Kalinowski, K., Buskmiller, C., & Ward, D. G. (2022). Reproductive Services and Conscience-Based Refusals in Obstetrics and Gynecology Training. The Linacre Quarterly, 89(3), 287-297. https://doi.org/10.1177/00243639211040589
Kalinowski K, Buskmiller C, Ward DG. Reproductive Services and Conscience-Based Refusals in Obstetrics and Gynecology Training. Linacre Q. 2022;89(3):287-297. doi:10.1177/00243639211040589
Kalinowski, Kristin, et al. "Reproductive Services and Conscience-Based Refusals in Obstetrics and Gynecology Training." The Linacre Quarterly, vol. 89, no. 3, 2022, pp. 287-297.
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Department of Obstetrics, Gynecology, and Women’s Health, St. Louis University, St. Louis, MO, USA01p7jjy08
OB/GYN Directors React Negatively to Birth Control Refusal
Most U.S. OB/GYN residency directors react negatively toward applicants who refuse to prescribe or counsel on birth control. A 2019 survey asked 279 program directors; 97 answered. Far fewer directors react negatively toward applicants who refuse to counsel on fertility awareness-based methods or who refuse to perform abortions.
Key Findings
96 of 97 program directors (99%) reacted negatively to applicants who refused to counsel on birth control, and 88 of 97 (91%) to those who refused to prescribe it.
91 of 97 directors (94%) reacted negatively to refusal to prescribe methotrexate, and 75 of 97 (77%) to refusal to counsel on abortion.
62 of 97 directors (64%) reacted negatively to refusal to participate in medical infertility treatment, compared with 34 of 97 (35%) for refusing to perform in vitro fertilization.
Only 23 of 97 directors (24%) reacted negatively to refusal to provide any abortion, and just 9 of 97 (9%) to refusal to counsel on fertility awareness-based methods.
45 of 97 directors (46%) said personal knowledge of the applicant could lessen a negative reaction, and 27 of 97 (28%) cited strong letters of recommendation.
Interpretation
The authors emailed an eight-question online survey to 279 U.S. OB/GYN residency program directors in 2019. Ninety-seven replied, a response rate of 35%. Directors answered a matrix question about hypothetical applicants. The authors note their response rate limits how broadly the findings apply. The findings support larger studies of how residency programs handle conscience-based refusals in real cases.
RRM Context
This survey asked about many kinds of conscience-based refusal. Refusal to counsel on fertility awareness-based methods drew one of the smallest negative reactions of any refusal studied, at 9 of 97 directors. FABM counseling sits near the bottom of program directors' list of conscience-based concerns, well below their reactions to birth control counseling and prescribing.
Our editorial summary of this paper, not the article's abstract.
Abstract
Purpose
Professional bodies such as the American College of Obstetrics and Gynecology recognize the impact of conscience-based decisions. The first time such decisions affect patients and providers is in residency. Our study sought to determine the attitudes of program directors towards various conscience-based refusals in potential applicants to obstetrics and gynecology programs.
Method
An eight-question survey was sent to 279 directors of U.S. obstetrics and gynecology residencies in 2019. The survey proposed hypothetical conscientious refusals of common aspects of obstetric and gynecology practice. The survey asked respondents to categorize their reaction to these choices and choose from a list of factors which could modify their reaction. Univariate analysis and multivariate logistic regression were performed.
Results
97 program directors (35%) responded. A majority of PDs reported that the inability to prescribe or counsel on birth control, to provide methotrexate, to counsel on abortion, or to clearly enumerate refusals was impossible to work around, likely to lower an applicant's rank, not compatible with training, or not good for patients; collectively, these responses were grouped as "negative reactions" (73-99%). Female program directors had more negative reactions to applicants who refused to prescribe birth control (aOR 15.8, 95% CI 1.7-99.5) and counsel on abortion (aOR 3.6, 95% CI 1.2-10.8). Directors from different locations and program types did not have significantly different responses. A few program directors identified that academic strength could mitigate otherwise negatively-viewed choices. Illustrative comments of directors' attitudes are provided.
Conclusions
Program directors agree that conscientious refusal to participate in certain activities is problematic for obstetrics and gynecology residency. There are very few subjective or regional differences on this stance, and few aspects of an application modify directors' reactions.
