Advertisement

Sources of support for and resistance to abortion training in obstetrics and gynecology residency programs

  • Jema K. Turk
    Correspondence
    Corresponding author: Jema K. Turk, MPA, MA, PhD.
    Affiliations
    Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA

    Kenneth J. Ryan Residency Training Program, University of California, San Francisco, San Francisco, CA

    University of California, San Francisco Fellowship in Family Planning, San Francisco, CA
    Search for articles by this author
  • Uta Landy
    Affiliations
    Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA

    Kenneth J. Ryan Residency Training Program, University of California, San Francisco, San Francisco, CA

    University of California, San Francisco Fellowship in Family Planning, San Francisco, CA
    Search for articles by this author
  • Jessie Chien
    Affiliations
    Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA

    Kenneth J. Ryan Residency Training Program, University of California, San Francisco, San Francisco, CA

    University of California, San Francisco Fellowship in Family Planning, San Francisco, CA
    Search for articles by this author
  • Jody E. Steinauer
    Affiliations
    Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA

    Kenneth J. Ryan Residency Training Program, University of California, San Francisco, San Francisco, CA

    University of California, San Francisco Fellowship in Family Planning, San Francisco, CA
    Search for articles by this author
Published:April 29, 2019DOI:https://doi.org/10.1016/j.ajog.2019.04.026

      Background

      Only 64% of obstetrics and gynecology program directors report routine, scheduled training in abortion, despite the Accreditation Council for Graduate Medical Education’s requirements for routine training. Most report that exposure to training is limited to specific clinical circumstances.

      Objective

      We sought to describe residency program directors’ perspectives of support for and resistance to abortion training in residency training programs in the United States.

      Materials and Methods

      A national survey of directors explored the availability of abortion training as well as support for and resistance to abortion training within their departments and institutions. In addition, directors who indicated that training was not available at all, available only as an elective, or as routine but limited to specific clinical circumstances, were also asked which procedures were limited, in what ways, and by whom. Descriptive and bivariate analyses were performed.

      Results

      A total of 190 residency program directors (79%) responded from throughout the United States (30% in the Northeast, 30% in the South, 23% in the Midwest, and 16% in the West), and 14% described their program as religiously affiliated. Most directors (73%) reported at least some institutional or government restrictions to training, and reported an average of 3 types of restrictions. Hospital policy was the most commonly reported restriction, followed by state law. Programs with routine abortion training reported an average of 2 restrictions, compared with 4 restrictions in programs with optional training, and 5 restrictions in programs with no abortion training.

      Conclusion

      Significant barriers to integrating abortion training into residents’ schedules continue to exist decades after the Accreditation Council for Graduate Medical Education training mandate. We should use these data to develop better support and targeted strategies for increasing the number of trained abortion providers in the United States.

      Key words

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

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Accreditation Council for Graduate Medical Education
        Clarification of Program Requirement IV.A.6.d. Review.
        Committee for Obstetrics and Gynecology. 2012; (Available at:)
        • Darney P.D.
        • Landy U.
        • MacPherson S.
        • Sweet R.L.
        Abortion training in U.S. 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
        • 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
        • Steinauer J.E.
        • Turk J.K.
        • Pomerantz T.
        • Simonson K.
        • Learman L.A.
        • Landy U.
        Abortion training in US obstetrics and gynecology residency programs.
        Am J Obstet Gynecol. 2018; 219: 86
        • American Medical Association
        Fellowship and residency electronic interactive database online.
        (Available at:)
        • 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
      1. APGO residency directory.
        (Available at:)
        http://www.apgo.org/student/residency.html
        Date accessed: December 14, 2014
        • 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
        • Steinauer J.
        • Landy U.
        • Filippone H.
        • Laube D.
        • Darney P.D.
        • Jackson R.
        Predictors of abortion provision among practicing obstetrician-gynecologists: a national survey.
        Am J Obstet Gynecol. 2008; 198: 39
        • Freedman L.
        Willing and unable: doctors' constraints in abortion care.
        Vanderbilt University Press, Nashville, TN2010
        • Freedman L.
        • Landy U.
        • Steinauer J.
        When there's a heartbeat: miscarriage management in Catholic-owned hospitals.
        Am J Public Health. 2008; 98: 1774-1778
        • Turk J.K.
        • Steinauer J.E.
        • Landy U.
        • Kerns J.L.
        Barriers to D&E practice among family planning subspecialists.
        Contraception. 2013; 88: 561-567
        • Freedman L.
        • Langton D.
        • Landy U.
        • Ly E.
        • Rocca C.H.
        Abortion care policies and enforcement in US obstetrics-gynecology teaching hospitals: a national survey.
        North American Forum on Family Planning, Atlanta, GA2017
        • Collaborators
        A statement on abortion by 100 professors of obstetrics: 40 years later.
        Am J Obstet Gynecol. 2013; 209: 193-199