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We welcome the recent BJOG Perspectives article from Ravi and colleagues
advocating for universal inclusion of stillbirth in UK medical school
curricula and their thoughtful discussion about opportunities for
medical students to contribute to perinatal bereavement
care1. We support their conclusions and offer further
justification in the form of the potential to benefit patients both in
the UK and overseas.
Stillbirth is a stigmatised and neglected problem that has been
overlooked by the local and global health agenda until very recently.
The Lancet’s Ending Preventable Stillbirths series (2016) emphasised the
medical, economic and psychological implications of the 2.6 million
stillbirths that occur annually and demonstrated the immense potential
for high-quality bereavement care to minimise associated trauma to
affected families2.
The survey conducted by Ravi et al. confirms that the Lancet’s renewed
call to action is yet to filter through to UK medical schools, where
only 57% of respondents reported that stillbirth featured somewhere in
their curriculum. This is particularly striking when considered in
numerical terms: in 2017 there were 2,873 stillbirths in the UK, a
figure that significantly exceeds the 428 deaths from HIV; but omitting
HIV from a medical school curriculum seems inconceivable.
As the authors acknowledge, the incidence of stillbirth in the UK pales
in comparison to rates in low- and middle-income countries, where the
vast majority (98%) of the international burden of stillbirth is
concentrated2. However, educating UK medical students
about stillbirth and the principles of perinatal bereavement care has
potential to translate into global benefit. Data from the latest F2
Career Destination Report demonstrate a persistent year-on-year
reduction in the proportion of F2 doctors planning to proceed directly
into specialist training in the UK (37.7% in 2018, compared to 50.4%
in 2016 and 71.3% in 2011)3. Over 15% of the 6,407
respondents stated their intention to transition from completion of F2
training to a destination outside the UK: given that the majority will
not have undertaken a Foundation Obstetrics & Gynaecology rotation and
as such are unlikely to have had specific training on stillbirth, their
medical school curriculum may represent the only opportunity to equip
them for encounters with this uniquely challenging scenario.
Finally, it is vital that any structured training programme designed to
teach medical students about stillbirth emphasises the important of
culturally sensitive care. Parents’ decision-making can be strongly
influenced by religious and social factors, and certain coping
strategies that are highly valued by parents and actively endorsed by
staff in high-income countries may not be desirable or culturally
appropriate in low- and middle-income countries. Staff should provide
information in different languages and avoid making assumptions about
parental attitudes according to their faith or ethnicity. It is also
important to acknowledge that mothers and fathers often respond
divergently to the death of their baby and fathers have specific needs
that are frequently overlooked4.
We thank the authors for bringing this issue to the attention of the
readership and hope that our additional perspectives reinforce the case
for incorporating stillbirth into UK medical school curricula.
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