New Gaps and Urgent Needs in Graduate Medical Education and Training in Abortion

Abstract

Abortion is essential health care, and abortion training and education are essential at all levels of medical education. Among the most common procedures performed in obstetrics and gynecology (OB/GYN), abortion is a core competency for OB/GYN residency programs. For nearly 50 years, the procedure was federally protected by the U.S. Supreme Court’s January 22, 1973, Roe v Wade decision. On June 24, 2022, amidst increasing state restrictions limiting abortion access, the Court’s decision on Dobbs v Jackson Women’s Health Organization effectively reversed Roe. As a result, immediate bans on abortion went into effect across the country, removing access to abortion for millions of people and newly limiting training and education in this core competency for many medical residents. As of June 2022, nearly half of U.S. OB/GYN residency programs and more than 40% of residents are located in states that have banned or are likely to ban abortion. In states where abortion is restricted or illegal, states must adapt quickly to ensure their residents meet training requirements. This adaptation may include developing and leveraging relationships with programs in states where access is protected, depending on simulation, and placing greater emphasis on education and training in pregnancy loss management and postabortion care. None of these is a comprehensive solution and even all together, they are insufficient to train residents and medical students. Ultimately, many future physicians will not receive the training they need to provide full reproductive health care to their pregnant patients. Legal and other systems of support are needed to ensure that current and future physicians can provide compassionate, evidence-based reproductive health care, including essential abortion care.

Abortion providers in the United States: expanding beyond obstetrics and gynecology

“… 32 One-third of the 89 Ryan Programs are in restrictive states with strict abortion laws. 33 These statistics do not include residents in other specialties, such as the 42 of 745 total FM programs that offer abortion training, whose education will also be affected by the Dobbs decision. 32 , 34 Newly imposed restrictions will further limit the opportunities for those trainees to learn how to provide lifesaving medical care.…”

“…Despite these restrictions, the ACGME has not lightened on its requirement for abortion training as a mandatory component of accredited obstetrics and gynecology residency programs. 33 Alternatively, it has mandated that if a program is in a jurisdiction where abortion care “is unlawful, the program must provide access to this clinical experience in a different jurisdiction where it is lawful.” 35 This has forced some obstetrics and gynecology residents who are unable to fulfill their ACGME requirements to complete rotations in states that still allow abortions and has left programs scrambling to find accommodations to maintain their accreditation status. 33 However, coordinating students to train in different locations is associated with its share of complicated logistics and financial hurdles.…”

“… 33 Alternatively, it has mandated that if a program is in a jurisdiction where abortion care “is unlawful, the program must provide access to this clinical experience in a different jurisdiction where it is lawful.” 35 This has forced some obstetrics and gynecology residents who are unable to fulfill their ACGME requirements to complete rotations in states that still allow abortions and has left programs scrambling to find accommodations to maintain their accreditation status. 33 However, coordinating students to train in different locations is associated with its share of complicated logistics and financial hurdles. Schedules need to be coordinated, program letters of agreement need to be completed, and liability insurance coverage needs to be provided through the home program.…”

“…Schedules need to be coordinated, program letters of agreement need to be completed, and liability insurance coverage needs to be provided through the home program. 33 Moreover, there are significant legal implications for physicians traveling out of state to provide abortion care. 33 …”

Considering the Effects of the Dobbs Decision on Clinical Training and Practice and on the Lives of Medical Professionals

“…35,36 Dobbs -related tension between state laws and national certification and licensure processes may require that residents travel out of state to obtain competency and meet residency objectives. 36 Approximately 10% to 15% of 5,000 students involved in a Medical Students for Choice initiative expressed interest in obtaining abortion training outside of the country, potentially side-stepping legal problems in the current practice and educational milieu of the United States. 41 The Dobbs decision may also impact how medical students and residents choose the location of their training and their specialty.…”