Jul 19, 2022 - Health

Abortion training set to change after Dobbs decision

Illustration of a segmented stethoscope

Illustration: Natalie Peeples/Axios

Virtual training and practice on anatomical models may soon become the norm for how OB-GYN residents learn how to safely conduct abortions as medical programs navigate new state abortion bans.

Why it matters: As programs retool in the post-Roe v. Wade landscape, there are concerns about how well prepared the next generation of OB-GYNs will be to meet the demand for induced abortions as well as emergency pregnancy care.

Training helps residents prepare for the one in four patients who are projected to have induced abortions during their reproductive years, along with other cases like miscarriage management.

  • “The big thing I am worried about is relying on miscarriage for all the patient care experience,” said Jody Steinauer, an OB-GYN and director of the Bixby Center for Global Reproductive Health. “I am worried there won't be enough people and patient encounters to become competent.”

Driving the news: Nearly half of the nation's accredited obstetrics and gynecology programs are in states that are certain or likely to ban abortion. The Accreditation Council for Graduate Medical Education recently proposed changes to its requirements that would replace hands-on training for students who can't find a facility that offers it.

What they're saying: The alternative training can't adequately simulate an emergency situation or a case with complications, said Caitlin Bernard, an OB-GYN in Indiana and assistant professor at the Indiana University School of Medicine, told Axios.

  • But the guidelines may keep some residents and programs out of legal trouble.

Context: Residency programs in states where abortion is protected are preparing for an influx of out-of-state residents from programs in red states.

  • Erica Hinz, an OB-GYN and director of the family planning residency program at the University of Illinois Chicago, said that her program is working to "increase our infrastructure to take on more [out-of-state] trainees."
  • But that won't happen overnight “when we are in the middle of this public health crisis and trying our best to take care of the increased volume of patients we are seeing," Hinz said.
  • Freestanding abortion clinics have limits on the number of trainees they can take and can't absorb the increased demand for slots, she said.
  • The new guidance from the accreditation council “leaves many questions unanswered regarding provision of resources and the expectations of institutions who may be asked to increase their training capacities,” Hinz said.

What we're watching: Limited opportunities for full OB-GYN training could weigh heaviest on states with "maternity care deserts" that lack hospitals offering obstetric care, birth centers or a sufficient number of obstetric providers.

  • "If you don’t come here to train, then it’s very unlikely for you to then come here for a job," Bernard said.

Between the lines: Limiting training in the post-Roe environment to hospital settings that just see medical emergencies like ectopic pregnancies or miscarriages can deprive future doctors of experience counseling patients or using ultrasound for diagnostic purposes.

  • Researchers at the Bixby Center say that abortion training provides OB-GYNs "with procedural and counseling skills" necessary to treat patients seeking elective abortions, as well as "to improve "general skills and confidence" when dealing with uterine evacuations, miscarriage management and pregnancy counseling.

Medical residents can still opt out of abortion training on religious or moral grounds: A 2018 study found that 75% of residents fully participated while less than 4% of residents opted out completely.

  • Beyond bans, some states have cultural barriers that work against training: In Alabama, nearly 60% of OB-GYNs in the state are men who before the end of Roe were less likely "to really encourage people to learn how to do abortion," said Robyn Marty, director of operations at West Alabama's Women's Center.

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