Structured training for abortion care

Dr V P Argent, medical director of bpas, examines the implications of the RCOG’s new Syllabus and Logbook for the Certificates in Abortion Care. 

The Faculty of Family Planning and Reproductive Health Care (FFPRHC) of the Royal College of Obstetricians and Gynaecologists (RCOG) has published the Syllabus and Logbook for the Certificates in Abortion Care. This is now the standard training package for nurses and doctors involved in induced abortion practice.

Up to now, there has been little structured training in abortion care. Since 1999, the RCOG has been developing Special Skills Training in all aspects of women’s health care. The FFPRHC has a multidisciplinary, multiagency working party to develop special skills. The RCOG Guideline on the Care of Women Requesting Induced Abortion has emphasised the need for training including ongoing education and maintenance of sufficient caseload. 

There has been little interest in abortion practice among Specialist Registrars and Consultants. Sometimes this is due to conscientious objection to abortion but the main reason is that many colleagues prefer other areas of specialisation such as assisted conception, cancer or fetal medicine. A structured training programme will improve the image of the important field of Sexual and Reproductive Health, which is high on the current health care agenda. An example of the resurgence of interest in training in this area was seen in a recent high profile General Medical Council case, where criticism was made of a practitioner’s lack of specific training in dilatation and evacuation. The new Standards also implement the recommendations of Med FASH (Medical Foundation for AIDS and Sexual Health) on ‘Recommended standards for sexual health service’ and the ‘Centre for HIV and Sexual Health – Quality standards in sexual health training’.

There are eight Certificates of Abortion Care available in total. For doctors and nurses these are:

For doctors only:

Such training is applicable to nurses, primary care specialists in general practice and family planning, and specialists and trainees in obstetrics and gynaecology and sexual health in both the NHS and the independent sector.

The Faculty of Family Planning and Reproductive Health Care suggests that under current law, discussed in the case of RCN v DHSS (1981), nurses and midwives are unable to perform abortion procedures but can provide the medication prescribes by a doctor for medical abortion and assist in the provision of surgical procedures.

This ruling has been much discussed and it has been argued that this practical reading may not be a true interpretation of the law. It could also be said that a nurse may perform any medical or surgical abortion procedure even if a medical practitioner is not present throughout the entirety of the procedure so long as the medical practitioner is in overall control.

The Training Objectives of the new Syllabus are an overview of the medical, social and legal aspects of practice. The trainee is required to understand his or her role in the service and the need to refer to other specialists, as well as the wider aspects of abortion care in the development of their local services.

The knowledge, skills, attitudes and competencies covered are: ethics and law, pre-assessment care, physical and psychological risk factors, clinical examination, methods of abortion, management of complications, early and late post procedure care, contraception and sexual health issues, understanding the patient’s perspective, communication, the non-judgemental approach and service networking.

The Training Components are made up of entry criteria, training programmes, the role of the Principal Trainer and Training Centre, a logbook, assessments, completion of training and revalidation. Candidates will gain experience by case reviews, clinical activity, and observed consultations. There will be tutorials on practice and topics from books, journals and the web and the use of role play.

The new Syllabus defines Competence levels. For example, direct supervision of surgical procedures should involve a minimum of 5 cases, if experienced, but 20 if no previous experience. The trainer will then sign that the competency has been achieved and the practitioner may undertake independent practice. Objective clinical assessment makes use of the current trend to label training assessments – for example, CbD = case based discussion, OSATS = Objective Structured Assessment of training, Mini-CEX = Clinical evaluation exercises.

There will be recognised centres and networks for Subspecialty Specialist Registrar training in Sexual and Reproductive Health including Principal Trainers for Certificates in Abortion Care. This new Syllabus will also direct the need for a comprehensive induction and training package for new medical, nursing and other staff and will also aid ongoing Continuous Professional Development.

bpas fully supports the new Syllabus from the Faculty of Family Planning and Reproductive Health Care and looks forward to playing a major role as a training centre.

See: Syllabus and Logbook for the Certificate in Abortion Care of the Faculty of Family Planning and Reproductive Health Care of the Royal College of Obstetricians and Gynaecologists.  RCOG London (2006) For further information visit www.ffprhc.org.uk