Abortion training?

[tiredmom]

Hi! I know this is a controversial topic... I'm not trying to stir things up. What do you do if you don't feel comfortable ethically performing abortions, and you are asked about it by a program? Are there programs that require you to perform abortions? If so, which ones?
Thanks

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[DrBuzzLightYear]

Hi! I know this is a controversial topic... I'm not trying to stir things up. What do you do if you don't feel comfortable ethically performing abortions, and you are asked about it by a program? Are there programs that require you to perform abortions? If so, which ones?
Thanks

you see that little search icon up in the corner?? go on, give it a try!

 

[G2P0112]

Hi! I know this is a controversial topic... I'm not trying to stir things up. What do you do if you don't feel comfortable ethically performing abortions, and you are asked about it by a program? Are there programs that require you to perform abortions? If so, which ones?
Thanks

I don't think that legally programs can make you perform anything you are ethically opposed to. That being said, certain programs are definetely more active in their AB training. The APGO website might have useful information for you. There is a section that asks if residents are required to perform 1st or 2nd trimester AB's, as well as if there is the opportunity for training. You can also look at the # of AB's performed, programs with higher numbers probably have more training opportunities. I go to school in Portland, all residents rotate through Planned Parenthood, as well as another clinic that performs 2nd trimester AB's and the program in general is very strong in their AB training. I believe that they look for residents with a pro-coice political view, but I am not totally sure.

 

[Flea girl]

Hi! I know this is a controversial topic... I'm not trying to stir things up. What do you do if you don't feel comfortable ethically performing abortions, and you are asked about it by a program? Are there programs that require you to perform abortions? If so, which ones?
Thanks

I do not think that any program requires you do elective abortions, if you have ethical issues with it.

 

[snowinter]

you see that little search icon up in the corner?? go on, give it a try!

MRBUZZLIGHTYEAR: dude. you take more time giving one-liner responses. why do you bother? if you aren't going to answer the questions. at least-- copy the link -- since you know it exists.

anyway, to answer your question TIRED MOM:
i had hte same dilemma /worries - -and i talked to the chairs of several places--and residents basically perform whatever they feel comfortable doing: from no discussion of birthcontrol (strict catholics) to ppl who only want to perferom VIPS for congenital anomalies -- but not for unplanned pregnancies -etc. to ppl who want to do it all.. to ppl who want to do no abortions at all. everyone still has to learn pre and post operative management of care -- (i think) It's a very appropriate question for all us to be asking ourselves right now-- going into obgyn... those of us who went to medical school in the south or at catholic schools may have had much less exposure to this issue-- and it is importnat to know: there is a lot of flexibility -- no one will make you FEEL BAD for your stance... and you should never feel bad. there will probraly be residents in your class who have varying stances. just be able to know your stance and refer the patient to someone who will feel comfortable dealing with her issues. i found it helpful to go and see some abortions (for trisomies, anacephaly, etc) just to *see*.
and -- my stance is currently "in progress" as far as what exactly i'd feel comfortable doing -- although iknow i can't do it for elective healthy fetuses .. that is my stance. not a political statement and remember you have the right to have your stance, not feel bad, and that's the end of it.
sorry if this is incoherent -- i'm post call and tired. (which is also why i lashed out you buzzlight year-- i'm also grouchy)
that's it.
snow

 

[reddirtgirl]

Just out of curiosity, how does getting training to do d&c's differ from getting trained to do surgical abortions?

 

[Carbo/Taxol]

Tiredmom -

I had the same questions as you did. I am opposed to elective abortions. If you didnt want to be pregnant you shouldn't have had sex....end of discussion....deal with the consequences. (sorry...had to vent). I know that this may be an uncommon opinion for a future Ob/Gyn, but thats what it is and that is what I am sticking too.

Now...on to answering your initial question.

Language of the ACGME requirement on abortion training that went into effect on January 1, 1996, is as follows:

No program or resident with a religious or moral objection shall be required to provide training in or to perform induced abortions. Otherwise, access to experience with induced abortion must be part of residency education. This education can be provided outside the institution. Experience with management of complications of abortion must be provided to all residents. If a residency program has a religious, moral or legal restriction that prohibits residents from performing abortions within the institution, the program must ensure that residents receive satisfactory education and experience in managing the complications of abortion. Furthermore, such residency program (1) must not impede residents in the programs who do not have religious or moral objections from receiving education and experience performing abortions at another institution and (2) must publicize such policy to all applicants to those residency programs.


I have also read that some pro-choice groups are pushing to make abortion training mandatory in public hospitals with requests to pull government funding to those hospitals that do not comply...so you may want to look into this. Hope this helps.

Controversial indeed.......

 

[DrBuzzLightYear]

MRBUZZLIGHTYEAR... buzzlight year

thats Doctor Buzzlightyear to you, missy.

 

[tiredmom]

you see that little search icon up in the corner?? go on, give it a try!

Did search... didn't find anything specific answering my question or current. If you don't care to answer, don't post.

 

[tiredmom]

Thanks for your answers.

 

[Alician]

I hope you don't speak to your patients that way. I thought as a culture we had moved away from reproduction being tied to sex. People make mistakes. I think it's hard to judge unless you have been in that situation.
Of course you have a right to your opinion, as long as it doesn't get in the way of providing good patient care.

Tiredmom -

I had the same questions as you did. I am opposed to elective abortions. If you didnt want to be pregnant you shouldn't have had sex....end of discussion....deal with the consequences. (sorry...had to vent). I know that this may be an uncommon opinion for a future Ob/Gyn, but thats what it is and that is what I am sticking too.

Now...on to answering your initial question.

Language of the ACGME requirement on abortion training that went into effect on January 1, 1996, is as follows:

No program or resident with a religious or moral objection shall be required to provide training in or to perform induced abortions. Otherwise, access to experience with induced abortion must be part of residency education. This education can be provided outside the institution. Experience with management of complications of abortion must be provided to all residents. If a residency program has a religious, moral or legal restriction that prohibits residents from performing abortions within the institution, the program must ensure that residents receive satisfactory education and experience in managing the complications of abortion. Furthermore, such residency program (1) must not impede residents in the programs who do not have religious or moral objections from receiving education and experience performing abortions at another institution and (2) must publicize such policy to all applicants to those residency programs.


I have also read that some pro-choice groups are pushing to make abortion training mandatory in public hospitals with requests to pull government funding to those hospitals that do not comply...so you may want to look into this. Hope this helps.

Controversial indeed.......

 

[ShambhalaRed]

I hope you don't speak to your patients that way. I thought as a culture we had moved away from reproduction being tied to sex. People make mistakes. I think it's hard to judge unless you have been in that situation.
Of course you have a right to your opinion, as long as it doesn't get in the way of providing good patient care.

Couldn't have said it more eloquently myself.

 

[ShambhalaRed]

Tiredmom -

I had the same questions as you did. I am opposed to elective abortions. If you didnt want to be pregnant you shouldn't have had sex....end of discussion....deal with the consequences. (sorry...had to vent). I know that this may be an uncommon opinion for a future Ob/Gyn, but thats what it is and that is what I am sticking too.

No, I'm still steamed and have to respond to this. That is an ignorant comment. I spent a month this spring working at Planned Parenthood and one of the patients I will remember for the rest of my life is a 24 year old girl who burst into tears when her pregnancy test came back positive. She told us that she had diligently tried every birth control method under the sun and this was her third unintended pregnancy and unfortunately she would have to get her third abortion because she just wasn't ready to have children yet. She was devastated. Would you tell this woman that she "shouldn't be having sex?" I walked away from that month certain of one thing: every birth control method that we have available today fails. You cannot tell people they shouldn't be having sex, and you cannot tell them they have to bear a child when it is not the right time in their life, for whatever reason. Yes, people make mistakes. But there is a second piece to this problem. Contraception is not perfect, and even the most responsible people find themselves in a very difficult situation and have to make the best decision for themselves at that point in their life.

You do not ever have to perform an abortion if you don't want to. But if you carry around that judgment that only irresponsible people get abortions, you will be doing many of your patients a disservice and subjecting them to shame that they do not deserve.

 

[tiredmom]

I'm not saying right or wrong, I just know I personally won't do it. I know that the procedures are the same as if the baby is dead already, so I would still get the procedure training that I would need to take care of my patients. The point of this is not to start a war - I don't want to bring something up at interviews that I shouldn't, and I don't want to waste money going places that I can rule out right away.

It sounds like this is a topic that is not taboo at interviews - is that right? I know for med school interviews it was - since my background is similar to the interviewer's wife, he brought it up, apologizing as he did since it was "off limits". I wasn't sure if something this important would be one of those 800 lb gorillas for OB/Gyn residency interviews. Looking at APGO - the only program I'd found so far that required it is Brown, but I haven't looked at everybody. They are not performed at the UH here.

tiredmom

 

[tiredmom]

Just out of curiosity, how does getting training to do d&c's differ from getting trained to do surgical abortions?

It's the same procedures - both D&C and D&E's. I just don't want to perform it on babies that are not already dead.

 

[DrBuzzLightYear]

Did search... didn't find anything specific answering my question or current. If you don't care to answer, don't post.

i've been here a lot longer than you, tiredmom, and let me tell you, there's plenty specific.

 

[Carbo/Taxol]

I hope you don't speak to your patients that way. I thought as a culture we had moved away from reproduction being tied to sex. People make mistakes. I think it's hard to judge unless you have been in that situation.
Of course you have a right to your opinion, as long as it doesn't get in the way of providing good patient care.

Of course I will not speak to patients that way! And I certainly will not jeopardize patient care nor try to influence their opinions or self-perceptions on accounts of my personal beliefs. This is where the importance of the patient referral comes into play (barring a medical emergency of course). My personal beliefs will continue to be my PERSONAL beliefs and colleagues nor the way this society is moving can expect to change them, just like I do not expect to change or attack anyone else's opinions.

As far as reproduction not being tied to sex....hmm...still havent figured that one out....

I would say more, but to avoid opening a giant can of worms...I will modestly cease and desist.

Thank for your responses.

 

[tiredmom]

i've been here a lot longer than you, tiredmom, and let me tell you, there's plenty specific.

I didn't find anything about bringing it up in interviews, etc... chill.

 

[ShambhalaRed]

I'm not saying right or wrong, I just know I personally won't do it. I know that the procedures are the same as if the baby is dead already, so I would still get the procedure training that I would need to take care of my patients. The point of this is not to start a war - I don't want to bring something up at interviews that I shouldn't, and I don't want to waste money going places that I can rule out right away.

It sounds like this is a topic that is not taboo at interviews - is that right? I know for med school interviews it was - since my background is similar to the interviewer's wife, he brought it up, apologizing as he did since it was "off limits". I wasn't sure if something this important would be one of those 800 lb gorillas for OB/Gyn residency interviews. Looking at APGO - the only program I'd found so far that required it is Brown, but I haven't looked at everybody. They are not performed at the UH here.

tiredmom

Speaking from the perspective of someone who wants to go to a program where abortion training is a part of the curriculum, I don't feel that the topic is taboo. It is an important component of Ob/Gyn training, and despite the ACGME requirements, programs definitely vary in terms of the training they offer/expect residents to get. The residents that I have talked to made a point to ask about it at interviews - that doesn't mean that every PD or resident they asked was comfortable disclosing their policy on it, but as is clear from this thread, it is important to us in choosing programs. Some hospitals allow d&c's to be performed for elective reasons in their hospitals and clinics, others do not. Some programs aggressively emphasize abortion training in their curriculum, others quietly minimize it. This process is about finding the program that fits you. If it is important to you that you not feel pressured to perform elective abortions for whatever reason, be it personal, religious or whatever, I personally think you should definitely ask about it at interviews. I definitely plan to.

 

[ShambhalaRed]

Looking at APGO - the only program I'd found so far that required it is Brown, but I haven't looked at everybody. They are not performed at the UH here.

tiredmom

Oh, as far as specific programs that talk about it on their website: OHSU and Pittsbugh (Magee) definitely do. UCSF might not talk explicitly about it, but they are known to emphasize family planning in their curriculum. I don't really think anyone "requires" it, but these are examples of places where applicants who want this kind of training tend to gravitate.

Hope that is helpful.

 

[Carbo/Taxol]

This process is about finding the program that fits you. If it is important to you that you not feel pressured to perform elective abortions for whatever reason, be it personal, religious or whatever, I personally think you should definitely ask about it at interviews. I definitely plan to.

Well said.
I agree that if you feel strongly that abortion training is something that you would rather not be exposed to (be it for whatever reason) you may want to bring it up during your interview with the faculty or at the very least ask the residents or medical students at the institution. The same goes for those who are of the opposite opinion. Good luck.

 

[AzMichelle]

It's the same procedures - both D&C and D&E's. I just don't want to perform it on babies that are not already dead.

Whether or not anyone agrees or disagrees with you, TiredMom, I think it's great that you stand behind what you believe. We all have our limits in life, nobody is an exception to that rule.

When I first went into medicine my list of what I won't do changed over the years, participating in abortions is one of them. The more patients you see the more your opinions tend to change. I'm not talking about abortion specifically, I'm talking about all kinds of issues.

Do what you sincerely believe is proper.

 

[ohbee gin]

Check the med students 4 choice website, programs indexed by state.
link

 

[tiredmom]

Thanks everybody - I think this discussion will make it easier for me to broach difficult topics such as this at interviews. I'm not a traditional student, and my past life experience (as a labor and delivery nurse) has blurred the lines of what is appropriate or taboo at formal interviews (even vaginal bleeding seems like normal conversation at times ). Y'all are helping a lot!

 

[Diane L. Evans]

At some point you'll need to know how to do a menstral aspiration (awake d&C use up to 9 weeks) or a D&E or D&C. At my residency if you don't do ab that's OK but you still will have to do them for missed ab or demises. Also broach the subject of how you would feel doing this on a trisomy 18 or acrania in your response to an interview question

 

[strathra]

I got a list of residencies that offer abortion training from the national abortion federation. If you want a copy, send me a message at [email protected]

I specifically applied to programs on this list. I guess you can avoid these programs if you are so inclined.

-Rich

 

[snowinter]

I got a list of residencies that offer abortion training from the national abortion federation. If you want a copy, send me a message at [email protected]

I specifically applied to programs on this list. I guess you can avoid these programs if you are so inclined.

-Rich

But, just because a program offers abortion training -- doesn't mean you have to participate in the abortion training. I know many people apply to schools with that criteria in mind-- and that is a big issue for them. I don't think ppl who don't want to learn abortion training should avoid schools that do offer abortion training. You may limit your range of schools & the schools may miss out on a great applicant as well. We can peacefully arrange our differences in opinion -- side by side. & each side and learn from the other.
snow

 

[tiredmom]

My understanding is that nearly all programs offer opportunities for abortion training, it's more of an issue for me to be REQUIRED to perform them. I'm not opposed to being at a program that performs them.

 

[jane2]

Most residencies don't force you to train to do abortions.

If you go to www.apgo.org there's a directory of residencies (if you don't already have a password for it you can email them for one) and as part of that it tells you for each program whether they offer abortion training at all, and whether they have compulsory training. I've been looking through the directory and am yet to find one where it's compulsory. I

 

[tiredmom]

I've been looking through the directory and am yet to find one where it's compulsory. I[/QUOTE]

So far, Brown requires first trimester abs to be done per the apgo directory. Haven't found anybody else that says up front they require it. The numbers I've seen for the California programs are high as far as the number of abortions performed per resident, but even they don't say they require it.

 

[HotWing]

Programs CANNOT REQUIRE you to perform abortions, according to the ACGME guidelines that were released in 1996 that state, "No program or resident with a religious or moral objection shall be required to provide training in or to perform induced abortions. Otherwise, access to experience with induced abortion must be part of residency education."

FYI: These guidelines were released in response to the decline in AB training in the early 90's, to increase the availability of training for those who would like it.

So no one can be required to perform them, but unfortunately, a lot of programs DO NOT FOLLOW the last part that states it must be part of residency education for those who desire it.

 

[tiredmom]

That's why I'm confused by this infomation on APGO from Brown's profile:
Abortion Services
Residents are required to perform 1st trimester elective abortion: Yes
Residents are required to perform 2nd trimester elective abortion: No
Residents have the opportunity to be taught 1st trimester abortion techniques: Yes
Residents have the opportunity to be taught 2nd trimester D&E techniques: Yes

 

[HotWing]

Yeah, that is confusing. Maybe it is a typo?

 

[tiredmom]

I hope it is, since the rest of the program looks great!!! Anybody out there with Brown connections know anything about it?