Abortion training in US obstetrics and gynecology residency programs

Am J Obstet Gynecol. 2018 Jul;219(1):86.e1-86.e6. doi: 10.1016/j.ajog.2018.04.011. Epub 2018 Apr 12.


Background: Nearly 15 years ago, 51% of US obstetrics and gynecology residency training program directors reported that abortion training was routine, 39% reported training was optional, and 10% did not have training. The status of abortion training now is unknown.

Objective: We sought to determine the current status of abortion training in obstetrics and gynecology residency programs.

Study design: Through surveying program directors of US obstetrics and gynecology residency training programs, we conducted a cross-sectional study on the availability and characteristics of abortion training. Training was defined as routine if included in residents' schedules with individuals permitted to opt out, optional as not in the residents' schedules but available for individuals to arrange, and not available. Findings were compared between types of programs using bivariate analyses.

Results: In all, 190 residency program directors (79%) responded. A total of 64% reported routine training with dedicated time, 31% optional, and 5% not available. Routine, scheduled training was correlated with higher median numbers of uterine evacuation procedures. While the majority believed their graduates to be competent in first-trimester aspiration (71%), medication abortion (66%), and induction termination (67%), only 22% thought graduates were competent in dilation and evacuation. Abortion procedures varied by clinical indication, with some programs limiting cases to pregnancy complication, fetal anomaly, or demise.

Conclusion: Abortion training in obstetrics and gynecology residency training programs has increased since 2004, yet many programs graduate residents without sufficient training to provide abortions for any indication, as well as dilation and evacuation. Professional training standards and support for family planning training have coincided with improved training, but there are still barriers to understand and overcome.

Keywords: gynecology/education; induced abortion; resident education; therapeutic abortion.

MeSH terms

  • Abortion, Induced / education*
  • Clinical Competence
  • Cross-Sectional Studies
  • Curriculum*
  • Gynecology / education*
  • Humans
  • Internship and Residency
  • Obstetrics / education*
  • Surveys and Questionnaires
  • United States