Effective abortion training practices for clinicians

Studies in multiple countries have found that aspiration abortion by trained nurses, midwives and other advanced-practice clinicians (APCs) is safe and accepted by patients. However, in the United States, most states only allow physicians to provide abortions. Allowing other clinicians to provide abortions could help address pressing challenges to accessing abortion care.

New research from Bixby and colleagues explores an effective model for training advanced-practice clinicians to perform first-trimester aspiration abortions. Trainers used a competency-based model, assessing knowledge and skills through a written test and clinical performance. The number of training days required for competence in performing procedures ranged from 6-10, with the number of procedures performed ranging from 40-56. Differences in the number of days or procedures weren’t associated with any underlying factors that researchers measured. Trainers rated the trainees’ competency higher than the trainees did in their own self-assessment, indicating that trainers and trainees were cautious in determining readiness to practice. By the end of training, the trainers and trainees were in agreement in feeling that the APCs were prepared to provide abortions.

Researchers found no significant difference in complication rates between training procedures performed by APCs and those performed by ob/gyn and family medicine residents. This is consistent with other studies showing that patient care isn’t compromised in the training process.

The most recent World Health Organization guidelines on abortion care provide evidence-based recommendations for including a wide range of health providers in providing abortion care. This training provides a model for APCs to safely provide first-trimester aspiration abortion. With policy change and implementation of training programs, APCs could help increase access to abortion care at a critical time.