The College’s publish details on medical abortion perform using the abortion pill have given rise to erroneous interpretations and concerted interventions towards the College that require final clarification . Regarding the role of the College, it is useful to recall certain principles:
- The College’s mission being the protection of the public and the promotion of the quality of the practice of medicine, all the decisions taken there are mark by these concerns alone.
- As a regulatory body, the College acts independently. It does not defend any cause and does not see itself or act as a lobby organization.
- With regard to abortion, it is surprising that some doctors even thought that the College was oppose to it. The College has always promoted a best practice in terms of voluntary termination of pregnancy, and this is reflected in each of the guides published on this subject.
Regarding medical abortion perform using the abortion pill, the College quickly got involved in setting up a committee of experts to make this new option accessible to women in Quebec. Without the perseverance of the College, the involvement of other professional orders (pharmacists and nurses in particular), and the contribution of the experts and clinicians consulted, the deployment of the abortion pill would have been more difficult to update in Quebec, in particular due to the barriers. initially imposed by Health Canada.
Three subjects in particular arouse reactions in the details:
- Training requirements for physicians
- Local implementation of assessment tools
- The mobilization of other health professionals
1-Training requirements related to the practice of medical abortion perform using the abortion pill
In the clarifications release last March, some minister training needs as a restriction that only doctors performing surgical abortions could prescribe medical abortion using the abortion pill.
This interpretation is erroneous because it does not reflect the intention of the College.
The training principles set out in the clinical guidelines apply to all areas of medicine in Quebec and in no way target pregnancy terminations or their accessibility. The College has publish these directives in order to provide a framework for the training of doctors and to ensure that all people who wish to consult a doctor practicing in the field of pregnancy terminations (of which medical abortion is part) receive quality services. . The doctor who plans to offer medical abortion care must be familiar with this practice and competent to carry out the continuum of care (pre-abortion, per and post abortion assessment).
Initial training
Physicians must practice within the limits of their competence and in the field in which they have been train. With regard to the practice of terminations of pregnancy, doctors specializing in obstetrics and gynecology have received, during their postgraduate training, adequate exposure and have acquired skills in the practice of different techniques, related to their specialty. This is not necessarily the case for other specialties, except for the family doctor who will have chosen to complete a training course in pregnancy planning / termination during his residency.
The field of terminations of pregnancy constitutes a particular field of family medicine and other specialties. Any doctor (other than those already train in the field of termination of pregnancy or obstetrics and gynecology) starting a medical abortion practice must inform the College, since this is a modification of his practice that could require the successful completion of a training course.
Training of practicing physicians
The College requires its members that before practicing in a field of practice, they have complete theoretical and practical training adapt to this field of practice.
Consequently, the doctor who wishes to offer medical abortion care must have acquired adequate initial training (theoretical and practical), or follow an appropriate update as the case may be (for example, for a specialist doctor who has achieve the objectives during the ‘initial training but not having performed clinical activities for some time). The training can be adapted to the procedures or techniques used (medical abortion only, surgical abortion technique, etc.).
The College’s Practice Improvement Department, well aware of the variability of practices in the field of abortions, regularly organizes internships in the field of pregnancy planning / termination and has the experience to adapt the objectives of internship according to the clinical reality of the doctor, his needs and the standards in force.
The formation continues
Physicians with initial training, as well as those already practicing in the field of termination of pregnancy, must ensure sufficient clinical exposure to maintain their clinical skills. They must also ensure that they maintain their skills by participating in recognize continuing education activities specific to the field of abortion, including those relating to medical abortion.
Any accredit training allowing an upgrade of knowledge is encouraged by the College. This continuing education can be done through various tools. It is up to physicians to determine the training tool that best meets their needs in terms of acquiring knowledge or skills, in particular on medical abortion.
If good quality online training tools are available to cover theoretical knowledge on medical abortion, it would be appropriate to adapt these tools so that they take into account at least the normative framework applicable in Quebec (examples of correction to bring: no pass mark is require to be able to prescribe a drug in Quebec, follow-up obligation for the doctor who initiates care, etc.).
In this regard, the medical federations have undertaken to help make such training available.
| In summary |
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| Medical abortion care perform using the abortion pill is not limited to physicians who perform surgical abortions, but can be offered by any physician who has been train in the above standards. The basic principles surrounding the supervision of medical training allow us to guarantee the require competence to anyone who wishes to consult a doctor practicing in the field of pregnancy terminations (of which medical abortion is a part). The person is thus assure that they will receive optimal quality services. Contrary to what is convey, this is not a “position of the College”, but the professional reality in force in Quebec and which applies to any new professional activity. |
2-Local implementation of assessment tools
In this regard, the College was question about the “compulsory” establishment of local registers on medical voluntary terminations of pregnancy (abortion). This initiative was perceive by some as an intrusion by the College into the current activities already present to assess the quality of the act in all abortion settings. In addition, this requirement would have acte as a brake on the introduction of medical abortion in certain establishments, due to the need to satisfy an administrative procedure perceive as cumbersome.
Rather, through this initiative, the College wante to promote a certain uniformity in the evaluation of the quality of the act. Several tools are suggest by the College in different sectors of activity. The register propose here should not therefore be confuse with the formal obligation of a register impose by a regulation, with the administrative proceures which follow. The intention in the present context is above all to encourage a common reflection on the practices in order to be able to identify the complications and the difficulties in the follow-up of the patients.
The culture of quality evaluation is omnipresent among physicians who practice in the field of abortions. The College will continue to work with these physicians to better identify the difficulties surrounding the deployment of medical abortion.
| In summary |
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| The College reaffirms, as was written in the clinical guidelines publish in December 2017, that the objective pursue by the registries was to locally provide an evaluation tool allowing the community to continuously analyze the quality of interventions (complications, quality of follow-up, etc.) and not to impose an additional constraint or, worse, to establish a list of patients who chose abortion. |
3-The mobilization of other health professionals
Finally, seeking to compare and standardize the models of abortion services in Canada, the College is criticize for not allowing specialize nurse practitioners (IPS) and midwives to prescribe the abortion pill.
In this regard, it is important to emphasize that the regulations in force and the recent publication of the guidelines on the practice of IPS in no way prohibit the practice of medical abortion by the IPS, provide that it works in partnership with one or more doctors who practice in the fields target by this practice. As for midwives, this is an autonomous professional order. The list of drugs that may be prescribe by midwives is subject to regulatory provisions. It is therefore up to the government to modify these regulations, in the event that the prescription of the abortion pill by midwives is consider.
Aware of the importance of interdisciplinarity, the College did not hesitate to include representatives of the Ordre des informers et informer’s du Québec and the Ordre des pharmacies au Québec in the committee dealing with the work for the deployment. of the abortion pill, as well as in the monitoring committee.
With regard to the organization of services and the distribution of the abortion pill and other drugs use during surgical abortions, the Order of Pharmacists and the College have agree on a new provision in the Regulation on the supply of drugs. by an establishment to ambulance technicians to regularize the current situation and allow doctors working in a clinic offering termination of pregnancy care to locally distribute certain drugs.