OB-GYN and family medicine students face tough abortion training

Students of obstetrics and gynecology and family medicine – two of the most popular medical residency – face tough choices about where to advance their training in the context of access. Legality for abortion varies from state to state.

Abortions are usually performed by an OB-GYN or family physician, and training often includes observation and assistance with the procedure, often in an outpatient clinic. Many doctors and students are now worried about non-existent or unprofessional training in states where clinics are closed or abortion laws have been tightened after Supreme Court overturned Roe v. Wade . case.

In some cases, applicants who want to have an abortion as part of their career are pursuing residency in states with more liberal reproductive laws and can continue their career there – likely to establish less permissive states because of OB-GYN shortages, observers said.

“To choose a state where I will be limited or I will not have full access is essentially a trade-off between myself and the diseases,” said Deborah Fadoju, a fourth-year medical student from Ohio State. my future for the quality of care I can provide.” said she looked at programs along the East Coast, where many states have laws protecting abortion.

As an OB-GYN, Fadoju says, she’ll be able to “do the whole thing.”

On the other hand, students who oppose abortion can find more accommodation in residential programs in states are largely outlawed.

Dr. Christina Francis, a board member and elected CEO of the American Association of Professional Obstetricians and Gynecologists, said her organization has previously received requests from students members seek information about where they will not have to do abortion referrals.

“We now see residents and medical students who don’t want to get involved in abortion saying ‘We’re going to look for residency placements where abortion can be restricted’ because – in theory and I think this is going to happen – there should be less pressure on them.”

OB-GYN residency programs must provide training in abortion, according to the Accreditation Council for Graduate Medical Education, although residents with religious or moral objections may choose not to participate. family. A September 17 update said abortion programs that are illegal must offer that experience elsewhere. There are no similar requirements for family medicine programs.

Pamela Merritt, executive director of Medical Students for Choice, which promotes access to education about abortion, says doctors need the “muscle memory” that only hands-on education can bring, especially especially for abortion.

“How many hours do you want the hepatologist to have before they try to do a biopsy?” Merritt said. “We will never argue about how to educate people without physical patient interaction about any other major healthcare issue.”

A research team led by Atlanta’s Emory University is surveying third- and fourth-year medical students across the country and across majors about their decision to apply for residency following the subversive ruling. Roe.

The team is still analyzing the data, but early results suggest many applicants are struggling with where to pursue further training, according to medical students Emory Nell Mermin-Bunnell and Ariana Traub, who also co-founded an advocacy group advocating abortion rights.

“There’s a lot of unknowns, and it’s scary for people applying for residency,” says Mermin-Bunnell. “There are really just so many question marks, and the way healthcare is being done is changing rapidly.”

More than three-quarters of the roughly 490 respondents said access to abortion would influence their decision about where to live, the researchers said. The survey did not ask respondents directly about their views on abortion, to avoid creating bias.

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Connor McNamee, a third-year family medicine resident at the University of Toledo, began exploring abortion training outside of Ohio last summer. State law forbids most abortions after cardiac activity is detected, but a judge blocked it while the trial went on.

McNamee is now looking at options in Virginia, where abortion is more widely available. He’s ready to move back to Ohio, but now he says the abortion limit is “the last nail in the coffin” for him.

“I couldn’t really be an abortion provider in Ohio, and that’s been a big part of my career,” McNamee said.

According to a 2021 report by the Association of American Medical Colleges, the majority of medical residents end up practicing in the state in which they completed their residency — and some doctors are concerned that fewer internships are available. More births will mean fewer obstetricians and gynecologists in states with tight abortion restrictions.

Dr. Elizabeth Mack, president of the South Carolina Association of America, said in South Carolina, students’ concerns about access to reproductive health education (for their careers) and abortion services (for their careers) himself) has hindered the recruitment of residents and medical fellows. Academy of Pediatrics, who testified in August before lawmakers pursuing tighter restrictions on abortion.

Francis, of the anti-abortion group of obstetricians, said she hopes the new restrictions could open the door for students interested in OB-GYNs but opposed to abortion to enter the field.

Nearly 44% of the 6,007 OB-GYN residents live in a state that is believed to be certain or likely to ban abortion if the Supreme Court overturns Roe, according to an article published online in April of the journal. Obstetrics & Gynecology.

President Joe Biden on Tuesday promised to codify abortion rights if Democrats hold enough seats in Congress – but while such federal protections remain elusive, education leaders The health department is looking for ways for residents in restricted states to continue their abortion training, including allowing travel to more permissive states.

According to the American Journal of Obstetrics and Gynecology, such “travel rotations” have been proposed by the American College of Obstetricians and Gynecologists, but the volume of demand is so great that bridging the gap becomes difficult. difficult, according to the journal Obstetrics & Gynecology.

Jody Steinauer, The Ryan Program, based at the University of California, San Francisco, piloted travel rotation for students to train outside of Texas last year.

Steinauer suggests partnering programs to help fund travel rotation and guide residents through the medical licensing process in new states. She also suggests stepping up simulation of abortion training to teach basic skills.

She fears legal changes will make training courses on emergency skills such as safely emptying the uterus after a miscarriage or abortion.

The surgical procedures for miscarriage and abortion are the same – which Francis says should allow people to be trained without participating in abortion.

People can still learn a lot from miscarriage care, says Steinauer, but routine abortion training correlates with better preparedness for all methods of early miscarriage management, including counseling and complications. And, she said, people need to see enough patients to feel competent – ​​which limitations make it difficult.

“The lack of comprehensive, adequate training in abortion leaves people often lacking in their skills,” says Steinauer. “Real programs will have to support their learners, who are able, to go to other states for training.”

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