You already know that fertility awareness methods (also known as fertility awareness-based methods or FABMs) can be effectively used to achieve or avoid pregnancy. You may also know that the American College of Obstetricians and Gynecologists (ACOG) has called the female menstrual cycle a key vital sign, (sometimes called the “fifth vital sign”) because of its ability to reveal information about the health and function of the reproductive system and the body overall [1]. We also know that far more women are open to learning FABMs than currently utilize them. A 2018 survey of 665 women found that 58% expressed interest in using FABMs for family planning and 42.8% were interested in FABMs for health monitoring [2].
Yet, physicians are often hesitant to endorse FABMs or promote them to their patients because the formal tracking of fertility biomarkers (like basal body temperature and cervical mucus), via FABMs, is not a part of standard medical school education.
Dr. Marguerite Duane, a board-certified family physician and now-Director of the Center for Fertility Awareness Education and Research at Duquesne University College of Osteopathic Medicine (DUQCOM), set out to change this when she and a team began offering medical students an online elective on FABMs for family planning and health monitoring through Georgetown University. A research study Dr. Duane and her team published in 2024 found that even a short online elective can expand medical students’ knowledge base dramatically and shift their openness to offer FABMs to future patients [3].
How the Georgetown fertility awareness elective came to be
The Georgetown University elective began in 2018 as a 2-week course available to healthcare professional students across the country. As a Georgetown University adjunct professor at the time, Dr. Duane was offered the opportunity to teach an elective for healthcare professional students on women’s health. Given her position as the co-founder and Executive Directors of FACTS (a group of physicians, healthcare professionals and educators working together to provide information about natural or fertility awareness based methods of family planning with the medical community), Dr. Duane chose FABMs and their uses as her elective topic, because she knew that the need for education on FABMs amongst medical students was great.
Patients want their doctors to know about FABMs
Dr. Duane also knew there would be great interest from these medical students’ future patients about FABMs. Previous research has established that patients want their physicians to know more about FABMS, because many hope to use them for family planning [4].
Medical students seek a broader array of tools for women’s health issues…
Increasingly, Dr. Duane found that interest from future healthcare professionals themselves was also great. Participation in the course steadily increased and then exploded during the pandemic. When Dr. Duane asked the students why they enrolled, 93% said that they hoped to utilize FABMs to provide patients with “more comprehensive approaches to reproductive health issues.”
One student shared, “I was surprised how little I had learned about reproductive health and was excited to learn more, not just to treat my patients but also for my own use.”
Another spoke to FABMs’ ability to assist in the treatment of infertility: “I came into this elective almost blind on this topic so, to be honest, most of the course was a surprise/huge benefit. I didn’t know how effective and evidence-based the FABMs are. I also had no idea how helpful cycle tracking could be for couples struggling with infertility.”
Medical schools offer little in the way of FABM education
And yet, Dr. Duane knew that doctors—no matter whether they are pursuing a Medical Doctor (MD) or Doctor of Osteopathy (DO) degree—are rarely educated on FABMs in medical school. Instead of gaining knowledge and experience about the benefits of FABMs, medical students are instead commonly instructed to prescribe birth control pills for issues like PCOS or IUDs for pregnancy prevention, for example. If these students hear about FABMs at all, they might hear about them after graduating medical school, during residency. This was the case for Dr. Duane herself. She first encountered FABMs and their many benefits while working with a senior resident who utilized them for her own patients.
A research study was necessary to demonstrate the elective’s impact
Despite great popularity and excellent feedback from elective participants, some schools were hesitant to include the elective course credits on these students’ transcripts, and Dr. Duane struggled to get the funding one would expect for such a successful course. She recognized that “to really establish the credibility of the elective… it was important to demonstrate it from a research perspective.” So that is exactly what she and her team did.
From 2020 to 2023, Dr. Duane and colleagues offered the elective on FABMs to a total of 571 medical students and nursing students (the majority were medical students) from 103 medical schools across the country. The aim of the study was to evaluate whether the elective improved student knowledge of FABMs, their confidence in offering them to patients, and the likelihood that they would do so in the future. Participants enrolled in either a 2-week or a 4-week version of the elective, which was entitled “FABMs for Family Planning and Women’s Health.” The format of each version “combined live online presentations, online self-directed presentations, live case-study discussions, and in-person and telemedicine clinical experiences, [which were] all supplemented with peer-reviewed research.”
My role in the FABM elective study
Once medical students become practicing physicians, their time discussing FABM options with patients is understandably limited. They are far more likely to offer them if they have qualified fertility educators to do the formal instruction and charting follow-up for them. With this in mind, one requirement of the Georgetown elective was for students to observe fertility awareness instruction led by trained fertility educators.
Being a Certified FertilityCare Practitioner myself, I had the opportunity to participate in the elective as a fertility education preceptor. Students could join me as I offered education to women and couples learning the Creighton Model System. This gave the students the opportunity to see instruction in action and hear from women and couples utilizing fertility education.
As a preceptor, I was struck not only by the interest among the medical students to stay engaged and ask questions, but also by clients who willingly agreed to have unknown medical students observe their sessions. Again and again, clients eagerly consented out of a desire to spread awareness and increase access to these services and their reproductive health benefits.
Increasing the use of fertility awareness-based methods in practice
In order to make FABMs more accessible through the medical system, education is essential to provide knowledge to and instill confidence in medical professionals. Dr. Duane’s study found that the elective significantly increased both. Of the 571 participants, 81% completed both pre- and post-test surveys, which revealed a statistically significant improvement in students’ knowledge and confidence in FABM use after attending the elective.
Dr. Duane says that a marked knowledge increase is not all that shocking. Medical students often have no other access to FABM education, so an elective would naturally increase their familiarity and confidence on the topic. Separate research previously showed a similar significant increase in knowledge after medical students attended just two short seminars on FABMs [5].
Fertility awareness elective participants were much more likely to offer FABMs to most or all women
The thing that’s more exciting, says Dr. Duane, is the radical change in perspective from the students. At the start of the class, many stated that they would not mention FABMs to patients, or would do so with reservations. By the end of the elective, 76% said they would offer FABMs as an option for most or all women. They also said they were significantly more likely to utilize FABMs to manage reproductive health issues, like PCOS. This is a remarkable shift!
At the start of the class, many stated that they would not mention FABMs to patients, or would do so with reservations. By the end of the elective, 76% said they would offer FABMs as an option for most or all women. They also said they were significantly more likely to utilize FABMs to manage reproductive health issues, like PCOS.
Future research will clarify whether students’ new knowledge translates to clinical practice
“It does appear that [FABM education] will change student behavior based on their intended plan for practice…” says Dr. Duane, “but we don’t know that they actually will.” In future studies, she hopes to investigate how FABM education affects clinicians’ actual actions and the treatments they offer their patients. Will educated medical students continue to offer these services once they are practicing? If not, is it because they no longer believe in their effectiveness, or because they have no further opportunities to grow in their application and use?
The bottom line
The Georgetown fertility awareness elective research is good news for women. It demonstrates that with only a few short weeks of education and exposure, medical students are more knowledgeable, more confident, and more likely to regularly and consistently recommend FABMs in their future practice. Women deserve access to fertility awareness-based methods, and educating the medical community is a vital step in the right direction.
Additional Reading:
Misconceptions your doctor might have about FAMs and how to respond to them
Why do so many doctors prefer birth control to fertility awareness methods?
