How do I #AskAboutAbortion during #Match2023? Reflections from 2 Recent Twitter Chats
Authors: Abigail Liberty, MD MSPH & Ian Fields, MD MCR
Keywords: medical education, abortion, residency, reproductive healthcare, healthcare policy, equity
#Match2023 applications have been submitted, signals designated, and students are awaiting interviews. Given that 13 states have near-total bans on abortion with elements criminalizing referring for abortion care, residency and medical school applicants are anxious about how restrictions impact education and training. Two recent social media events sought to create space to speak about these concerns. We’d like to highlight the themes of the chats to empower women in medicine to continue the conversation across all specialties.
The Alliance for Clinical Education hosts a bimonthly chat (#MedEdChat) focused on interdisciplinary and collaborative discussion among preclinical medical educators. On August 18th, @MedEdChat hosted a TwitterChat about abortion restrictions and medical education.
Participants hypothesized that applicants will prioritize training in states without restrictions in order to maximize training opportunities and protect personal bodily autonomy. This is projected to exacerbate competitiveness between states that protect abortion care and those that prohibit it. However, applicants may not forgo a spot in medical school or residency even if they are disappointed to train in a restrictive environment. Current studies are underway by Dr. Vinny Arora, a hospitalist and Dean for Medical Education at the University of Chicago, to understand how restrictions impact applicants’ career goals from residency to independent practice. No studies appear available at the medical school application and matriculation level.
Participants reported that no-questions-asked, unlimited and private medical leave is critical for protecting trainees’ access to abortion care. Students need pro-active guidance navigating insurance and medical systems as adults and abortion cannot be a blind spot, unaddressed until an acute need arises and a student realizes they have insurance that does not cover reproductive health. This needs to be actively incorporated into recruitment and onboarding. Participants hypothesized that lack of attention to reproductive health will only exacerbate inequities among medical students and is directly counterproductive to efforts to fortify diversity and inclusion in medicine.
A week following the #MedEdChat, @Inside_TheMatch and @OHSUSOM co-hosted a chat entitled #AskAboutAbortion to crowd source advice for residency applicants concerned for the impact of abortion restrictions on their training. The majority of participants included attending physicians, predominantly from the host institution, but with key voices from states with restrictions including Texas and Georgia. Despite non-specialty specific advertising and the fact that restrictions on reproductive rights have the ability to impact trainees in all specialties, the majority of attendants were OBGYNs or Family Medicine providers.
The discussion voiced concern for deficits in training without abortion care and debated whether experience managing perinatal loss is enough to gain proficiency in those skills. Generally, physicians felt that skills of miscarriage management improve when taught alongside abortion care.
Applicants were encouraged to ask directly about abortion care opportunities if they felt that attending a program that was not supportive of abortion care would be harmful for them. Some applicants reported concern about potential negative ramifications of asking about a controversial topic, namely the fear of discrimination from an interviewer who is anti-abortion. In these situations, physician participants validated that fear and encouraged applicants to ask about adjacent topics: contraception, miscarriage, referrals within the catchment, initiatives aimed at diversity, inclusion and anti-racism. Furthermore, people shared that in their experience, trainees who do not intend to provide abortion care are also disadvantaged by policies which stigmatize or abortion care
Lastly, the chat discussed the specifics about the importance of national curriculum objectives in advocating for abortion care. The ACGME accreditation guidelines for OBGYN education were addended to prevent discrediting of programs now barred from providing abortion care and to provide a framework to ensure resident physicians gained experience in providing abortion care at outside institutions. The discussion ended on the stark revelation that funds for graduate medical education and improved systems for away rotations are only the beginning of innovations needed to protect patient-centered care.
We are only just beginning to understand the impact of restrictions on reproductive rights as it pertains to trainees in medicine. We must continue to provide the time and space for our trainees to participate in these important conversations.
About the authors: Abigail Liberty (she/her, Twitter: @abbyliberty1) is the second year Complex Family Planning fellow at OHSU where she works with diverse trainees in Family Planning settings. Ian Fields (he/him, Twitter: @eeyanmiller) is an Assistant Professor of Obstetrics and Gynecologist within the Division of Urogynecology and Assistant Program Director for the OBGYN Residency at OHSU.
