Anatomy of a physician education programme

This paper describes an innovative abortion training programme implemented in three free-standing clinics of a women's health care agency in a large US city. It was designed to address the growing shortage of clinicians trained and willing to perform abortions, a shortage that has restricted women's access to abortion services. Since legalisation of abortion in 1973, abortion services have been relegated to free-standing clinics, peripheral to mainstream women's health care. As a result, abortion providers have been stigmatised or ignored by hospital-based, academic obstetrician-gynaecologists. Physicians have also been reluctant to enter the field because anti-abortionists harass and threaten clinics and sometimes murder their staff. In its first three years, this programme trained 60 physicians and 2 physician-assistants to provide first trimester abortions, using local anaesthesia. The successes and challenges in implementing an innovative programme, which also called for change from a medical model of care to patient-centred care, are described.