APGO

Abigail A. Delaney, M.D.
University of Louisville and University of Nebraska Medical Center, Louisville, KY

Study Objectives: Assisted Reproductive Technology (ART) has long been a source of controversy. Despite this, greater than 2% of all infants born in the United States yearly are conceived using ART. We conducted a survey to assess both the beliefs of those in training with regard to ART and the status of ethics education within US Ob/Gyn residency programs. The last survey of Ob/Gyn residents regarding ethics education was published in 1994 and did not assess education regarding ART.

Methods: The survey was developed with the help of the University of Nebraska Medical Center’s College of Public Health and the Ethics Committee from the American College of Obstetricians and Gynecologists (ACOG). It consisted of 25 questions covering patient demographics, specific ethical scenarios and referral for ART, and ethics education. The survey was sent electronically to all enrolled US Ob/Gyn residents using the ACOG database in October 2010.

Results: 285 surveys were returned. Among the respondents, 77 (27%) were in their first year of residency while 66 (23%), 74 (26%) and 68 (23.9%) were in years 2, 3, and 4, respectively. Mean age of respondents was 29.8 with a range of ages 25-44. 238 (87%) were female, and 204 (76%) were Caucasian. All states with residency programs were represented except for Iowa and Mississippi. Religious preferences of respondents were as follows: Roman Catholic (23%), Non-Evangelical Protestant (17%), all other religions (24%), Atheist/Agnostic (11%), none or no religious preference (25%). Upon analysis of the clinical scenarios posed in our study, the following percentages of respondents would not recommend referral for ART: patient’s partner is female (8%), patient is not married (11.6%), patient plans to be a single parent (14.4%), patient has 5 healthy children (38.7%), patient has HIV (40.4%), patient’s life expectancy is <5 years (74.7%), patient is 50 years old (75.9%) and patient with 25% risk of death in pregnancy (91.7%). With regard to residency program characteristics, only 30% of respondents stated that their program addressed bioethics. Thirty-six percent felt inadequately trained to deal with ethical issues such as those posed in our clinical scenarios. The survey revealed the following statistically significant findings: 1) those with more frequent religious attendance gave more weight to the importance of religion in medical decision making (p < 0.001) and 2) those with more frequent religious attendance were less likely to have an intention to recommend ART (p=0.037).

Conclusions: 1.) At the resident physician level, attendance and participation in religious activities influences medical decision making and adversely affects referral for ART. 2.) The data suggests that a more robust and comprehensive reproductive ethics curriculum including ART needs to be implemented in U.S. residency programs.

Key Words: Assisted Reproductive Technology, Ethics education