Incorporating abortion and family planning into Ob-Gyn resident
education in the United States
U. Landy, J. Steinauer, R. Lewis, P. Darney
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of
California, San Francisco, USA
Introduction: Abortion in the United States was
legalized in 1973. Since that time, elective abortion has become one of the most
common surgical procedures in the United States, with an estimated 1.3 million
elective abortions performed in 2000. Despite the high volume of pregnancy
terminations, abortion is not a routine component of graduate medical education
in many departments of Obstetrics and Gynecology (Ob-Gyn). According to a survey
conducted in 1992, only 12% of Ob-Gyn residency programs require first trimester
abortion training for residents, and 7% offer training in second trimester
abortions. In 1996, the Accreditation Council for Graduate Medical Education (ACGME)
created a mandate for Ob-Gyn residency programs to increase abortion training.
Aims and Methods: The Kenneth J. Ryan Residency Training Program in Abortion and
Family Planning (Ryan Program) was founded in 1999 in response to the ACGME
mandate. The Ryan Program provides technical expertise and funding to assist
Ob-Gyn residency programs in efforts to ensure that abortion and contraception
become a routine aspect of resident education.
Results: Since 1999, the Ryan
Program has established twenty training rotations throughout the United States.
Program sites have integrated abortion into the Ob-Gyn residency curriculum
using a variety of approaches and settings. Training occurs in high volume,
outpatient, hospital-based services or in collaboration with free-standing
reproductive health clinics. Rotations range in length from 4 to 10 weeks, take
place most commonly in the first, second and/or third year of residency, with a
minimum of 1 dedicated abortion training day per week. In addition to the
clinical training component, Ryan Program sites employ a variety of strategies
to integrate didactic teaching in abortion and contraception into the core
residency curriculum. Initial evaluation has shown that all Ob-Gyn departments
to implement a Ryan Training Program have experienced an increase in the number
of residents who report knowledge of and clinical competency in methods of
pregnancy termination when compared to baseline.
Conclusions: The Ryan Program
has been successful in assisting selected departments of obstetrics and
gynecology in fulfilling their professional mandate of incorporating abortion
education in the residency curriculum.