Implementing a Medication Abortion Curriculum in an Internal Medicine Residency: An Educational Innovation

Medication abortion using mifepristone and misoprostol is safe and effective, yet few internal medicine (IM) physicians provide this care due to barriers such as stigma, institutional restrictions, and limited training. General deficits in reproductive health training have long been recognized in IM resident training, and gaps remain.

To evaluate the implementation and outcomes of a medication abortion curriculum for IM residents at Cambridge Health Alliance, a Harvard-affiliated program, during the 2022-2023 academic year.

A structured curriculum was developed in partnership between the IM and family medicine departments with 3 components: a 1-2-hour online module, a 70-minute in-person session, and a 3-hour clinical experience at a reproductive health clinic. Data were collected on curriculum participation rates and from online pre- and post-curriculum surveys. Surveys assessed residents' attitudes toward medication abortion, self-reported comfort with counseling and eligibility determination, and knowledge using a brief internally developed assessment.

Twenty-three of 24 residents (96%) completed ≥1 components. In the pre-survey, 79% (15 of 19) of residents indicated they would like to provide medication abortion services during residency if trained, and 74% (14 of 19) intended to incorporate it into their future practice. Post-survey results showed significant improvements in comfort with counseling on early abortion options (95% CI, 0.54-1.84; P<.001), determining eligibility (95% CI, 0.61-1.86; P<.001), counseling on medication abortion regimens (95% CI, 0.62-1.89; P<.001), and managing failed abortions (95% CI, 0.50-1.79; P=.001).

This curriculum significantly increased IM residents' comfort in providing medication abortion services over 6 months.