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      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

      research-article
      a , b , c , d
      Sexual and Reproductive Health Matters
      Taylor & Francis
      story completion, abortion care, medical students, doctors in specialist training

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          Abstract

          A 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 at the Royal College of Physicians of Ireland (RCPI) from July to December 2022. SCM involves 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 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's, or couple's, 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.

          Plain language summary

          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 trained 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.

          Résumé

          Une crise pendant une grossesse en début de grossesse peut être due à une grossesse non désirée ou à une suspicion d’anomalie. Les personnes enceintes ont le droit de recevoir des conseils neutres et complets sur toutes les options de la part des prestataires de soins de santé. En utilisant des modèles de complément d’histoire, cette étude qualitative avait pour but d’explorer les attitudes des étudiants en médecine et des médecins en formation à l’égard des grossesses non planifiées et non désirées, plus précisément deux scénarios: une grossesse précoce non désirée et une anomalie fœtale mortelle (anencéphalie). Les participants ont été sélectionnés parmi les étudiants en médecine fréquentant le University College Dublin (UCD) et des médecins se formant en obstétrique et gynécologie au Royal College of Physicians of Ireland (RCPI). Les modèles de complément d’histoire consistent à présenter au participant ayant donné son consentement une situation hypothétique qui sert de début à une histoire et à lui demander de la compléter. Les histoires ont été recueillies et traitées à l’aide d’une analyse thématique. L’UCD et le RCPI ont donné l’approbation du Comité d’éthique de la recherche. Les normes de rapport établies par les directives sur la recherche qualitative ont été respectées. Huit médecins en formation et six étudiants en médecine ont accepté de participer à l’étude; tous à l’exception de deux étudiants en médecine ont complété les deux histoires avec le nombre de mots requis, ce qui a produit 25 histoires à analyser. Pour les deux situations, les histoires décrivaient une variété d’approches, toutes fondées sur les souhaits de la personne ou du couple, depuis la poursuite de la grossesse jusqu’à la décision de l’interrompre.

          Resumen

          Una crisis en las etapas iniciales del embarazo puede deberse a un embarazo no planificado o a una anormalidad sospechada. Las personas embarazadas tienen derecho a recibir de profesionales de salud asesoría integral sin prejuicios sobre todas las opciones. Utilizando modelos de conclusión de historias (MCH), el objetivo de este estudio cualitativo era explorar las actitudes de estudiantes de medicina y médicos bajo capacitación sobre los embarazos en crisis, en específico dos escenarios: embarazo temprano no planificado y anormalidad fetal mortal (anencefalia). Se invitó a participar estudiantes de medicina que asisten a University College Dublin (UCD) y médicos bajo capacitación en el departamento de Ginecología y Obstetricia del Royal College of Physicians of Ireland (RCPI). El MCH implica dar a la persona que consiente en participar una introducción a una situación hipotética que actúa como el principio de una historia y pedirle que la concluya. Se recopilaron y analizaron historias utilizando el análisis temático. Tanto en UCD como en RCPI, el Comité de Ética de Investigación autorizó el estudio. Se cumplieron las normas de rendición de informes de las directrices de investigación cualitativa. Ocho médicos bajo capacitación y seis estudiantes de medicina consintieron en participar en el estudio; todos salvo dos estudiantes de medicina concluyeron las dos historias con el número de palabras exigido, lo que dio un total de 25 historias para su análisis. En ambas situaciones, las historias describían una variedad de abordajes, todos basados en los deseos de la persona o de la pareja, que variaban desde continuar el embarazo hasta decidir interrumpirlo.

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          Most cited references59

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          Using thematic analysis in psychology

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            Standards for reporting qualitative research: a synthesis of recommendations.

            Standards for reporting exist for many types of quantitative research, but currently none exist for the broad spectrum of qualitative research. The purpose of the present study was to formulate and define standards for reporting qualitative research while preserving the requisite flexibility to accommodate various paradigms, approaches, and methods.
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              Thematic analysis of qualitative data: AMEE Guide No. 131

              Thematic analysis is a widely used, yet often misunderstood, method of qualitative data analysis. It is a useful and accessible tool for qualitative researchers, but confusion regarding the method's philosophical underpinnings and imprecision in how it has been described have complicated its use and acceptance among researchers. In this Guide, we outline what thematic analysis is, positioning it in relation to other methods of qualitative analysis, and describe when it is appropriate to use the method under a variety of epistemological frameworks. We also provide a detailed definition of a theme, as this term is often misapplied. Next, we describe the most commonly used six-step framework for conducting thematic analysis, illustrating each step using examples from our own research. Finally, we discuss advantages and disadvantages of this method and alert researchers to pitfalls to avoid when using thematic analysis. We aim to highlight thematic analysis as a powerful and flexible method of qualitative analysis and to empower researchers at all levels of experience to conduct thematic analysis in rigorous and thoughtful way.
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                Author and article information

                Journal
                Sex Reprod Health Matters
                Sex Reprod Health Matters
                Sexual and Reproductive Health Matters
                Taylor & Francis
                2641-0397
                21 October 2024
                2024
                21 October 2024
                : 32
                : 1
                : 2419150
                Affiliations
                [a ]Consultant Obstetrician, National Maternity Hospital Dublin , Dublin, Ireland; Associate Professor, University College Dublin (UCD) Perinatal Research Centre , Dublin, Ireland
                [b ]Consultant Obstetrician, University College Dublin (UCD) Obstetrics and Gynaecology, UCD Perinatal Research Centre , Dublin, Ireland
                [c ]Consultant Obstetrician, Obstetrics and Gynaecology, Cork University Maternity Hospital , Cork, Ireland
                [d ]Researcher, University College Dublin (UCD) Obstetrics and Gynaecology, UCD Perinatal Research Centre , Dublin, Ireland
                Author notes
                Article
                2419150
                10.1080/26410397.2024.2419150
                11721858
                39429030
                a1e9a9c1-2d05-4d29-bfb7-50d633f41043
                © 2025 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent.

                History
                Page count
                Figures: 2, Tables: 1, Equations: 0, References: 64, Pages: 16, Words: 7818
                Categories
                Research Article
                Research Article

                story completion,abortion care,medical students,doctors in specialist training

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