Virtual training and practice on anatomical models could soon become the norm for how OB-GYN residents learn to perform safe abortions as medical programs navigate new state abortion bans.
Why is this important: As programs reorganize in the post-Roe v. Wade, there are concerns about preparing the next generation of OB-GYNs to meet the demand for induced abortions as well as emergency pregnancy care.
The training helps residents prepare for the one in four patients who are expected to have induced abortions in their childbearing years, as well as other cases like managing miscarriages.
- “The big thing that worries me is relying on a miscarriage for the entire patient care experience,” said Jody Steinauer, obstetrician-gynecologist and director of the Bixby Center for Global Reproductive Health. “I’m afraid there aren’t 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 Higher Medical Education recently proposed changes to its requirements that would replace hands-on training for students who cannot find an institution that offers it.
What they say : Alternate training cannot adequately simulate an emergency situation or a case with complications, Caitlin Bernard, an OB-GYN in Indiana and assistant professor at Indiana University School of Medicine, told Axios.
- But the guidelines may keep some residents and programs out of legal trouble.
The context: Residency programs in abortion-protected states are bracing for an influx of out-of-state residents from programs in red states.
- Erica Hinz, an obstetrician-gynecologist and director of the family planning residency program at the University of Illinois at Chicago, said her program aims to “augment our infrastructure to support more [out-of-state] trainees.”
- But that won’t happen overnight “when we’re in the midst of this public health crisis and doing our best to take care of the increased volume of patients we’re seeing,” Hinz said.
- Free-standing abortion clinics have limits on the number of interns they can accommodate and cannot absorb the increased demand for slots, she said.
- The new guidelines from the Accreditation Council “leave many questions unanswered regarding the provision of resources and the expectations of institutions that may be asked to increase their training capabilities,” Hinz said.
What we are looking at: Limited opportunities for comprehensive OB-GYN training could weigh more heavily on states with “maternity care deserts” that lack hospitals offering obstetric care, birthing centers, or sufficient numbers of health care providers. ‘obstetrics.
- “If you’re not coming here to train, it’s very unlikely that you’re coming here for a job,” Bernard said.
Between the lines: Limiting training in the post-Roe environment to hospital settings that only see medical emergencies like ectopic pregnancies or miscarriages may rob future physicians of the experience counseling patients or using ultrasound for diagnostic purposes.
- Bixby Center researchers say abortion training provides OB-GYNs with “the procedural and counseling skills” needed to treat patients seeking elective abortion, as well as “to improve ‘soft skills and confidence’ when uterine evacuations, management of miscarriages and pregnancy advice.
Medical residents can still opt out abortion training on religious or moral grounds: A 2018 study found that 75% of residents fully participated while less than 4% of residents withdrew completely.
- Beyond prohibitions, some states have cultural barriers that militate against training: in Alabama, nearly 60 percent of obstetrician-gynecologists in the state are men who, before Roe ended, were less likely to “really encourage people to learn how to have an abortion”. said Robyn Marty, director of operations at West Alabama’s Women’s Center.
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