location.
 Duane M, Carson G, VanderKolk K, Adams E, Gordon L. An Evaluation of US Medical Schools’ Reproductive Health and Family Planning Curricula. Issues Law Med. 2022;37(2):117-128.
 Lundsberg LS, Pal L, Gariepy AM, Xu X., Chu MC, Illuzzi JL. Knowledge, attitudes, and practices regarding conception and fertility: a population-based survey among reproductive-age United States women. Fertil Steril. 2014;101(3):767-74.
 Cocanour CS. Informed consent-It’s more than a signature on a piece of paper. Am J Surg. 2017;214(6):993-997. doi:10.1016/j.amjsurg.2017.09.015.
ABOUT THE AUTHOR
Jennifer Pires, DO
Jennifer Pires, DO is in her first year of residency and a recent graduate of Rowan School of Osteopathic Medicine in Stratford, New Jersey. She completed her undergraduate degree at the University of Connecticut. She enrolled in the FACTS elective to learn more about the female fertility cycle and how a woman can learn how to interpret signs in her body to improve her health and quality of life. She would like to incorporate some of these skills into her practice to support her patients.