Medical schools adapt to Dobbs’ abortion decision

Over the years, the ambitious Ob-Gaines Hope Clinic at Louisiana State University’s School of Medicine has run a four-hour journey from the New Orleans Institute to Shreveport for an intensive two-week training, the only practice in the state where students can observe and experience surgical abortion procedures. .

But after the Supreme Court overturned Rowe v. Wade last month, Hope Clinic is probably in the final days of its operation, awaiting an almost final end to a temporary court ban that currently prevents Louisiana’s abortion ban from taking effect. Now, LSU must find new ways to give medical students the training they need — and with the legitimacy of abortion-related medical education more complex than ever, they are carefully exploring their options.

“Finding out how to train our residents is going to be a big challenge, which I am very concerned about. But I’m also concerned about the impact this is going to have on all of our patients in our community, “said Nicole Freehill, director of the Clinical Residency Program for Ob-Gain at the Health Sciences Center at LSU in New Orleans. “The big question mark is, what do we do now?”

Freehill is far from alone in asking this question. Medical schools and students from Louisiana to Texas, Ohio to Florida, are dealing with the sudden impulse of their reproductive health-care training.

A study conducted in April by researchers from the University of California, San Francisco and UCLA found that 45 percent of ob-gen residency programs and 44 percent of residents themselves were located in states where abortion would be completely prohibited if Roi v. Wade flipped over.

“By 2020, 92% of maternity and gynecology residents reported having access to some level of abortion training,” the researchers wrote in the study. “We predict that if Rowe vs. Wade is reversed, it will drop to a maximum of 56%.”

With the Supreme Court ruling in Dobs v. Jackson Women’s Health Agency now in books, eight states have banned contraception in virtually all situations, and many more are likely to do so in the near future.

The limited availability of abortion-related medical education was already a problem before Rowe was overturned. More than 800,000 abortions, surgeries and medications are performed in the United States each year, making it one of the most common surgical procedures performed on women in the country. Yet according to a 2020 survey by researchers at Stanford University, half of all medical schools either offer no formal abortion training or just give a lecture – and that was before Dobbs ’decision.

“Abortion is one of the most common medical procedures, yet abortion-related topics are clearly missing from the medical school curriculum,” the researchers wrote.

Now, abortion training is almost certain to become more rare — and, for the first time since 1973, much more legal risk.

“Medical schools and hospitals are incredibly risk averse,” said Pamela Merritt, executive director of Medical Students for Choice, an organization that supports access to abortion training and provides students with curricular resources. “As a result of Hornet not wanting to pierce the home, only states that do not have restrictions are likely to provide this type of training and care.”

Janet Lager, director of UC San Francisco’s Ob-Gain program, says the reality may lead to fewer applications to programs in states where abortion training has been made illegal, including at some of the nation’s best-known medical schools: Washington University in St. Louis, for example, or Atlantis M. .

“[Students] They have to make a tough decision whether they want to train in a state program that does not provide abortion care, ”Lager said. “These programs will have fewer applicants, and states that can provide abortion care will be flooded with more applications.”

Training for abortion procedures will not be the only thing affected by DOBS. Laws triggered or activated by a Supreme Court decision may limit the ability of medical schools to teach a range of family planning, medical ethics, and treatment options that may be off the table due to the possibility of miscarriage as a side effect, such as lithium, which treats severe depression and schizophrenia. Used for.

At the Bunshaft School of Medicine at Wright State University in Ohio, where Dobbs’ decision initiated the implementation of a ban on abortion after six weeks of pregnancy, a family planning elective was canceled when the women’s health clinic normally closed it. Some students fell in itAnd institutions like the Right State are waiting for explanations from accreditors and state lawmakers.

“Rowe’s overturned medical school has affected academic programming, not just in Ohio, but across the country,” Seth Bogues, a Wright State spokesman, wrote in an email. Higher Ed inside. “Like other schools, the School of Medicine is looking to the Accreditation Council for the Graduate Medical Education and Residency Review Committee for further guidance on how recent decisions will ultimately affect the curriculum.”

Freehill said there are simulated and virtualized approaches that LSU is exploring to replace personal experience, but he added that “simulations can only take up a certain amount of patient care space.”

Freehill said he believes LSU’s medical program is good enough to withstand any enrollment reduction as a result of the state’s post-Row abortion law. But he worries that the residency program for ob-guins will suffer.

“If we can’t find a way to make sure this part of their training is intact, then I’m worried that the good candidates we want to recruit might not look at us,” he said.

Merit said medical students across the discipline, not only ob-gyns in training, now need to understand the legal risks they take when taking the Hippocratic oath.

“Everyone needs to understand abortion. Each physician is working with a population where one in three people who are able to conceive will consider an abortion, “says Merritt.” Give medical advice. “

“It will have a strong impact across each single concentration,” Merritt added. “What we are seeing is a slow-moving, man-made disaster that will affect the lives of all people in this country very quickly.”

Pressure on accreditors

Some approvers are now looking for ways to care for abortions by standards that do not encourage criminal activity in some states. The Accreditation Council for Graduate Medical Education, which sets standards for residency programs, has proposed new guidelines that would allow state programs to be recognized, including abortion restrictions, to help students live in states where the practice is still legal.

“Access to the experience of induced abortion must be part of the curriculum so that trained physicians have the opportunity to gain the experience necessary to care for all the needs of their patients,” the council wrote in a statement after the Dobbs decision.

Over the years, students, reproductive health care advocates and caregivers have called on the primary medical school accreditor, the Liaison Committee on Medical Education of the American Association of Medical Colleges, to create a universal standard for family planning education recognized institutions, such as abortion. Training is a universal need. Those calls have grown louder since Dobbs’ decision.

“Losing approval means you’ll lose an incredible amount of money, and it’s a black mark against your organization,” Merritt says. “That’s our only leverage.”

Veronica Catanis, AAMC Senior Director for Accreditation Services, says Higher Ed inside That committee “does not determine the content of the specific curriculum to be included in the curriculum of the MD-Granting Medical School” and therefore will not change the standard of recognition in light of Dobbs.

“Each individual medical school is responsible for creating a medical education program and curriculum that ensures that medical students, after graduation, have the appropriate professional skills to enter any residency program and pursue contemporary medical practice,” he continued.

Merritt said he realized it was a “long question” to get accreditors and universities to draw a line in the sand around a practice that is now illegal in many states. But she said that when it comes to women’s reproductive health, she hopes more organizations will see it as a risk to take.

“For a narrow and recurring legal analysis we should not change the fundamental value of the living experience in training,” he said. “Unless we want to see people lose their fertility and lose the best quality of care and potentially their lives, we have to take a huge level of risk.”

Increasing regional disparities

Freehill was born and raised in Louisiana and earned his medical degree at the university where he grew up. But in 2009 he moved to Philadelphia for his residence, and four years ago he finally stayed in the Northeast as an Ob-Gin practitioner for 13 years before finally taking a job in his home state.

He was thrilled to be back in Louisiana, but in terms of Dobbs, he was now facing a decision, saying the choice would be more difficult.

“It won’t be easy,” he said. “I had to think twice.”

In the Red State, medical students, especially ob-gyns, have been matching residents outside the state year after year বিশেষ especially as the number of abortion clinics in that state has declined. Now, doctors say, clinics in states that have pledged to protect abortion rights will be surrounded by more patients than ever before, cutting down on the time and resources they can spend training students.

Freehill said that before they partnered with Hope Clinic, LSU often sent its ob-gyne students out of state for abortion training due to the lack of reputable clinics in Louisiana. He said the university is exploring the possibility of reviving that practice, but finding more out-of-state residents with more programs in terms of Dobbs could make it more difficult than ever.

“We are one of 24 states that are now looking at sending students out of state,” Freehill said. “Trying to figure out what we’re going to do is not the only residential program.”

Lager said that in the past UCSF has welcomed medical students from states where the number of residents trained in abortion was low. He said the university would continue to do so, although a large increase in demand would likely put pressure on its resources.

Lager expressed concern that if more students leave the red state for their residence, it would create a shortage of ob-gin practice in states where students do not have access to abortion training.

The American College of Obstetricians and Gynecologists estimates that by 2020, there was a shortage of 8,800 ob-gynecologists nationwide, with more than half of all U.S. counties practicing no ob-gynecology. According to a 2021 survey by the Association of American Medical Colleges, more than half of all medical students who graduated between 2010 and 2019 practiced in the state where they finished their training.

“I think this will have a cascade effect where there will be more problems in the red state as current suppliers start to leave and then students, residents and other trainees decide to stay where they think they can. Still provides safe abortion care, ”Lager said.

“It makes a terrible decision for doctors, but those interested in providing good, patient-centered ob-gyne care are going to go where they can,” Merritt says.

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