A thoughtfully implemented opt-out policy is key to the success of an integrated abortion training program. Significantly more trainees receive abortion training when it is incorporated as a part of a routine training curriculum with opt-out provisions, compared to when it is elective only. In addition, training opt-out trainees may reduce abortion stigma by humanizing both patients and providers.

By including opt-out trainees in this curriculum, they will develop the knowledge necessary to provide unbiased, evidence-based reproductive health counseling and care. Providing a spectrum of potential participation and skill exposure to these trainees often results in their gaining many new skills. As learners realize that choices to provide abortion services are not always simple for providers, opt-out trainees often expand their participation through the rotation (Steinauer 2013). Studies show that trainees opting-out of abortions were able to identify specific aspects of their training that impact future patient care, specifically medical knowledge, exam, procedural, and counseling skills, and appropriate referrals and professionalism (Steinauer 2014, Freedman 2010, Nothnagle 2008). Although respect for conscience is important, refusals that constitute an imposition of religious or moral beliefs on patients, negatively affect a patient’s health, are based on scientific misinformation, or create or reinforce racial or socioeconomic inequalities are unacceptable (ACOG 2016).

The ability to provide balanced pregnancy options counseling, referral and follow-up, management of self-managed abortion, management of EPL, and contraceptive care is critical for all learners. By tailoring program content to focus on individual interest, trainees ambivalent about abortion provision can still gain critical reproductive health skills.

For opt-out or partial-participation trainees, we recommend that trainers:


Current evidence suggests that the flipped classroom approach in health professional education yields a significant improvement in student learning compared with traditional teaching methods (Hew 2018). A flipped classroom reverses traditional methods, delivering instruction online, outside of class, using interactive modalities such as this curriculum.

A growing body of literature also supports the use of simulation models in medical education (Lofaso 2011, Okuda 2009, Ziv 2003). Simulation can help learners with procedural comfort, complication management, and stress-readiness during a crisis.

Existing simulation models for uterine aspiration include anatomic and fruit models developed at the TEACH Program, such as the papaya (Paul 2005) and pitaya (Goodman 2015) models; both enable trainees to practice cervical anesthesia, aspiration, pelvic exams, IUD placement, and / or complication management.


In the role of trainer, our own interactions with patients and staff communicate our underlying philosophy. Given the sensitivity of this work, we encourage you to specifically consider the following resources to:


TEACH Abortion Training Curriculum Copyright © 2022 by UCSF Bixby Center for Global Reproductive Health. All Rights Reserved.