Teledoulas: Medical Students' Experiences Providing Remote Support for Abortion Patients

Liu, Morgan
Claypoole, Lauren
Pearlman-Shapiro, Marit
Raidoo, Shandhini
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Introduction: The number of trained abortion providers in the U.S. has been steadily declining even though 1 in 4 pregnancy-capable people will have an abortion in their lifetime [1, 2]. Nationwide surveys on abortion education in medical schools reveal that only 32% of schools provide lectures on abortion and only 45% of Ob/Gyn clerkships provide clinical exposure to abortion care [3, 4]. During the COVID-19 pandemic, there has been an increase in patients seeking medication abortions via telemedicine and a decrease in direct patient care opportunities for medical students [5]. The Doula Project is a program that provides JABSOM students with the opportunity to remotely serve as telemedicine doulas (teledoulas) for patients undergoing medication abortions in Hawaii.

Objectives: The purpose of our study was to investigate medical students’ experiences volunteering as abortion teledoulas in providing emotional support, education, pain management, and self-advocacy via phone call and text messaging to patients throughout the medication abortion process.

Methods: We designed online pre- and post-training surveys for JABSOM medical students undergoing training as teledoulas to assess the following: (1) clinical knowledge and attitudes towards abortion, (2) acquisition of skills including communication and patient advocacy, and (3) impact on professional goals pursuing fields in reproductive healthcare. We invited a total of 28 medical student teledoula volunteers (22 preclinical and 6 clinical across two training cohorts) to participate in our study. The first cohort of 10 teledoulas completed the post-training survey only. The second cohort completed both pre- and post-training surveys. This study was determined to be exempt by the University of Hawaii IRB.

Results: Nine teledoulas (90.0%) from the first training cohort completed the post-training survey. Six of the 18 teledoulas (33.3%) from the second cohort completed both the pre- and post-training surveys. All self-identified as “pro-choice.” Prior to training, 93.3% had not had clinical exposure to abortion care. After training, most felt more capable of advocating for their patients (73.3%) and answering questions regarding the medication abortion procedure (86.7%), common complications (80.0%), and pain management options (93.3%) (Figure 1). Overall, most students reported a positive impact on their personal development (66.7%), emotional maturity (66.7%), and education (80.0%) (Figure 2). After participating in the program, 60% reported a greater inclination to pursue a career in women’s health or incorporate it into their career path and 80% reported that they intend to become abortion providers. When self-rating communication skills on a Likert scale, pre-training students reported a mean comfort level of 3.53/5 in discussing difficult topics with patients while post-training students reported a mean comfort level of 3.93/5 (p-value = 0.14; NS) (Figure 3).

Discussion: Medical students volunteering as teledoulas report improvement in their clinical knowledge, patient advocacy, and communication skills. Clinical exposureto abortion care and patient support during medical school as teledoulas can impact medical students’ awareness of reproductive health, support them in their career goals, and improve their self-perceived ability to communicate with patients.

Target Audience: Medical curriculum coordinators

1. Pace L, Sandahl Y, Backus L, Silveira M, Steinauer J. Medical Students for Choice’s Reproductive Health Externships: impact on medical students’ knowledge, attitudes and intention to provide abortions. Contraception. 2008;28(1):31-35. doi:10.1016/j.contraception.2008.02.008.
2. Jones RK and Jerman J, Population group abortion rates and lifetime incidence of abortion: United States, 2008–2014. American Journal of Public Health. 2017;107(12):1904-1909. doi:10.2105/AJPH.2017.304042.
3. Espey E, Ogburn T, Chavez A, Qualls C, Leyba M. Abortion education in medical schools: A national survey. Am J Obstet Gynecol. 2005;192(2):640-643. doi:10.1016/j.ajog.2004.09.013
4. Espey E, Ogburn T, Leeman L, Nguyen T, Gill G. Abortion education in the medical curriculum: a survey of student attitudes. Contraception. 2008;77(3):205-208. doi:10.1016/j.contraception.2007.11.011
5. Aiken ARA, Starling JE, Gomperts R, Tec M, Scott JG, Aiken CE. Demand for Self-Managed Online Telemedicine Abortion in the United States During the Coronavirus Disease 2019 (COVID-19) Pandemic. Obstet Gynecol. 2020;136(4):835-837. doi: 10;1097/AOG.0000000000004081.

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