Approaches to a crisis in early pregnancy: an explorative qualitative study of medical students and doctors in training in Ireland, using a story completion model.

Abstract\nPlain language summaryA crisis in early pregnancy can be due to an unplanned pregnancy or a suspected abnormality. Pregnant people have the right to unbiased and comprehensive advice of all options from healthcare providers. Using story completion models (SCM), the aim of this qualitative study was to explore the attitudes of medical students and doctors in training towards crisis pregnancy, specifically two scenarios: early unplanned pregnancy and fatal fetal abnormality (anencephaly). Participants were invited from medical students attending University College Dublin (UCD) and trainees in Obstetrics and Gynaecology in the Royal College of Physicians of Ireland (RCPI) from July to December 2022. SCM involve giving the consenting participant an introduction to a hypothetical situation that acts as the beginning of a story and asking them to complete it. Stories were compiled and analysed using thematic analysis. Research Ethics Committee approval was given by both UCD and the RCPI. The standards for reporting of qualitative research guidelines were followed. Eight doctors in training and six medical students consented to participate in the study; all but two medical students completed both stories to the required word count, giving 25 stories for analysis. For both situations, stories described a variety of approaches, all of which were based on the person, or couples wishes, from continuing in pregnancy to deciding to end the pregnancy. SCM allowed detailed analysis of potentially sensitive subjects such as pregnancy options. This study showed that participating medical students and doctors in training recognise that pregnant people have the right to all choices in crisis pregnancy.There are several reasons that a person may have a crisis in early pregnancy. Some people may not have planned to become pregnant and need counselling on their options. Others may suspect that there is a problem with the pregnancy. People who are in a crisis deserve kindness, compassion, and information. This is a very emotional area and can be difficult to research. People may give different answers from what they think. A story completion study is a way of overcoming this. People read a couple of sentences and are asked to decide how they would finish off the story. This can suggest what they really think, rather than what they think people want them to say. For this study we gave two stories. One story described a pregnant person with an unexpected pregnancy, and the other described a person who discovers that their baby has anencephaly. This is a problem where the baby’s head does not develop. Six medical students and eight doctors training to work with pregnant people took part in this study. Almost everyone completed both stories, giving 25 stories for us to study. For both situations, the students and doctors based their story on the patient’s emotions and thoughts about their pregnancy and their wishes. This could be anything from continuing in pregnancy to deciding to end the pregnancy. This study suggests that the participants recognised all choices in crisis pregnancy and that the most important factor was what the person wanted to do. [ABSTRACT FROM AUTHOR]