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The fall of Roe scrambles abortion training for university hospitals

The fall of Roe scrambles abortion training for university hospitals

The Washington Post

Nick Anderson

June 30, 2022

Medical schools and teaching hospitals around the country are scrambling to cope with the fallout of the Supreme Court’s decision to overturn Roe v. Wade as many long-standing programs to train doctors in the procedures of abortion are now in jeopardy.

Universities in states that allow abortion pledge to continue the training. Others, in states hostile to abortion, are squeezed between an emerging array of abortion bans and accreditation rules that promote training in how to terminate pregnancies.

Emory University in Atlanta is a case in point. A ban on abortion after about six weeks into a pregnancy is likely to take effect soon in Georgia, threatening abortion training programs connected to the university’s medical center. Emory officials say they are exploring contingency plans. The university’s president, Gregory L. Fenves, said in a statement that he wants “to make sure health care students, residents, fellows, and providers can continue to train in — and practice — world-class obstetrics at Emory. “Experts say that training in methods of emptying the uterus at various stages of pregnancy is crucial for obstetrics and gynecology, and that it can play a role in other fields, such as family medicine.

The Accreditation Council for Graduate Medical Education, which sets standards for residency and fellowship programs, requires medical institutions to offer abortion training for OB/GYN residencies. Typically, that means OB/GYN residents are able to participate in a multiweek rotation in a teaching hospital or nearby outpatient clinic that provides abortions. Those who object for moral or religious reasons can opt out.

After the court’s ruling, the accreditation council issued a proposal to maintain that position but with a twist: Programs in states that legally restrict the clinical abortion experience “must provide access to it in a jurisdiction where no such legal restriction is present, and program support must be provided.” That means trainees would need to travel elsewhere if they want to learn the material. In a further step, the accreditation council proposed that when residents are unable to travel for abortion training, their programs must offer a combination of “didactic activities, including simulation,” that would enable them to learn procedures for terminating pregnancy.

The council started developing the proposal several months ago, as the high court was considering the challenge to Roe from a lawsuit originating in Mississippi. It is seeking comment on the measure in advance of a council board vote in September.

“We don’t want to put any program in the position of doing something illegal,” said John Combes, the chief communications and public policy officer for the council. “But we did want to make sure the requirement remained.” Combes said abortion training gives doctors “foundational” skills that apply in many pregnancy situations.

Programs that don’t follow the council’s requirements may risk being cited for noncompliance with standards.

A doctor who represents OB/GYN specialists opposed to abortion was skeptical of the proposal.

“What is it that’s motivating this really extreme position on abortion training?” asked Christina Francis, a board member of the American Association of Pro-Life Obstetricians and Gynecologists. Francis, who practices in Indiana and is in line to become the association’s chief executive next year, said that direct clinical experience with abortion is not necessary for OB/GYN competency and that residency programs must be mindful of state laws. She predicted lawmakers and taxpayers in states that ban abortion will take a dim view of efforts to pay for doctors to travel elsewhere for abortion training.

The proposal to support out-of-state abortion training is “walking a very tenuous line,” Francis said. “Their call for ‘workarounds,’ I would say, is suspect. And it needs to be looked at very closely.”

However, Francis suggested she was open to teaching about abortion through exercises such as computer simulations. “I wouldn’t have a problem with it,” she said. Doctors who support abortion rights say simulations are no substitute for hands-on experience.

The court’s ruling in Dobbs v. Jackson Women’s Health Organization sent shock waves through medical education. “We strongly oppose this decision and will continue working with our medical schools and teaching hospitals to ensure that physicians are able to provide all patients with safe, effective, and accessible health care when they need it,” David J. Skorton, president and chief executive of the Association of American Medical Colleges, said in a statement.

A recent study from University of California researchers found that of roughly 6,000 OB/GYN residents nationwide, 44 percent are based in states where access to abortion training is certain or likely to disappear after the fall of Roe. The study doesn’t account for medical students or residents in other fields who also seek clinical experience in abortion.

In Tennessee, where a six-week abortion ban has taken effect and a wider ban will soon follow, the Vanderbilt University Medical Center said in a statement that the court ruling “has substantial negative health implications for our region’s women and their families.”

The center, based in Nashville, did not address questions about abortion training, but it pledged to remain “in full compliance with federal and state law.” Vanderbilt officials have created a task force to address the impact of the ruling on clinical care and educational instruction. In California, where abortion rights are protected, the UC system operates medical centers in San Francisco, Los Angeles, San Diego and elsewhere in the state.

The system’s president, Michael V. Drake, said in a statement that the court’s ruling is “antithetical to the University of California’s mission and values.” He said UC will continue to offer “the full range of health care options possible in California” and will “continue to offer comprehensive education and training to the next generation of health care providers.”

Soon many doctors who in years past would have received abortion training elsewhere could be headed to states such as California. Jennifer Kerns, an associate professor of OB/GYN at UC-San Francisco, said the university helped doctors from Texas receive abortion training after that state imposed severe abortion restrictions last year.

“UCSF has long been a leader in training,” Kerns said. “We’ve always hosted visiting trainees from other sites.” But she said there are logistical challenges to the scale of the training expansion that may be required under the new legal landscape. “Training takes a lot of effort,” Kerns said. “It’s a lot of one-on-one time with somebody to train them. You can’t just sort of dump five trainees in one clinic and think that in the course of a month, they’re all going to get trained up. It’s really one person at a time.”

Kerns noted that OB/GYN residents receive many kinds of intensive training. Rearranging busy and complicated schedules to allow for a significant volume of out-of-state abortion rotations could prove a formidable task. “It’s a real crunch on the system from all sides,” she said.

Kerns, who flies to Kansas regularly to provide abortions, said she and her colleagues in medical academia are committed to helping teach abortion methods. “This is one way that we know we can contribute,” she said. “We will just totally double down on it and try to accommodate trainees from other programs.”

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