When Susan Richman, a professor at the Yale School of Medicine, was an obstetrics and gynecology resident at Yale-New Haven Hospital 23 years ago, she was frustrated by the scarcity of exposure to abortion training at the hospital.
“We did some abortions,” she said. “But those of us who wanted more training always had to go to Planned Parenthood.”
For the past 10 years, the hospital has required its residents to undergo abortion training — barring individual religious or moral objections. But the hospital’s in-house program offered doctors little real-life exposure, as very few abortions are performed at the hospital, said Dr. Charles Lockwood, chair of the school’s OB/GYN department. Perceiving a need to expose residents to the full scope of women’s health issues, Yale administrators entered into an official collaboration with the Connecticut branch of Planned Parenthood (PPC) last year that enables interested residents to receive training at PPC’s facility under the guidance of Yale faculty.
The six-week abortion training program takes place at Planned Parenthood’s three-year-old Whitney Street location. Residents are educated in family planning and birth counseling on Monday rotations and on abortion services, ultrasound, recovery and post-abortion complications on Wednesday rotations, said Mary Bazwa, chief operating officer of PPC.
Emphasis on abortion training has risen in national consciousness since 1996, when the Accreditation Council for Graduate Medical Education, which accredits all post-M.D. medical training programs, made it a requirement for OB/GYN residents.
The ACGME is an accreditation board that oversees 23 review committees, one for each standard field of medicine, and sets the standards for each specialty.
The 1996 ruling allowed residents to forgo abortion training for personal reasons, but required that they be trained in treating complications of abortions, such as excessive bleeding and infection, ACGME spokesperson Julie Jacob said.
“All residents must receive training unless they have a personal, religious or moral objection,” Jacob said. “So basically, it’s the resident’s decision.”
Because the ACGME is headquartered in Illinois, where state law protects the confidentiality of information gathered in the peer review process, the board cannot reveal any information regarding what goes on in the meetings, including the reasons behind their guidelines.
But pro-choice advocacy groups such as Planned Parenthood and Medical Students for Choice, a nonprofit coalition of nearly 7,000 medical students, interpret the measure as an attempt to address the approximately 40 percent decline in the number of physicians performing abortions.
“Working in family planning, we often talk about the ‘graying’ of abortion providers,” Bazwa said. “Physicians are getting older and retiring, so we want to maintain that pool, ensuring there are enough physicians.”
MSC Executive Director Lois Backus said she estimates that about 2,000 physicians currently practice abortion in the United States. She said she hopes to encourage physicians to enter the specialty of family planning by reaching students while they are in still in medical school and just beginning to explore what interests them.
Backus’ group partnered with PPC to offer medical students at the University of Connecticut Medical School a lecture course on reproductive health services, co-taught by PPC’s director of medical and clinician services.
“It’s nice to hear that Yale, which is in a less conservative area and has the support of the faculty, is now taking strides in this direction as well,” Backus said. “In general, in medicine, very little education is provided on abortion.”
Because surgical abortion is relatively safe and does not require a hospital setting, abortion services are routinely provided at outpatient services such as Planned Parenthood rather than at hospitals, Bazwa said.
The low volume of abortion cases Yale-New Haven receives each year prompted doctors such as Stillman to seek out their own training, such as setting up electives at a local Planned Parenthood clinic.
Some medical schools offer no in-house training, instead encouraging residents to seek a rotation elsewhere. But National Women’s Health Network Executive Director Cynthia Pearson said it is not enough simply to make training available rather than require it of consenting students.
“The schools say, ‘If you want, you can go to Planned Parenthood as your elective, but we don’t require it, and we don’t even teach it ourselves,’” Pearson said.
To address this concern, chapters of Planned Parenthood have been partnering with their local universities to offer residency programs similar to the program at Yale, in which University clinicians use PPC’s facilities to teach.
Currently 37 Planned Parenthood affiliates are educating approximately 161 physicians and residents per year in abortion services.
When PPC was designing the health center at their new Whitney building location three years ago, they were mindful to select a space that would accommodate students, Bazwa said.
“We thought, ‘Wouldn’t it be wonderful to have residency students down here?’ ” she said. “So we planned for the examination rooms to accommodate a residency training program.”
Richman praised the PPC facility and resources while de-emphasizing the political sensitivity of the issue, pointing out that elective abortions comprise only a fraction of a resident’s overall abortion education. Residents must also learn about stillbirth, miscarriage, and the complications related to abortion.
“We’re not always talking about elective abortions,” Richman said.
But some students said they do not feel it is a physician’s role to perform abortions.
“If physicians take the Hippocratic Oath — which in its classical version explicitly prohibits abortions — or believe that life begins at conception, then requiring them to learn and practice abortions amounts to nothing less than a coerced violation of that oath and their beliefs,” said Stephen Kappa ’07, a pre-med student and a member of Yale Students for Christ.
Yale policy states that OB/GYN residents do not have to perform or be trained to perform elective abortions, nor are they required to be exposed to pre-abortion counseling or ultrasounds. Still, Mazwa said, all six residents in the department elected to participate last year.