Beyond Paternalism: Rethinking Teratogen and Fertility Counseling Education from a Learner Perspective.

Abstract

Medical education plays a crucial role in shaping how future physicians understand and approach the prescribing of teratogenic medications to individuals with the capacity for pregnancy. The teaching that we, as medical students, experienced on this topic relied on blanket cautions derived from current guidelines that either warn students to never prescribe teratogenic medications for "women of childbearing age" or to adhere to rigid contraceptive mandates that lack guidance on contraceptive counseling, reproductive goals, or individual risk. This educational approach erases patient diversity and undermines the principles of reproductive justice. As students who are invested in reproductive health both from an educational and personal standpoint, and with our clinical education taking place in an institution and geographic and political context supportive of comprehensive reproductive health, we felt a better approach was possible. We have witnessed thoughtful, nuanced conversations between patients and providers surrounding the friction between patients' fertility goals and treatment options for other medical conditions. We outline three anecdotes that exemplify the discordance between the limited preclinical instruction most of our classmates receive and the clinical practices we have observed that foreground reproductive justice, inclusivity, and patient-provider trust. Moreover, there is a lack of empiric evidence regarding medical students' knowledge and capacity to conduct teratogenic medication counseling. Existing literature reveals a fragmented and simplified approach taken by many clinicians in prescribing these drugs. These shortcomings are related to those that exist in the context of our personal education, and it is likely that medical education on the topic of teratogenicity, contraception, and fertility is institution dependent. Given that best practices and instructions for approaching these counseling situations are not yet formalized, it is reasonable to assume that students are likely graduating from medical school with varied levels of confidence, skill, and training in this area. We find it necessary that reproductive counseling and contraceptive care for patients on teratogenic medications is taught comprehensively to students to reflect our responsibility as physicians to respect individual reproductive goals, provide inclusive and affirming care, and build trust. The individual tension we have identified within our educational experience sheds light on an area of instruction that may hold significant potential in shaping a generation of thoughtful, effective physicians.