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Millar E. Abortion stigma, abortion exceptionalism, and medical curricula. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2023; 32:261-276. [PMID: 36916481 DOI: 10.1080/14461242.2023.2184272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
ABSTRACTWhile it is well established that medical student learning about abortion is inadequate and lacks systemisation, there is little research on why this might be the case. This exploratory study draws on a survey sent to 438 medical educators at Australia's 21 accredited medical schools through March-May 2021. Forty-eight educators responded to the survey. In this article, I examine their responses alongside policy and research on medical education to consider how curricula are determined. I conceptualise abortion exceptionalism - the singling out of abortion from other areas of medicine on the grounds that it is special, different, or more complex or risky than is empirically justified - as a mode of 'stigma-in-action', arguing that medical curricula are powerful sites for its reproduction and undoing.
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Affiliation(s)
- Erica Millar
- Department of Social Inquiry, School of Humanities & Social Sciences, La Trobe University, Bundoora, Australia
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Hinojosa-Millán S, Suarez-Orozco L, Gómez-Jaramillo V, Sánchez-Duque JA. La pandemia ignorada del aborto inseguro: una llamada a la acción. Semergen 2023; 49:101909. [PMID: 36527752 DOI: 10.1016/j.semerg.2022.101909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/16/2022] [Indexed: 12/23/2022]
Affiliation(s)
- S Hinojosa-Millán
- Semillero de investigación Ginecología y Obstetricia. Departamento de Obstetricia y Ginecología, Facultad de Ciencias de la Salud, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia
| | - L Suarez-Orozco
- Departamento de Medicina Familiar, Facultad de Salud, Universidad del Valle, Cali, Valle del Cauca, Colombia
| | - V Gómez-Jaramillo
- Facultad de Ciencias Jurídicas, Sociales y Humanísticas, Fundación Universitaria del Área Andina, Sede Pereira, Pereira, Risaralda, Colombia
| | - J A Sánchez-Duque
- Grupo de Investigación Salud, Familia y Sociedad, Departamento de Medicina Social y Salud Familiar, Facultad de Ciencias de la Salud, Universidad del Cauca, Popayán, Cauca, Colombia.
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Yekta-Michael SS, Färber CM, Heinzel A. Evaluation of new endodontic tooth models in clinical education from the perspective of students and demonstrators. BMC MEDICAL EDUCATION 2021; 21:447. [PMID: 34429092 PMCID: PMC8383916 DOI: 10.1186/s12909-021-02848-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 07/09/2021] [Indexed: 05/09/2023]
Abstract
BACKGROUND The quality of root canal treatments performed by undergraduate students is often unsatisfactory questioning the current methods of teaching. Based on treatment errors made by students participating the endodontic courses at RWTH Aachen University (Germany), new radiopaque artificial root canal treatment models (DRSK RCT; incisor, premolar, molar) were designed and developed. The aim of the study was to evaluate these models by groups of students and demonstrators. METHODS A total number of 60 students and seven demonstrators from a single institution (RWTH Aachen) participated in this study. They performed endodontic treatments on either initial versions of the DRSK RCT or modified versions. The initial versions were evaluated by students (n = 25) and demonstrators (n = 7). The obtained questionnaire was conducted as 7-point Likert-Scale covering the topics material properties, feeling while performing exercises and perception of its closeness to reality via 19 items (students) and 21 items (demonstrators). According to the evaluations several alterations were applied to the DRSK RCT, the whole study was repeated and evaluated by different students (n = 35) and the same demonstrators (n = 7). Additionally, the demonstrators blindly evaluated the quality of root canal treatments performed by the students (n = 35) on the modified DRSK RCT. Comparisons between the initial versions and the modified versions were calculated using Chi-squared tests. RESULTS Students as well as demonstrators positively evaluated both variants of the DRSK RCT with especially high ratings in the overall evaluation. Students' rating of the pulp anatomy significantly increased from 5.4 ± 1.1 (mean ± SD) to 5.9 ± 0.9 (mean ± SD; p < 0.05) for the modified model. Likewise, students felt that the ability to flare root canals improved after alterations have been applied. Ratings significantly increased from 4.8 ± 1.6 (mean ± SD) to 5.6 ± 1.0 (mean ± SD; p < 0.05). CONCLUSION The results indicate that the DRSK RCT is a promising candidate to be used as an alternative to extracted teeth or as an additional tool for improving dental education. However, some limitations of our analysis have to be considered.
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Affiliation(s)
- Sareh Said Yekta-Michael
- Department of Orthodontics, RWTH Aachen University, Aachen, Germany.
- Interdisciplinary Center for Clinical Research, RWTH Aachen University, Aachen, Germany.
| | - Christoph Maria Färber
- Department for Operative Dentistry, Periodontology and Preventive Dentistry, RWTH Aachen University, Aachen, Germany
| | - Alexander Heinzel
- Department of Nuclear Medicine, RWTH Aachen University, Aachen, Germany
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Schuklenk U. Conscience-based refusal of patient care in medicine: a consequentialist analysis. THEORETICAL MEDICINE AND BIOETHICS 2019; 40:523-538. [PMID: 31754928 DOI: 10.1007/s11017-019-09510-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Conscience-based refusals by health care professionals to provide care to eligible patients are problematic, given the monopoly such professionals hold on the provision of such services. This article reviews standard ethical arguments in support of conscientious refuser accommodation and finds them wanting. It discusses proposed compromise solutions involving efforts aimed at testing the genuineness and reasonability of refusals and rejects those solutions too. A number of jurisdictions have introduced policies requiring conscientious refusers to provide effective referrals. These policies have turned out to be unworkable. They subject patients to a health care delivery lottery, which is incompatible with the fundamental values of medical professionalism. This paper sheds light on transnational efforts aimed at undermining progress made in reproductive health by means of conscientious refusal accommodation claims. The view that the accommodation of conscientious refusers is indefensible on consequentialist ethical grounds, as well as on grounds related to medical professionalism itself, is defended.
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Affiliation(s)
- Udo Schuklenk
- Department of Philosophy, Queen's University, Watson Hall 309, Kingston, ON, Canada.
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Bento SF, Pacagnella RDC, Faúndes A, de Pádua KS, Fernandes KG, Araújo DM, Fahl ID, Duarte Osis MJ, Duarte GA. The abstract versus the concrete: differing opinions of medical residents in obstetrics and gynaecology about abortion and punishment of abortion. EUR J CONTRACEP REPR 2019; 24:494-500. [PMID: 31670994 DOI: 10.1080/13625187.2019.1682135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To investigate the opinions of Brazilian medical residents in Obstetrics and Gynaecology on abortion legislation according to their personal beliefs.Material and methods: A multicentre cross-sectional study. Residents at 21 university teaching hospitals completed a self-report questionnaire on their opinions in abstract terms, and about punishing women who abort in general and women they know.Results: In abstract terms, 8% favoured allowing abortion under any circumstances (fully liberal); 36% under socioeconomic or psychological constraints (broadly liberal); 75.3% opposed punishing a woman who has aborted (liberal in general practice); and 90.2% opposed punishing women they knew personally (liberal in personal practice). Not having a stable partner and not being influenced by religion were factors associated with liberal opinions. In personal practice, however, 80% of those who are influenced by religion were liberal. The percentage of respondents whose opinions were liberal was significantly greater among those who believed that abortion rates would remain the same or decrease following liberalisation.Conclusions: Judgements regarding the penalisation of women who abort are strongly influenced by how close the respondent is to the problem. Accurate information on abortion needs to be provided. Although about one third of the respondents were broadly liberal, the majority oppose punishment.
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Affiliation(s)
- Silvana Ferreira Bento
- Campinas Centre for Research in Human Reproduction (CEMICAMP), Campinas, Brazil.,Professor José Aristodemo Pinotti Women's Hospital, Center for Integral Attention to Women's Health (CAISM), State University of Campinas, Campinas, Brazil
| | | | - Aníbal Faúndes
- Campinas Centre for Research in Human Reproduction (CEMICAMP), Campinas, Brazil.,Department of Obstetrics and Gynaecology, School of Medical Sciences, State University of Campinas, Campinas, Brazil
| | - Karla Simônia de Pádua
- Campinas Centre for Research in Human Reproduction (CEMICAMP), Campinas, Brazil.,Professor José Aristodemo Pinotti Women's Hospital, Center for Integral Attention to Women's Health (CAISM), State University of Campinas, Campinas, Brazil
| | - Karayna Gil Fernandes
- Professor José Aristodemo Pinotti Women's Hospital, Center for Integral Attention to Women's Health (CAISM), State University of Campinas, Campinas, Brazil.,School of Medicina of Jundiaí, Brazil
| | - Danielle Miyamoto Araújo
- Professor José Aristodemo Pinotti Women's Hospital, Center for Integral Attention to Women's Health (CAISM), State University of Campinas, Campinas, Brazil
| | - Isabela Dias Fahl
- Professor José Aristodemo Pinotti Women's Hospital, Center for Integral Attention to Women's Health (CAISM), State University of Campinas, Campinas, Brazil
| | - Maria José Duarte Osis
- Department of Obstetrics and Gynaecology, School of Medical Sciences, State University of Campinas, Campinas, Brazil.,School of Medicina of Jundiaí, Brazil
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Macfarlane E, Paterson H. A survey of the views and practices of abortion of the New Zealand Fellows and trainees of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Aust N Z J Obstet Gynaecol 2019; 60:296-301. [PMID: 31411741 DOI: 10.1111/ajo.13039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/12/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Abortion is a common procedure in New Zealand (NZ). Currently, it is only legal when two certifying consultants agree that the person seeking an abortion meets the statutory grounds outlined in Section 187A of the NZ Crimes Act (1961). The Crimes Act also states that one-half of certifying consultants must be practising obstetricians/gynaecologists. However, with abortion law reform on the political agenda, the way that abortion services are provided in NZ may change. AIM This survey of NZ Fellows and trainees evaluates their attitudes toward training requirements for abortion, abortion care provision, and conscientious objection. MATERIALS AND METHODS A pre-validated questionnaire was sent electronically to all NZ trainees and Fellows. Quantitative data were analysed using descriptive statistics and qualitative data analysed using generalised inductive thematic analysis. RESULTS Most respondents (95.9%) believe that abortion should be available and 46.8% of respondents either provide abortion, or counsel women about their options and refer. The majority of respondents (73%) support abortion training in FRANZCOG and 68.5% support training in DRANZCOG. Qualitative data reflect a range of views on abortion, the role of conscientious objection in abortion care, and gestational limits. CONCLUSION This study identifies overall support for abortion provision in NZ and abortion training. However, there is a range of views and practices of abortion among RANZCOG trainees and Fellows that reflects the complexity of the abortion debate.
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Affiliation(s)
- Emma Macfarlane
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Helen Paterson
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Shaw D, Norman WV. When there are no abortion laws: A case study of Canada. Best Pract Res Clin Obstet Gynaecol 2019; 62:49-62. [PMID: 31281015 DOI: 10.1016/j.bpobgyn.2019.05.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/19/2019] [Accepted: 05/20/2019] [Indexed: 10/26/2022]
Abstract
Canada decriminalized abortion, uniquely in the world, 30 years ago. We present the timeline of relevant Canadian legal, political, and policy events before and since decriminalization. We assess implications for clinical care, health service and systems decisions, health policy, and the epidemiology of abortion in the absence of criminal legislation. As the criminal abortion law was struck down, dozens of similar private member's bills, and one government bill, have been proposed, but none were passed. Key findings include that initially Canadian provinces attempted to provide restrictive regulations and legislation, all of which have been revoked and largely replaced with supportive policies that improve equitable, accessible, state-provided abortion service. Abortion rates have been stable over 30 years since decriminalization, and a falling proportion of abortions occur late in the second trimester. Canada demonstrates that abortion care can safely and effectively be regulated as a normal component of usual medical care.
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Affiliation(s)
- Dorothy Shaw
- University of British Columbia, Vancouver, Canada
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Myran D, Bardsley J. Abortion remains absent from family medicine training in Canada. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2018; 64:618-619. [PMID: 30108080 PMCID: PMC6189888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Daniel Myran
- Family physician and a fourth-year public health and preventive medicine resident at the University of Ottawa in Ontario
| | - Jillian Bardsley
- Family physician who recently completed family medicine training at the University of Ottawa
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Myran D, Bardsley J. [Not Available]. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2018; 64:e361-e362. [PMID: 30108091 PMCID: PMC6189898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Daniel Myran
- Médecin de famille et résident de 4 année en santé publique et médecine préventive à l'Université d'Ottawa, en Ontario
| | - Jillian Bardsley
- Médecin de famille et a récemment complété sa formation en médecine familiale à l'Université d'Ottawa
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