Midwives and abortion care: a model for achieving competency.

Throughout history, the care of women's reproductive health needs has included termination of unwanted pregnancy. Unfortunately, access to safe first-trimester abortion is restricted by a lack of skilled providers. In an effort to provide data-based evidence and increase access to first-trimester abortion care in California, the University of California, San Francisco, under the auspices of the Health Workforce Pilot Program, developed a competency-based training model to increase the number of certified nurse-midwives, nurse practitioners, and physician assistants who can provide uterine aspiration. This article describes the training program, which uses a curriculum comprising both self-directed didactic material and supervised clinical experience with a minimum of 40 procedures. Successful completion of the program requires passing a written examination and satisfactory achievement of a competency-based clinical assessment. Thirty-eight trainees have completed the training to date, achieving competency following an average of 6 training days. Competency development in the clinical area is monitored by both the trainer and the trainee, using daily and final competency assessments in 4 domains: patient comfort, procedural completeness, speed, and ability to identify problems. Analysis of complications is used to identify concerns about clinician safety. The availability of a competency-based training curriculum for uterine aspiration has the potential to increase the number of first-trimester abortion providers by making training available to experienced clinicians, including nurse-midwives, who would like to provide this care.