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Community is an essential concept of human interaction and productivity. It can be built around religion, political orientation, artistic interests and other shared beliefs and activities. Community creates a sense of belonging, connection and support, and allows groups to accomplish specific tasks.
The first reforms in health education occurred in response to the publication of the Flexner Report in 1910, more than a hundred years ago . The reforms, sparked by the discovery of the germ theory in Europe and other scientific advances, led to the integration of early developments in medical science into the academic education of physicians. Ten years ago, the Lancet published a report, “Health Professionals for a New Century: Transforming Education to Strengthen Health Systems in an Interdependent World,” based on the findings of a global independent commission to address the inequities in health, despite enormous scientific advances in medicine . In this report, twenty professional and academic leaders representing the perspective of diverse countries defined an educational strategy for medicine, nursing and public health. Its intention was to consider the relationship between health systems and education and recommend strategies to produce a workforce that addresses the health needs of a particular country.
Contraception and abortion allow women to control their reproduction. The means to accomplish reproductive control have improved over the past century as the result of revolutionary social and medical advances. The subtitle of this book refers to family planning and abortion, but our primary focus is on abortion. Contraception, while still politically embattled and not universally available, is no longer in the eye of the reactionary storm in most countries. Nevertheless, integration of all aspects of contraception into medical education is incomplete.
Although academic obstetrician-gynecologists were important advocates for legal abortion, few teaching hospitals became sources of abortion care in the USA. Instead, private clinics provided nearly all abortions and medical students and residents had little opportunity to learn about abortion. Likewise, when contraception was earlier legalized, the major sources became Planned Parenthood and public health department clinics funded through the US Government’s Title X Program. Academic organizations responsible for training obstetrician-gynecologists recognized these deficiencies and moved to require training in family planning and to set standards for it. A few major teaching hospitals provided models for such training. Their efforts were emulated and financially supported at training programs around the USA through the “Ryan Residency Training Program in Abortion and Contraception” reaching one hundred programs over a 20-year effort. Because teaching hospitals largely ignored abortion and their reproductive endocrinologists were busy with IVF, academic training programs failed to develop researchers in abortion and contraception. In response to the need for clinical research and teaching in family planning, post-residency fellowship programs were simultaneously established in 30 medical schools, eventually leading to recognition in 2020 of “Complex Family Planning” as one of the official subspecialties of obstetrics and gynecology.
The University of California, San Francisco (UCSF) became the first site for the Fellowship in Family Planning when Dr. Philip Darney enrolled Dr. Dilys Walker as a fellow in 1991. UCSF subsequently became home to two national programs: the national Family Planning Fellowship, founded to develop physician-leaders in reproductive health, and, soon after, in 1999, The Ryan Residency Programs, conceived by Dr. Uta Landy, a nation-wide initiative to integrate and enhance family planning training for obstetrics and gynecology residents. Now with 30 fellowship sites at leading US medical schools and over 100 Ryan Residency Programs, faculty, fellows, and residents provide family planning care and training, and conduct a broad range of family planning research. These two programs have led to improved clinical care, teaching, education, research and culture change in academic medicine and the field of family planning in the US and around the world.
Neither legalization of abortion nor scientific and political advances in contraception and abortion ensure that training and research in family planning are routinely integrated into medical education. Without integration, subsequent generations of healthcare professionals are not prepared to incorporate evidence-based family planning into their practices, teaching, or research. Omission of this crucial component prevents the cultural and professional normalization of an often stigmatized and embattled aspect of women's health. Taking the successful US-based Ryan and Family Planning Fellowship programs as templates for training, teaching, and academic leadership, this book describes the integration of family planning and pregnancy termination into curricula with an international outlook. With an evidence- and systems-based approach, the book is a unique and practical guide to inspire and train the next generation of healthcare professionals.
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