Med schools may have been intimidated by survey

Abortion Training on the Increase?

By Randall K. O'Bannon, Ph.D., NRL Director of Education & Research

After bitterly complaining for years that the number of obstetrics and gynecology residency programs that provide abortion training is declining, abortion industry representatives are now singing a different tune. They are touting the results of a recent survey purporting to show a significant increase in the number of obstetrics and gynecology residency programs that now routinely train medical students to perform abortions. Yet a closer examination suggests that the changes may not be nearly as dramatic as indicated.

The results of the survey of the 261 accredited U.S. residency programs in obstetrics and gynecology, sponsored by the National Abortion Federation (NAF), was published in the November/December 2000 issue of Family Planning Perspectives.

A full 81% of the 179 programs that responded to the 1998 survey said training in first-trimester abortion was offered in residency programs, either routinely (46%), or as an elective (34%). Nearly as many (74%) said they offered second-trimester abortion training either routinely or as an elective.

The figure of 46% of residency programs that routinely offer training in first-trimester abortions represents a near four- fold increase over the 1995 figure of 12%.

Seeking to translate survey data from programs into data on individual residents, the authors of the article--Rene Almeling, Laureen Tews, and Susan Dudley--took data from the survey and correlated it to information on program size gleaned from the 1998-99 American Medical Association directory. They calculated that 84% of ob-gyn residents were enrolled in accredited obstetrics and gynecology residency programs that offered first- trimester abortion training, with just less than half (49%) involved in residency programs that offered such training routinely.

Vicki Saporta, executive director of NAF, attributes the increase to new guidelines put in place by the powerful Accreditation Council for Graduate Medical Education (ACGME) in 1996. Those guidelines mandated abortion training in all U.S. medical residency programs that did not have religious or moral objections. The ACGME is the organization that handles medical school accreditation in the U.S.

"We believe the ACGME training requirement has substantially impacted the availability of abortion training," said Saporta. "We worked closely with other organizations to make the ACGME aware of the lack of access to abortion training for many residents. This survey confirms that the requirement was needed, and that it has made a difference. Not only are many more residency programs offering routine abortion training, but those programs that aren't are contacting NAF and others to aid them in meeting the requirement."

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.

Language proposed in 1995 by the ACGME that would have given residency programs less freedom to "opt out" of providing or referring for abortion training was dropped after objections from members of Congress and Catholic medical institutions. Still not entirely happy with the present language, Congress passed a law in 1996 saying that no residency program that lost accreditation for failing to provide abortion training would risk losing federal funds (Ob.Gyn. News, 7/15/96).

RESULTS MAY BE MORE AMBIGUOUS

How much detail about the ACGME guidelines and the congressional measure to safeguard federal funding for institutions that do not provide abortion training was made available to programs participating in the NAF survey is unknown. Almeling, Tews, and Dudley do say in their report that "there is reason to be cautious in interpreting these results, including possible response bias and pressure to report the availability of abortion training because of new guidelines from the [ACGME]."

One very suggestive result is that many fewer residency programs responded to the 1998 survey than did to previous NAF surveys. NAF's 1991-92 study had a response rate of 87%, but only 69% responded to the 1998 survey.

More intriguing yet is that the authors offer data showing that if one assumed that non-respondents did not offer abortion training, the percentage of residency programs choosing not to offer abortion training could be as high as 44%, rather than the 19% reported by those who responded to the survey. If true, this would actually be a sharply higher percentage refusing to offer abortion training than found in either the 1992 (30%) or 1985 (28%) surveys.

Further muddying the results is the survey's failure to define what "abortion training" entailed, or to specify what qualified as "routine" or "elective." Medical residents learn the dilation and curettage technique used in most first-trimester abortions when being trained how to use the technique to handle miscarriages. Does this qualify as "abortion training" or not?

How much and what kind of training qualifies as "routine"? How much of an effort does a program have to put forth to be counted as offering abortion training as an "elective"? One medical student from California whose school was listed as providing abortion education when she was in school said all she was ever required to do was write a half-page paper on the subject (American Medical News, 8/15/96).

There is also a question regarding the accuracy of the reports or perceptions of the program directors who filled out the survey. Authors of the 1998 NAF survey said that an earlier survey showed that program directors tended to report more clinical experience with abortion than did residents.

The NAF researchers said, "Pressure to affirm the presence of abortion training in residency programs may come from the new ACGME standard, which links abortion training with accreditation. No residency program could lose its accreditation simply because it does not offer abortion training; however, program directors may have exaggerated the existence and routine nature of abortion training, especially if they are under the misapprehension that NAF is a political watchdog organization." However, the authors offered no reassurances that there was anything in the NAF survey or accompanying materials that would clear up this misunderstanding.

The authors were anything but circumspect in laying out their agenda. "It is not enough for training to be available on an elective basis to overworked residents," they write. "Programs need to set expectations of resident participation in routine abortion training so that trainees who exercise a conscience clause provision to opt out become the exception and not the rule."

The authors pointed out that mandatory abortion training means not only more residents learning abortion skills but more sympathy for their cause: "Residents who have experience with abortion are more likely to have a positive attitude toward it and to discuss all pregnancy options with their patients."

Back in 1995, Dr. Pamela Smith, then president-elect of the American Association of Pro-Life Obstetricians and Gynecologists, recognized that there was a larger aim to this mandatory abortion training than just breaking down the resistance of residents and recruiting them to join the ranks of abortionists.

Dr. Smith told Congress, "The mandate has the clear purpose of ' mainstreaming' abortion practice within the medical community and presenting to the American public the totally false impression that all physicians believe abortion is just another medical procedure, when clearly it is not" (Washington Times, June 15, 1995.)

No regulation can ultimately change the reality of abortion, however. This study shows, by the number of programs resisting the mandate and refusing to return the survey, that the efforts of the abortion lobby have not been entirely successful. There are a lot of doctors in America who still believe that killing has no place in the healing profession.