Adaptations to Medical Education in a State-Specific Abortion Ban Paradigm

The United States (US) Supreme Court’s overturning of Roe v Wade in 2022 via the decision made in Dobbs v Jackson Women’s Health Organization removed the national protection for doctors to perform abortions and made states able to impose restrictions on this medical procedure. This change immediately affected health care availability in the US, with many states outright banning or effectively banning abortion through gestational limits. Immediate negative effects were reported in populations and locations where maternal health outcomes were already poor, including among Black women and patients living in rural areas. Here we review how the Dobbs decision disrupted medical education and the adaptations that have been made, primarily in the specialties of obstetrics and gynecology, internal medicine, family medicine, and emergency medicine. To comply with accreditation standards, certain graduate medical education programs must provide access to abortion education regardless of local restrictions. Thus, the differences in state-by-state regulations have affected where doctors choose to learn, practice, and live. In states that have enacted abortion restrictions, residency programs have been forced to adapt their educational practices by increasing the amount of simulation-based learning and by sending residents to learn in states where they can practice the procedures they must gain competency with to become qualified independent physicians. These measures do not provide the full benefit of a normal rotation schedule, which enables learners to have repeated, hands-on training. Looking forward, if states where abortion is banned continue to disincentivize qualified doctors from practicing medicine, the consequences will likely extend beyond abortion and maternal care, and may extend into overall women’s health.