Medical students participate in internships at abortion clinics

Discussion of abortion and contraception re-enters the Med School curriculum for first-year students.
September 15, 2009

Ani Kolasa-Lenarz often faced protestors when entering her summer internship. One of five students from the University of Minnesota who participated in Reproductive Health Externships,” Kolasa-Lenarz, a second-year medical student and president of Medical Students for Choice, knew the challenges involved in working at an abortion clinic.
Students are told not to wear their white coat until after they are inside the clinic, said Stacey Burns, who helped Medical Students for Choice arrange the internships through her former job at the Abortion Provider Expansion Project. Protestors target physicians entering the clinic, calling them “baby killers … evil, the devil, they yell at physicians,” Kolasa-Lenarz said. But she said the internship was worth it, providing an experience commonly missed at many medical schools.
A controversial topic in medical education, the discussion of abortion has floated in and out of classes like human sexuality — a required first-year medical course — taught by Dr. Eli Coleman, director of the Program in Human Sexuality .
Abortion hasn’t been on the curriculum for 3 to 4 years, said Dr. David Baram, advisor of Medical Students for Choice, and director of the OB-GYN clerkship at Regions Hospital for third and fourth-year medical students.
The class probably did not address abortion because it was being covered by other people in the medical school, the choice was determined by “logistics,” not controversy, said Dr. Jamie Feldman, an associate professor in Family Medicine and Community Health, who helped teach the human sexuality course over the summer.
Schools “walk a very fine line,” trying to accommodate everyone, and risk losing state funding, Baram said.
Third-year and fourth-year rotations at Regions Hospital offer students the option of participating in the Gynecologic Special Services Clinic, one of seven clinics in Minnesota that perform abortions.
But this is an option, and anyone with a “conscientious objection” does not need to participate, emphasized Dr. Jane van Dis , Assistant Professor in the Department of Obstetrics, Gynecology and Women’s Health.
She said although there is no “national stipulation” requiring students to learn about abortion, they should do so. Thirty-three percent of women with unintended pregnancies have an abortion, according to statistics collected by the Guttmacher Institute in July 2008.
However, groups like Students for Human Life at the University of Minnesota and the Center for Bioethical Reform, a non-profit group not affiliated with the University, disagree with abortion being taught to medical students. Leona Jovanovich, a third-year nursing student and President of Students for Human Life, said medical professionals should make every decision with the intention of preserving the life of a child. Students in the group volunteer with pregnant women and provide counseling, Jovanovich said.
Although the groups support discussion of the topic in the Medical School, Mark Harrington, executive director of the Center for Bioethical Reform, said the abortion discussion in academia is “one-sided” in favor of abortion rights and dialogue has “virtually ceased.”
The Medical School tries to limit controversy; if they find students oppose abortion and contraception education during regular curriculum time, they will drop it, then the other side will complain and they will switch back, Baram said.
He said abortion is not on the Medical School’s “checklist” of procedures students should know, and of the group of third-year students doing rotations at Regions Hospital, about half choose to participate in the abortion option, Baram said.
The Association of Professors of Gynecology and Obstetrics determines curriculum content for medical schools, or at least makes recommendations that most schools follow.
The association’s suggested curriculum says students should know about spontaneous and septic abortion ─ both accidental types of abortion. The curriculum does not include surgical or medicine-induced abortion.
According to a February 2005 survey by the American Journal of Obstetrics & Gynecology, 17 percent of accredited United States medical schools reported no formal education about abortion in clinical or preclinical years. About half offered a clinical experience for third-year and fourth-year students, but few students participated.
To address what they see as a lack of providers nationally due in part to limited education, members of the Medical Students for Choice organized the Reproductive Health Externships program. This is an opportunity for interested students to learn more about abortion, van Dis said.
Each intern works at various abortion providers in Minnesota, including Midwest Health Center for Women and Planned Parenthood in Minneapolis. As an intern this summer, Laura Melcher, co-president of Medical Students for Choice, said she shadowed physicians, did initial exams, pelvic exams and performed some parts of the surgical abortion procedure under close supervision. It was “hands-on,” Melcher said.
Despite challenges and difficult moments, Kolasa-Lenarz said much of her experience was rewarding.
She tells a story of an Ecuadorian woman who came in on a Wednesday and was being deported the following Monday. She lived in a poor area in Ecuador, without the resources to perform the procedure, Kolasa-Lenarz said. The woman was not far enough along in her pregnancy to receive an abortion then, but the clinic had her return the following Saturday and performed the procedure before she left the country.
Jovanovich said this violates the Hippocratic Oath that doctors take to ensure ethicality, because physicians join the profession, “to protect life, not to destroy it.”
However, Steven Miles, a professor at the Center for Bioethics, said the oath does not speak against abortion and it is “essential that it be taught.”
“Politics should not dictate a medical school curriculum,” Miles said.
“It’s an important part of women’s health,” said Melcher, “it’s like any other procedure … you would not become an Obstetrician/Gynecologist and not be able to perform a hysterectomy and deliver a baby.”

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