Background and objectives: Family physicians are critical to reproductive health service provision including miscarriage management and abortion care, but many graduates report barriers in integrating these services into practice. We designed and implemented CREATE (Continuing Reproductive Education for Advanced Training Efficacy), an elective advanced training and leadership program for senior residents aimed to help new graduates integrate miscarriage and abortion care into practice.
Methods: We surveyed all 53 program graduates at graduation, and 47 completed a follow-up survey in March 2016. We describe program graduates' current reproductive health practices and differences by respondent characteristics. We report facilitators (or enabling factors) and barriers that graduates encountered in attempting to integrate reproductive health care into practice, as well as the perceived impact of the CREATE program.
Results: Forty-two percent of CREATE graduates were providing miscarriage management and 35% were providing abortion care at the time of the follow-up survey. Factors associated with abortion provision at follow-up include strength of intention to provide at graduation and higher volume of uterine aspirations performed during residency. Graduates reported a range of barriers, including internal factors such as strength of competing interests, and external barriers such as administrative and staff resistance. Graduates found the additional procedural training, networking opportunities, and the complication simulation to be the most helpful aspects of the CREATE program.
Conclusions: The CREATE program model may provide a useful template for family medicine residencies working to incorporate advanced abortion training or other advanced procedural skills into their curricula. Future curricular interventions should consider providing additional postgraduate support, particularly in provider shortage areas.