Health

Abortion education at risk for medical students, residents

Look through any medical dictionary, and before appendicitis and anesthesia, you will find an abortion.

The first two procedures are part of standard medical education. But for many US medical students and residents who want to learn about abortion, there are few options.

And new restrictions are piling up: over the past year, bills or laws aimed at restricting abortion education have been proposed or passed in at least eight states. The change comes from anti-abortion opponents, encouraged by new restrictions on the procedure itself, as well as a pending Supreme Court ruling that could overturn Roe v. Wade’s landmark decision to legalize abortion.

“What’s going on is just awful,” said Ian Pick, a third-year medical student in Oklahoma, where the governor signed a law on April 12 banning most abortions.

Abortion education is not provided in Oklahoma’s two medical schools, and education on the topic is limited. Aspiring doctors who want to learn about this usually look for doctors who perform abortions outside of the traditional medical education system.

Pick, 32, said that if he wanted to learn how to do a colonoscopy, for example, he could work with school staff to follow up with a doctor doing research or working in a clinic.

“That would be easy,” he said. “To do the same with abortion is almost impossible.” He said it took him six months to find a provider willing to teach him.

Nevada medical student Natasha McGlone received external training and organized a workshop on how to perform a standard medical procedure used in abortion. She offers it at night, in her free time.

The 27-year-old is the daughter of “pro-feminist” parents and the mother of two girls whose reproductive choices she wants to protect.

“It was kind of a joke in my family that if people tell me I can’t do something, I will do it twice as hard,” she said. “I kind of feel this moral, righteous urge to go for it.”

LESSONS “CLEARLY MISSING”

Medical education in the US usually includes four years of medical school, where students learn the basics of general medicine and practical patient care. They receive higher medical education, which officially makes them doctors. Most then spend at least three years in residency programs where they receive intensive on-the-job training and special skills.

US medical schools require students to complete a clerkship in obstetrics and gynecology, but do not require this to include training in abortion. At the postgraduate level, the OB/GYN residency programs are required by the accreditation panel to grant access to abortion education, although residents who object may choose not to perform abortions.

Most abortions in the US are performed by obstetrician-gynecologists, followed by family medicine specialists. But these aren’t always the first doctors women encounter when they find out about an unwanted pregnancy. Abortion rights advocates argue that all physicians should know enough about the procedure to inform and counsel patients, and that such education should begin in medical school.

In 2020, Stanford University researchers said they found that half of the medical schools had no formal abortion training or only one lecture.

“Abortion is one of the most common medical procedures,” they wrote. “However, topics related to abortion are clearly absent from medical school curricula.”

McGlone helped sponsor a measure last year that asked the American Medical Association to support mandatory abortion education in medical schools with an opt-out clause. An influential group has long opposed compulsory curricula and rejected the proposal, but has said it supports giving medical students and residents the opportunity to learn about abortion and opposes attempts to interfere with such education.

ADDITIONAL RESTRICTIONS

Legislative efforts to restrict abortion are targeted at all levels of medical education.

An Idaho law passed last year illustrates this trend. It prohibits the use of tuition and abortion fees and related activities in school clinics in publicly funded institutions.

Other efforts include a Wisconsin bill to ban employees from the University of Wisconsin and its hospitals from participating in abortions, including training. It failed to move forward in March, but its sponsor plans to reintroduce the measure. Similar proposals target public universities in Missouri and Ohio.

Divya Jane was not introduced to abortion at her medical school in Missouri, where she says the procedure is rarely discussed, but at a family planning clinic in Kansas. She has volunteered at the clinic and has seen the difficulties women from other states have with the procedure. According to Jane, some of them mistakenly ended up in a pregnancy crisis center across the street that tried to change their minds.

Jane, 23, said her first experience of witnessing an abortion was “anti-climatic,” far from the dire image she’d heard from opponents.

“This is a normal internal procedure,” she said. “These are just patients seeking medical attention.”

She knew at that moment that she wanted to have an abortion. “It was like snapping fingers. It changed my life,” said Jane, who studies public policy at Harvard while on leave from his medical degree from the University of Missouri Kansas City.

The daughter of open-minded but traditional parents who immigrated to Kansas from India, Jain remembers growing up feeling trapped in her family’s traditional culture and conservative white community, where abortion was never discussed.

“I loved stirring the pot” and pushing boundaries,” she said.

Jane knows that the US Supreme Court’s decision on whether to uphold the Mississippi ban on abortion after 15 weeks of pregnancy could fundamentally change the picture of abortion in the US. Regardless of a decision expected by the summer, Jane said her goal is set: to get abortions in “hostile” states that lack medical workers.

“It’s very difficult for patients to get the treatment they deserve and need, and I just think it’s not right,” Jane said.

EXPANDING LEARNING

Dr. Keith Reisinger-Kindle, 33, associate director of the obstetrics and gynecology residency program at Wright State University School of Medicine in Dayton, Ohio, said his goal to increase abortion education “has been an uphill battle” due to legislative hurdles.

When he arrived at the school almost two years ago, he said that “there was no formal education on abortion.” He created and implemented abortion courses for medical students and residents with the support of his university and offers training at a nearby clinic where he also performs abortions.

The doctor said the state legislator lobbied the university administration to fire him. And in December, the governor of Ohio signed a law barring government doctors from working as backup doctors at abortion clinics for rare complications. The clinic where Reisinger-Kindle works is suing to block the law.

“There are definitely difficult days,” Reisinger-Kindle said. Young doctors eager to learn help him move on. There are currently 24 residents participating in the program. They can opt out of abortion education, but he said almost everyone chose to participate “at least in some capacity.”

He worries that new restrictions on abortion are coming, but adds: “I believe that in the long term we will achieve this. I just hope my students don’t have to suffer.”


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