Religious Ethical and Cultural Impacts on the Delivery of Reproductive Healthcare: A Program for InterProfessional Education (RECIPE)


The resources and products created through this grant-funded project have been assembled into a curriculum and made available to APGO members.

This project was developed through an educational grant from the APGO Medical Education Endowment Fund Grant Program. It has not been created or peer-reviewed by APGO and therefore the accuracy of the content cannot be endorsed by the organization.

Project Title: Religious Ethical and Cultural Impacts on the Delivery of Reproductive Healthcare: A Program for lnterProfessional Education (RECIPE)

Institution: Western Michigan University Homer Stryker MD School of Medicine

Project Team: Gonzalo J. Rodriguez, Jr. MD, Robert W. Rebar, MD, Vicki R. McKinney, PhD, Michael Redinger, MD, Tyler Gibb, JD, PhD, Joan M. Porcaro, RN, BSN, MM, CPHRM

Objectives:

  1. Discuss the legal rights of reproductive patients.
  2. Identify strategies for providing healthcare for reproductive patients.
  3. Recognize how religion impacts the reproductive decision within families.
  4. Recognize how one’s personal values and opinions about different cultures, communities, personal attributes, and beliefs impact reproductive patient care.
  5. Discuss the role of the healthcare team in reproductive patient care.

Time Required: 90 minute session/ video

Equipment/Staffing Required: Computer, Video projection equipment

Instructions for module: 

  1. Put an interprofessional faculty team together to participate in the small group discussions. Send the team the date, time, room and facilitator guide for the case a week prior to the event.
  2. Set up the chairs in a U-shape or around a table (depending on size of group). Make sure everyone can see the monitor or screen.
  3. Administer the survey prior to start the session and at the end of the last session.
  4. Show the video. Do not provide learners with any details.
  5. Several of the video have multiple scenes allowing you to stop the video and discuss the case as it unfolds.
  6. After the video plays, ask the learners their reaction to the case. Warning: Some of the videos do not show the healthcare teams following best practices.
  7. The facilitator guides have suggested content and questions to help with the discussion.
  8. Enjoy the session!

Overview
This project created a curriculum for third-year medical students, which also can be used by nursing, pharmacy, and osteopathic students, social workers, and residents in primary care fields. It explores the impact of religious, ethical, and cultural influences on the delivery of reproductive health care. The curriculum, developed by a multidisciplinary task force, consists of readings, a series of short case-based video vignettes and facilitator guides to be utilized in interactive team-based case studies. Case studies include interprofessional faculty­ facilitated team-based debriefings. The curriculum explores attitudes of healthcare providers and patients with a variety of backgrounds about topics such as contraception, decisions involving pregnancies, gender identity and abortion.

This curriculum is fundamental to today’s clerkships because of the challenging ethical dilemmas facing healthcare workers in providing appropriate reproductive health care. Health care providers need to understand the belief systems of individuals of diverse religious, ethnic and cultural groups in order to counsel and manage the reproductive needs of patients appropriately. Students and other health care providers should begin by exploring their own beliefs to recognize how they might positively or negatively influence the provision of appropriate care. Working together, all members of a health care team must present consistent information and religiously, ethically, and culturally sensitive recommendations to patients.

Videos
Sixteen case vignettes were developed and produced that represent various religious, ethical and cultural issues that are commonly experienced in providing reproductive care. By design the scripts do not include the entire case and leave the case hanging to promote discussion. Many of the script dialogues written for this project by the team have the case inappropriately managed by the physician to facilitate discussion. Some of the topics explored in the cases include parental consent, informed consent, right to refuse medical treatment, sex selection, physician/patient confidentiality and social justice. The broad selection of topics allows programs to select topics that are relevant to their patient care and to their specific learning objectives.

We suggest the videos be shown to the learners at the beginning of a scheduled session. The nature of the ending of each video should then promote discussion to discuss the issues raised in the video. The number of videos produced easily permits multiple small group discussions during a rotation/course.

Facilitator Guides
Each of the sixteen videos has an easy-to-read supplementary facilitator guide. The guides are designed to generate ideas to help faculty teams facilitate small group discussions that meet the needs of their learners. Each guide includes facts to help initiate discussion, background information on the topics in the case, critical information the students should hear, suggested questions and suggested closing comments. The facilitator guides are instructional tools. Learners and faculty bring their own personal experiences into small group discussions so the guides are designed to support the patient concerns and needs the learners may have.

Materials
Have students take the Women’s Health Assessment Survey before and after the session. Download the survey.

 

Case Description Discussion Topics Video Facilitator Guide
Case 1 A 17 year old girl presents to her primary care provider because her last menstrual period was about six weeks ago. Adolescent Rights to Medical Care, Parental Consent, Abortion View Download
Case 2 A 20 year old married woman presents at 21 4/7 weeks gestation with ruptured membranes in preterm labor with a cervix 80% effaced and 2 cm dilated with contractions every two to three minutes. Abortion View Download
Case 3 A 24 year old woman married for two years presents with fever, lower abdominal pain, and cervical motion tenderness. Cultures are positive for both chlamydia and gonorrhea. Empathy, Expedited Partner Care View Download
Case 4 A 14 year old female patient comes to an OB/Gyn clinic seeking help with puberty suppression. The teenager’s mother has agreed to accompany her daughter to the clinic but has not agreed to support the minor’s request for puberty suppression. Transgender Minors, Value Choices, Parental Consent View Download
Case 5 A gay couple comes into the clinic desiring help to have a baby. Social Justice View Download
Case 6 A 28 year old pregnant woman requests an early ultrasound so she can have an abortion if the fetus is female. Sex Selection, Abortion View Download
Case 7 A 23 year old refugee arriving in labor with a compromised fetus documented by fetal heart rate monitoring refuses a Cesarean section because of her fear of dying and her family’s desire not to intervene. Cultural Beliefs, Right to Refuse Treatment, Informed Consent View Download
Case 8 A patient only wants to receive care from a female provider. Religious and Cultural Impact on Choice of Provider, Sexual Assault View Download
Case 9 Patient wants to have a natural birth and refuses standard of care when an IV is needed. Informed Consent, Patient Autonomy, Right to Refuse Treatment View Download
Case 10 Opiate dependent patient is seeking pregnancy care. Discrimination, Bias, Substance Abuse View Download
Case 11 Patient with a wanted pregnancy has an ultrasound that finds a severe birth defect (Down Syndrome). Genetic Testing, Abortion View Download
Case 12 A 15 year old new patient comes to clinic asking for contraception. Adolescent Autonomy, Confidentiality View Download
Case 13 A patient requests pregnancy termination from a physician who does not believe in abortions. Value Choices, Right to Conscience View Download
Case 14 A new patient comes to clinic for pregnancy care. During the patient history it is revealed she is a physically abused. Intimate Partner Violence View Download
Case 15 A patient finds out she is pregnant and carries the Huntington’s gene. Genetic Testing, Abortion View Download
Case 16 Pregnant patient finds out she has stage 2 cervical cancer. Difficult Decisions, Abortion View Download

 


 This project was developed through an educational grant from the APGO Medical Education Endowment Fund Grant Program. It has not been created or peer-reviewed by APGO and therefore the accuracy of the content cannot be endorsed by the organization.