5. Evaluating an Adolescent and Young Adult-Focused Medication Abortion Curriculum for Pediatric Trainees

Abstract

Background

22 states ban or restrict abortion, limiting access for adolescents and young adults (AYAs) and reducing number of abortion providers. Further, AYA-focused medication abortion (MAB) curricula are lacking. We developed, implemented, and evaluated an AYA-focused MAB curriculum for pediatric trainees (pediatric residents, nurse practitioner students, and medical students).

Methods

Using Kern's Six Steps, we designed a curriculum of four online modules (videos with readings on adolescent pregnancy options counseling, MAB provision, post-abortion care, and harm reduction strategies) and a 2-hour workshop (module review, a values clarification exercise, and a clinical case). Adolescent themes included AYA-specific barriers and health equity concerns, developmental considerations, and confidentiality concerns. 9 workshops were held over the 2023-2024 academic year. Pre- and post-surveys assessed key components of behavior change according to Social Cognitive Theory including learner satisfaction, knowledge, intentions, values, and self-efficacy. McNemar test and Wilcoxon signed-rank test assessed differences in quantitative pre/post results; we analyzed open-ended responses using a thematic content approach. This study received IRB approval.

Results

29 of 53 participants completed both surveys (54%); most learners were pediatric residents (52%) or nurse practitioner students (45%), with one medical student also participating (3%). Learners’ cumulative knowledge score increased after curriculum completion (60% vs 90%; p<.001). Overall intentions to provide, refer, and advocate for MAB did not change significantly (average of 3 questions on a Likert scale 1-5: 4.3 vs 4.3; p=.92). Similarly, learners' feelings around caring for patients seeking abortions did not change significantly (average of 7 questions on a Likert scale 1-5: 4.4 vs 4.4, p=.76). After completion, learners felt fairly or completely confident in counseling on pregnancy (72%) and abortion options (66%), determining medical eligibility (88%), and providing anticipatory guidance (89%). 85% of learners rated the overall curriculum excellent or outstanding. In open-ended responses, learners described the curriculum as highly valuable.

Conclusions

This AYA-focused MAB curriculum improved pediatric trainees' knowledge of MAB management with learners feeling fairly confident or greater to perform key aspects of MAB care after curriculum completion. Intentions to provide MABs did not change significantly, possibly due to high pre-scores. While values scores did not shift significantly, many learners noted this curriculum was a valuable contribution to their pediatric training.