The future of abortion training for medical people is bleak

IIn 2021, Dr. Mallika Govindan, a resident family physician at Mount Sinai Health System, received disappointing news. Although she pursued a career in medicine to become an abortion provider – and chose a residency in New York City, where she felt she would receive the best training – she she will not be able to learn how to provide abortion care locally. Due to pandemic prevention, Planned Parenthood New York City, which trains many medical residents, has had to downsize its abortion training program.

Govindan spent months researching other options and applying for scholarships. In February 2022, she traveled to Chicago for 12 days for abortion training with a reproductive health nonprofit.

It’s been hard for Govindan to get training in abortion – but in Chicago, she’s constantly hearing whispers that it might soon be getting harder for medical residents like her. The abortion providers who supervise her say that training residents can become more challenging if Roe v. Wade was overturned; as clinics in places like Chicago expand their capacity to meet the growing demand for abortion care from people traveling from the state where the procedure is prohibitedthey may decide to stop training foreign residents to accommodate the influx of patients.

Govindan is concerned that abortion training with even less access to doctors will make it harder for people to get proper care. “There is a total shortage of doctors and service providers,” she said. “The [number] those willing to do this are even smaller. ”

Abortion training for medical residents has been a logistical nightmare in the US Ob-gyn residences that are required by the Accreditation Council for Graduate Medical Education (ACGME) to provide training. create about abortion to be recognised, although residents can opt out if they wish. Training usually includes a week or month-long rotation at a local hospital or abortion clinic. But these sites are in short supply. Almost 90% of US counties currently no clinics offering abortion care — meaning those that do exist are likely to be discovered by both patients and interns if Roe v. Wade overturned. According to a thing published by the American College of Obstetricians and Gynecologists (ACOG) in April, nearly 44% of current ob-gyn residents in the United States are training in states that definitely or are likely to ban abortion. Roe v. Wade abolished.

In a statement, an ACGME spokesperson said the organization was preparing for the Supreme Court’s ruling. “If it becomes illegal in some states to practice aspects of family planning, the ACGME is exploring alternative pathways to completing this training. At this time, the ACGME requirements remain the same” – including all ACGME-accredited ob-gyn programs must have a family planning program and “experienced training in variables.” evidence of abortion and the opportunity to receive direct procedural training in termination of pregnancy. Access to experience with medical abortion should be part of the curriculum to ensure that trained physicians have the opportunity to gain the experience needed to care for all of their patients’ needs. . “Programs that restrict abortion or other family planning services “must arrange for such residential training to be conducted in another facility.”

In a state like Utah, it’s hard to be an ob-gyn, said Dr. David Turok, an associate professor in the University of Utah’s department of obstetrics and gynecology and head of the family planning division. One State law enacted in 2017 Turok asked doctors to tell their patients seeking abortions a number of unproven lies, including claims that the abortion pill reversible mifepristone. Providers are also required by law to give patients pain medication – for the fetus – at 20 weeks or more of pregnancy, which doctors say is no scientific basis. But restrictions on abortion loom if Roe v. Wade the ending will be “on a whole different level,” Turok said.

Turok already has plans to send its ob-gyn residents to other states for training if Utah bans abortion, which is expected to happen soon. Roe overturned. Another option might be simulated procedures — such as practicing techniques on a dummy — common in residency programs. However, he fears that it won’t be good enough. “By limiting care and limiting training, you are essentially compromising the quality of care,” he said. “I do not worry; I’m scared.”

There are signs that abortion training isn’t enough in the US, especially for out-of-time abortions performed during the first trimester. Based on search published in 2018 in American Journal of Obstetrics and Gynecology, only 71% of resident directors who responded to the survey think their ob-gyn graduates are competent in the common early-stage abortion procedure known as first-trimester aspiration, and only 66% feel residents are adequately trained in medical abortion. Only 22% of directors said their ob-gyn graduates were capable of performing other abortion techniques, including dilatation and grasping, commonly used in the second trimester.

That lack of knowledge can be partly attributed to access issues. In some ob-gyn programs, it is the responsibility of residents to tailor the training themselves to their schedule, which can be burdensome, while others face limitations at the hospital. their limits on where and how the procedure is performed, according to ACOG. Many religiously affiliated hospitals do not offer abortion services at all.

Debra Stulberg is chair of family medicine at the University of Chicago and director of training at the Midwest Outreach Project (MAP), a reproductive health nonprofit that connects residents – including Govindan – with abortion training. She said the MAP gets a lot of inquiries from residents at religious hospitals, as well as from residents in specialties whose programs don’t always offer a lot of training on abortion, but who may need it as much as an ob-gyn. Family medicine doctors, in particular, are major supplier Abortion in the United States, especially in rural areas, is deprived – but often without proper training. “Even if they have [the] “They may just be in the clinic for a few days and not enough to really develop the capacity they need,” says Stulberg.

To augment their training, many such residents eventually need to travel to other states. But that will not be the solution to the severe shortage of training opportunities that could develop if abortion suddenly becomes illegal in many states, said Dr. Kavita Vinekar, a scientist specializing in planning Complex family planning, co-author of the book, said ACOG Comments. “[It] would not be feasible at this scale,” she said. “The reality is that we will never be able to arrange for nearly 44% of our residents to travel far away from their home facilities, away from hospitals that rely entirely on residents to function, to get the necessary training. She and her co-authors suggest that residential programs may instead need to increase training in miscarriage, which overlaps with training in abortion, and incorporate simulations to compensate for the loss of pregnancy. this shortfall.

Financing is another obstacle to residency programs that causes people to lose or stop traveling. Hospital budgets for graduate medical education, paid for through Medicare, do not come with resident patients, so a new budget must be found to pay them for the duration of the round. family planning rotation, includes abortion training and can last several weeks Dr. Laura MacIsaac, professor and associate director of the Family Planning Fellows program at the Icahn School of Medicine at Mount Sinai , said. “I have visited residents who come to New York with that request, but we have such, so many requests and we really cannot honor all of them,” MacIsaac said.

Turok, from the University of Utah, worries that claims that abortion are outlawed will not appeal to ob-gyns studying or eventually practicing. The states will probably ban abortion in this case Roe “Not realizing they are digging a huge hole in the quality of medical care they will be able to provide and who they will be able to train and retain in their state,” Turok said. “What health care provider wants to practice where they are unable to provide adequate services to their patients?”

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