Introduction
As part of its dedication to furthering sexual and reproductive health care and rights in Europe, the ESC aims to improve and facilitate knowledge and use of contraception and improve abortion care. To this end, six times a year, the society publishes The European Journal of Contraception and Reproductive Health Care (EJCRHC), containing original, peer-reviewed research papers as well as review articles and other appropriate educational materials.
Since 1990, in Paris, an international congress has been organised every 2 years, the last being held in Budapest, Hungary, in May 2018. The next congress will be held in Ghent, Belgium, in September 2021. The ESC also participates at many other congresses and meetings, such as those of the International Federation of Gynaecology and Obstetrics (FIGO), the International Federation of Professional Abortion and Contraception Associates (FIAPAC), the European Board and College of Obstetrics and Gynaecology (EBCOG) and the International Society of Gynecological Endocrinology (ISGE), and regularly organises pre-congress courses. Besides biennial seminars in different countries, other educational activities have included workshops in Hungary, Serbia, and Bosnia and Herzegovina. These workshops have attracted young doctors from different countries in the region, who often have an unmet educational need in the field of contraception and sexual and reproductive health.
Over the years, the ESC has published a number of statements on contraceptive issues (https://escrh.eu/education/statements/). In 2019, a position paper on sexual and reproductive health and rights (the Madrid Declaration) was launched on World Contraception Day (https://escrh.eu/wp-content/uploads/2019/11/ESC-Position-Paper-LV-October.pdf). In 2020, the society adopted resolution 2331 of the Parliamentary Assembly of the Council of Europe: ‘Empowering women: promoting access to contraception in Europe’ (https://escrh.eu/resolution-adopted-empowering-women-promoting-access-to-contraception-in-europe/). The ESC has collaborated since its beginning on the Contraception Atlas project, an initiative supported by the European Parliamentary Forum for Sexual and Reproductive Rights in partnership with a group of experts in sexual and reproductive health and rights who designed the questions and structures (https://www.contraceptioninfo.eu/).
Teach the teachers courses: a step forward
Working with WHO guidelines is highly efficient, but modern contraceptive counselling demands a greater depth of education: health care professionals (HCPs) should understand the reasons behind WHO categories 1, 2, 3 and 4 and the number of potential adverse events where the use of a particular method is restricted. On the one hand, the figures are helpful to remove myths about contraceptive hormones and infertility, cardiovascular and cancer risks; on the other, they facilitate assessment of the risk–benefit balance based on the individual profile of each woman.
In close collaboration with the European WHO representatives Mario Festin, from Geneva headquarters, and Gunta Lazdane, from the European regional office, a first set of slides was created in 2016 which built further on the WHO tools. A Teach the Teachers (TTT) course was developed, in which representatives from countries with high unmet needs for advanced teaching materials about contraception are educated using slide sets, which they may then use after the course to carry out local educational activities. Two TTT courses took place, in 2017 and 2018, both in Belgrade, Serbia, consisting of two full days of training, with interactive stations and mock consultations/simulations. A pre-congress TTT course was organised at the 15th ESC congress in Budapest, Hungary. TTT lectures have been held at EBCOG congresses in Antalya, Turkey (2017), and Paris, France (2018), and at an ESC seminar for doctors in St Petersburg, Russia (2017), as well as at the ESC congress in Basel, Switzerland (2016). In Moldova, a 1 day TTT event was organised for top-level stakeholders from the Commonwealth of Independent States, for which the slides were translated into Russian, since in these countries Russian is often the language of education.
Training improvement programme
On 4 May 2019, the organisers of the TTT course and members of the ESC executive committee established an ESC educational programme group with the mission statement ‘To improve sexual and reproductive health care through training of health professionals in Europe’. Based on the TTT slide sessions, a training improvement programme was developed, not only for teaching but also for self-study (https://escrh.eu/education/training-improvement-programme/). The TTT slide sets covering 19 modules were made available free of charge on the ESC website (https://escrh.eu/education/training-improvement-programme/table-of-content/). The slides are regularly updated with the most recent information and promoted in the ESC newsletter and through social media. Free access to the TTT slide course is also available to non-members of the ESC. The average annual hit rate is over 1000.
The programme does not provide new guidelines but enables the clinician to understand the background of the WHO medical eligibility criteria for contraceptive use and be aware of possible complications and the importance of taking a complete patient history to avoid serious adverse events. The intention is thus to facilitate and improve clinical decision making in daily practice as well as in more unusual situations.
The slide contents are based on the most recent evidence, and references are provided to enable HCPs to deepen their knowledge. The programme also includes five sessions about contraception in women with medical conditions as well as case studies and a quiz. As it is an advanced training programme, less experienced nurses and doctors are advised to study the USAID/WHO/UNFPA training tools (www.fptraining.org/) before enrolling on a course. This self-study concept allows all interested professionals, both ESC members and non-members, to use the programme for self-training and updating their knowledge about contraceptive methods.
The ESC welcomes opportunities for educational partnerships with countries or regions. Members may send an email to the central office ([email protected]) if they wish to organise a course with the support of the training improvement programme.
More recent ESC training activities
As a society we have been looking at new, interactive ways of engaging with our members. Recently the ESC executive committee and the educational group initiated the use of tools such as webinars for providing online continuing education (https://escrh.eu/education/webinars/). The first ESC webinar was held on 30 June 2020, entitled ‘Contraception in COVID time’, with presentations on ‘Challenges in reproductive health and contraception in COVID time’ and ‘Innovation: new estrogen-free contraceptive choices’. The second webinar was on ‘Breast cancer risk associated with hormonal contraception and menopause hormone treatment’, held on 16 September 2020. The next webinar on ‘Emergency Contraception’ is planned to take place on 18 November 2020.
A COVID-19 resource has been opened on the ESC website with links to relevant publications on SARS-CoV-2 infections related to contraception and sexual health (https://escrh.eu/education/covid-19/). The chapter is continuously updated.
Recently, the ESC introduced an interactive forum for a threaded discussion on matters relating to sexual and reproductive health. The society has partnered with DocMatter to create an interactive online forum for high-quality clinical discussions among our members; a profile is created for each ESC member within DocMatter. This online clinical community of peers is a resource to collaborate, share best practice and disseminate important information about contraception, abortion care and other related topics as well as peer-to-peer education. DocMatter provides personalised support and facilitates discussions to decrease the time and effort required to collaborate and referral back to discussions in the future.
In close cooperation with EBCOG, the ESC is developing a curriculum and training programme in sexual and reproductive health care including family planning: contraception, counselling and care, abortion care; preventive care (sexually transmitted infections, infertility, cancer, cardiovascular diseases); and sexual health care (sexual violence, sexual dysfunctions). The curriculum will address the educational and training needs of HCPs on two levels:
Level 1: sexual and reproductive health and rights for HCPs who provide clinical care (nurses, midwives, general practitioners, community gynaecologists);
Level 2: sexual and reproductive health care for HCPs who provide specialised care, leading services, policy-makers and programme developers (gynaecologists, public health specialists, policy-makers).
The curriculum will be competence-based with learning objectives and a modular three-dimensional structure (knowledge, skills and attitudes). The teaching methodology includes web-based learning and face-to-face educational courses. The faculty consists of experts in the various fields under the guidance of the steering committee comprising EBCOG and ESC experts. A textbook based on the curriculum is currently being written by an international team and edited by Professor Johannes Bitzer (ESC) and Professor Tahir Mahmood (EBCOG), in collaboration with Cambridge University Press. Participants in the level 1 programme can obtain a diploma in sexual and reproductive health care by passing a written and practical exam organised by EBCOG in collaboration with the ESC. Participants in the level 2 programme can become a fellow in sexual and reproductive health care by delivering a short thesis and passing a written and practical exam organised by EBCOG in collaboration with the ESC. The educational programme is due to start at the end of 2020.
Conclusion
To improve knowledge on contraception and sexual and reproductive health and further understanding of sexual and reproductive rights among HCPs in Europe and beyond, the ESC has recently extended its existing educational tools (such as the EJCRHC, international congresses, meetings and courses) to include a training improvement programme, interactive webinars, a DocMatter discussion platform, and collaboration with EBCOG to develop and establish exams to harmonise and certify standards of training in sexual and reproductive health care across Europe.