It's nearly impossible to find a third or fourth year medical student in clinical rotation who hasn't witnessed episiotomies and had at least some didactic exposure to the procedure so routine during childbirth. It would not be uncommon for medical students to have simulated experience in performing and repairing episiotomies. Medical residents perform episiotomies. And why not? Episiotomies are one of the most common surgical procedures that women undergo. Medical students and residents should have a good education surrounding something 50% of their patients may, and often do, face.

Abortion is another of the most common surgical procedures that women undergo, but the story is far different. Statistics indicate that approximately 33% of women will have an abortion during their lives, but medical education on abortion care is spotty at best. First and second year med students rarely receive any education at all about abortion. Third and fourth year students hardly ever see abortions performed during their clinical rotations and surgical simulations in the classroom are nearly unheard of. And medical residents spend all their time at hospitals, while nearly all abortions are performed in private clinics, not hospitals.

So it's not surprising that the pool of abortion providers continues to shrink, and women often have to travel 50 or 100 miles or more to access the healthcare they need. And omnipresent threats from violent anti-choice activists can make a professional life that includes abortion provision a daunting prospect. But if medical students and residents aren't even provided the basic education about abortion and many other reproductive procedures that many of their patients will face, how can physicians be expected to give advice or treatment about some of the most routine health care needs to their patients?

Medical Students for Choice (MSFC), a nonprofit created by medical students for medical students concerned about access to reproductive health curriculum, undertook the Curriculum Mapping Project in 2003 to see exactly what reproductive education was being taught in medical schools. We learned that while most students are taught about the basics of pregnancy, it's unusual to find medical schools providing education on a wide range of reproductive topics. Abortion isn't the only thing not being taught - in fact, most medical students spend more time learning about Viagra than contraception, infertility issues, and pregnancy options counseling.

Certainly we can be outraged that our future physicians aren't being educated about abortion, but can we expect medical schools to include abortion and contraception curriculum? After all, medical school education isn't standardized, and medical students rarely get a comprehensive education about any one area. But medical schools should provide the best education around the most common medical issues - and for physicians who plan to include women in their patient load, abortion is something many of them will face. It benefits all women to expect medical schools to include information in the curriculum about a procedure that impacts them so frequently.

Medical Students for Choice works with medical students on 127 medical school campuses and in 200 residency programs throughout the U.S. and Canada to improve reproductive education. Permanent curriculum reform is a major focus - MSFC works with medical students, providing them with the materials they need to work with administrators and empowering them to make changes that will enhance their educational experience.

For instance, there were no OB/GYN residency programs at medical schools in Philadelphia that included abortion training integrated within their medical centers; however, the OB/GYN residency program at a Philadelphia medical school is providing abortion training in its medical center beginning just last month. MSFC activists on campus lobbied administrators to include this education, and pressure by MSFC's local collaborative partners has been a large part of this shift in educational policy. At another school in Oregon, MSFC activists worked with administrators to incorporate a course on women's reproductive health choices, which includes a history of reproductive rights, options counseling, and a contraception overview.

Curriculum change often starts with MSFC medical student activists sponsoring on-campus lectures on reproductive topics, including various abortion techniques (and abortion simulation using papayas); the history of abortion in the U.S. and the legal issues that impact physicians; and contraception, pregnancy options, and sexually transmitted disease. MSFC chapters organize panels on faith and reproductive choice, talks by physicians about what it's like to be an abortion provider, and arrange for shadowing days at local abortion clinics. Medical students want the exposure to the education, and administrators are many times shocked by the high attendance at these events.

However, pressure from anti-choice trustees and faculty continues to be a barrier in achieving the addition of reproductive topics to medical school curriculum. One medical school's dean refused to allow an MSFC chapter to hold meetings or sponsor events on campus, and even prohibited the chapter from notifying students of off-campus chapter meetings and events. A faculty member at another school failed a chapter member for choosing emergency contraception as a poster topic, because it was insensitive to the Catholic students in the class. Hostility and threats of violence from anti-choice students are sometimes a barrier in bringing the education to campus, as well. A fellow student threatened to shoot an MSFC member on a California campus if the chapter held events on campus, among other incidents on campuses throughout North America.

Research indicates that a medical student is far more likely to become an abortion provider if their intentions to do so are developed and cultivated in medical school. It is the single greatest predictor of future practice. So MSFC also runs the Reproductive Health Externship program to help medical students and residents get clinical exposure to abortion. The only externship program of its kind in North America, students and residents are matched with abortion providers and are required to spend a certain number of clinic hours getting first hand exposure not only to abortion, but to options counseling, contraception, and other reproductive topics. The RHE program directly increases the number of future abortion providers, and directly impacts the quality of healthcare for women.

While it is not the responsibility of any medical school to encourage practice in any particular field, MSFC feels that our future physicians should, at the very least, be provided with an education geared toward the most pressing medical issues patients may face. And if all women are to have the true freedom to choose when to have families and what those families will look like, we have to expect that our physicians are able to offer comprehensive medical care - including abortion.