Advertisement

Abortion training in US obstetrics and gynecology residency programs

Published:April 12, 2018DOI:https://doi.org/10.1016/j.ajog.2018.04.011

      Background

      Nearly 15 years ago, 51% of US obstetrics and gynecology residency training program directors reported that abortion training was routine, 39% reported training was optional, and 10% did not have training. The status of abortion training now is unknown.

      Objective

      We sought to determine the current status of abortion training in obstetrics and gynecology residency programs.

      Study Design

      Through surveying program directors of US obstetrics and gynecology residency training programs, we conducted a cross-sectional study on the availability and characteristics of abortion training. Training was defined as routine if included in residents’ schedules with individuals permitted to opt out, optional as not in the residents’ schedules but available for individuals to arrange, and not available. Findings were compared between types of programs using bivariate analyses.

      Results

      In all, 190 residency program directors (79%) responded. A total of 64% reported routine training with dedicated time, 31% optional, and 5% not available. Routine, scheduled training was correlated with higher median numbers of uterine evacuation procedures. While the majority believed their graduates to be competent in first-trimester aspiration (71%), medication abortion (66%), and induction termination (67%), only 22% thought graduates were competent in dilation and evacuation. Abortion procedures varied by clinical indication, with some programs limiting cases to pregnancy complication, fetal anomaly, or demise.

      Conclusion

      Abortion training in obstetrics and gynecology residency training programs has increased since 2004, yet many programs graduate residents without sufficient training to provide abortions for any indication, as well as dilation and evacuation. Professional training standards and support for family planning training have coincided with improved training, but there are still barriers to understand and overcome.

      Key words

      To read this article in full you will need to make a payment

      References

        • Jones R.K.
        • Jerman J.
        Population group abortion rates and lifetime incidence of abortion: United States, 2008-2014.
        Am J Public Health. 2017; 107: 1904-1909
        • Accreditation Council for Graduate Medical Education
        ACGME program requirements for graduate medical education in obstetrics and gynecology.
        ACGME, Chicago (IL)2014
        • Accreditation Council for Graduate Medical Education
        Clarification on requirements regarding family planning and contraception: review committee for obstetrics and gynecology clarification of program requirement: IVA6d)(1)-(3).
        ACGME, Chicago (IL)2017
        • ACOG
        Abortion training and education. Committee opinion no. 612.
        Obstet Gynecol. 2014; 124: 1055-1059
        • Darney P.D.
        • Landy U.
        • MacPherson S.
        • Sweet R.L.
        Abortion training in US obstetrics and gynecology residency programs.
        Fam Plann Perspect. 1987; 19: 158-162
        • MacKay H.T.
        • MacKay A.P.
        Abortion training in obstetrics and gynecology residency programs in the United States, 1991-1992.
        Fam Plann Perspect. 1995; 27: 112-115
        • Grimes D.A.
        Clinicians who provide abortions: the thinning ranks.
        Obstet Gynecol. 1992; 80: 719-723
        • Westhoff C.
        • Marks F.
        • Rosenfield A.
        Residency training in contraception, sterilization, and abortion.
        Obstet Gynecol. 1993; 81: 311-314
        • Evans M.L.
        • Backus L.V.
        Medical students for choice: creating tomorrow's abortion providers.
        Contraception. 2011; 83: 391-393
        • Almeling R.
        • Tews L.
        • Dudley S.
        Abortion training in U.S. obstetrics and gynecology residency programs, 1998.
        Fam Plann Perspect. 2000; 32 (320): 268-271
        • Eastwood K.L.
        • Kacmar J.E.
        • Steinauer J.
        • Weitzen S.
        • Boardman L.A.
        Abortion training in United States obstetrics and gynecology residency programs.
        Obstet Gynecol. 2006; 108: 303-308
      1. American Medical Association. Fellowship and residency electronic interactive database online. Available at: https://www.ama-assn.org/life-career/search-ama-residency-fellowship-database. Accessed: Dec. 14, 2013.

        • Steinauer J.E.
        • Turk J.K.
        • Fulton M.C.
        • Simonson K.H.
        • Landy U.
        The benefits of family planning training: a 10-year review of the Ryan Residency Training Program.
        Contraception. 2013; 88: 275-280
        • Guiahi M.
        • Westhoff C.L.
        • Summers S.
        • Kenton K.
        Training at a faith-based institution matters for obstetrics and gynecology residents: results from a regional survey.
        J Grad Med Educ. 2013; 5: 244-251
        • Fennimore R.
        • Guiahi M.
        • Gottesfeld M.
        • Ricciotti H.
        Enhancing family planning training at a Catholic obgyn residency program.
        Obstet Gynecol. 2017; 130: 56S
        • Guiahi M.
        • Cortland C.
        • Graham M.J.
        • et al.
        Addressing ob/gyn family planning educational objectives at a faith-based institution using the TEACH program.
        Contraception. 2011; 83: 367-372
        • Turk J.K.
        • Preskill F.
        • Landy U.
        • Rocca C.H.
        • Steinauer J.E.
        Availability and characteristics of abortion training in US ob-gyn residency programs: a national survey.
        Contraception. 2014; 89: 271-277
        • Steinauer J.
        • Landy U.
        • Filippone H.
        • Laube D.
        • Darney P.D.
        • Jackson R.A.
        Predictors of abortion provision among practicing obstetrician-gynecologists: a national survey.
        Am J Obstet Gynecol. 2008; 198: 39.e1-39.e6
        • Dalton V.K.
        • Harris L.H.
        • Bell J.D.
        • et al.
        Treatment of early pregnancy failure: does induced abortion training affect later practices?.
        Am J Obstet Gynecol. 2011; 204: 493.e1-493.e6
        • Guiahi M.
        • Lim S.
        • Westover C.
        • Gold M.
        • Westhoff C.L.
        Enablers of and barriers to abortion training.
        J Grad Med Educ. 2013; 5: 238-243