FABM Training in Medical Education: Student’s Perceived Functionality of an FABM Elective

Background: Fertility Awareness Based Methods (FABMs) are methods used to track fertility by external signs with various biomarkers, such as cervical mucus, basal body temperature, and more. FABMs can be used by a couple to achieve or avoid pregnancy. FABMs have particularly been increasing in demand in recent years, as evidenced by various smartphone applications rising on the market, one of which even being FDA approved in 2018. Despite this increase in demand, medical education has notoriously not included FABMs in their curricula, due to the misconception that they are ineffective when compared to artificial birth control.

Purpose: The objective of this study was to determine which factors determine the functionality of an FABM elective with the goal of integrating the training into medical school curricula.

Methods: The optional online elective, FABMs for Family Planning and Women’s Health, was delivered from August 2020 to May 2023. Students completed pre- and post-knowledge surveys. A non-saturated binomial logistic regression was performed to determine which factors influence the students’ perceived functionality of FABMs.

Results: A total of 67% of students who completed the pre- and post-surveys reported receiving FABM education in their professional program, while 33% reported receiving no education on FABMs (n=452). Additionally, 33.4% of participants received FABM training in some form outside of their professional program, while 66.6% of participants did not. The criteria of a “functional” FABM program were defined by the student responding that they would recommend the FABM elective and that they will seek further FABM training after completing the current FABM elective. A non-saturated binomial logistic regression was performed to ascertain the effects of 9 independent variables and the likelihood that the student acknowledged the FABM elective as being functional. The logistic regression model was statistically significant [χ2(2) = 35.789, p < 0.001], and it explained 15.1% (Nagelkerke R2) of the variance in program functionality while classifying 71% of the cases correctly. The sensitivity of the model was 98% and the specificity was 7.1%. Of the 9 independent variables, two of them were statistically significant predictors of program functionality: receiving FABM training outside of medical school and the student’s specialty interest. Students who received FABM training outside of medical school had 3.90 times higher odds to perceive the FABM elective as functional compared to those students who had not received FABM training outside of medical school. Within this, students interested in family medicine or OB/GYN had an increased likelihood of perceiving the functionality of FABMs electives by a factor of 1.22 compared to students interested in psychiatry or those who were undecided.

Conclusion: It is important for medical school curricula to include FABMs training/electives because exposure can determine the receptiveness and perceived functionality of practicing with FABMs. Implementation of FABMs in medical school curriculum is critical to increase perceived practicality, particularly in students interested in fields pertaining to women’s health. It is necessary to increase awareness of family planning and infertility treatment options for women seeking alternatives to current standards of care.