- Email: [email protected]
Resident training in abortion: summary of Ryan Programs in ob-gyn residency programs in the United States and Canada
396
Abstracts / Contraception 94 (2016) 387–434
P12 THE EFFECT OF MEDICAID-FUNDED ABORTION ON THE LARC METHOD UPTAKE RATE IN THE DISTRICT OF COLUMBIA Sutherland M Medstar Washington Hospital Center, Washington, DC, USA
Conclusions: The Ryan Program has been successful in integrating abortion and family planning into 34% of all ob-gyn residency programs. These rotations have led to approximately 2750 ob-gyns graduating with proficiency in abortion and contraception care. http://dx.doi.org/10.1016/j.contraception.2016.07.053
Ye P, Moreno N, Van S
P14 Objectives: Every year since 1988, Congress has attached a rider to the city budget of the District of Columbia prohibiting the use of DC tax dollars to help women pay for abortions. This ban was briefly lifted between August 2010 and April 2011. During this time, Medicaid-eligible women could receive fully funded surgical or medical abortions at one academic center in Washington, DC. Incidentally, they were also eligible for free LARC method insertions through the Ryan Program. This study examined how the absence of financial barriers to abortion and LARC methods changed the LARC method uptake rates. Methods: In a retrospective chart review of 883 patients, this 8-month period of Medicaid-funded abortions was compared with the two adjacent 6-month intervals at an academic center in Washington, DC. Results: While the Medicaid ban was lifted, the number of Medicaid patients who presented to the academic institution increased significantly. Patients during this period had the same LARC method uptake rate as those seen during the adjacent time periods; however, at 31%, this was much higher than the national average. Because of the increased patient volume, twice as many LARC method insertions per month were performed while the Medicaid ban was lifted. Conclusions: The true benefit of the change in Medicaid funding laws may have been to draw patients from private clinics into an academic center where LARC methods were freely available. Future district-wide prospective trials are needed to clarify the effects of publicly funded abortions and LARC methods on unwanted pregnancy rates.
“YOU CAN’T GIVE THIS JOB AWAY”: BEING A LEADER IN ABORTION CARE Bennett AH Albert Einstein College of Medicine, Department of Family and Social Medicine, Bronx, NY, USA Seewald M, Hassinger JA, Harris LH, Martin LA, Gold M
Turk J University of California, San Francisco, San Francisco, CA, USA
Objectives: This study aimed to describe the experiences of leaders of abortion services. We sought to define the leadership role and explore leaders' motivations, challenges, sources of resilience, the impact of stigma on their lives and work and impressions of the future of abortion care leadership. Methods: We conducted in-depth interviews with 29 US abortion care leaders including clinic owners, administrators, CEOs and medical directors in several practice settings. Interviews were audio-recorded, transcribed and analyzed using a grounded theory approach. Results: Leaders had varied professional backgrounds, including business, nonprofit, social work and medicine. There was no consistent pathway to leadership. Leaders' roles included a wide range of activities; most had no “typical day.” All expressed passion for their work but described intense challenges. These included personal costs (financial and interpersonal), harassment and violence, stigma, isolation and lack of support, burnout, legislative burdens and constant scrutiny. Despite this, participants demonstrated humor and resilience. Regarding the future, most had no succession plan and believed that it would be hard to find their replacement. As one said, “You can’t give this job away.” Participants identified the lack of a “leadership pipeline” as a key challenge. Conclusions: A pipeline exists for sustaining a physician work force in abortion care, but no equivalent pipeline exists for leaders of abortion care organizations. Abortion care leadership is uniquely challenging, and training and preparation are needed. Movement-wide priorities need to expand beyond physician training to include the development and mentorship of new leaders in abortion care from a variety of disciplines.
Simonson K, Landy U, Steinauer J
http://dx.doi.org/10.1016/j.contraception.2016.07.054
Objectives: The Kenneth J. Ryan Residency Training Program in Abortion and Family Planning (Ryan Program) provides support for residency programs to comply with the Accreditation Council for Graduate Medical Education (ACGME) mandate to integrate abortion into training and enhance training in abortion and contraception. Since 1999, some 84 programs have been established in 33 states and two Canadian provinces. Our objective is to describe the impact on residents' clinical competence and the departments overall. Methods: All Ryan Programs are systematically reviewed through postrotation surveys completed by residents and through annual reports, site reviews and yearly surveys completed by Ryan Program directors, department chairs and residency program directors. Results: In 2015, a total of 254 (94%) residents completed postrotation surveys. In the same year, 22 of 23 (96%) directors, chairs and residency program directors of actively funded Ryan Programs completed their annual surveys. On average, residents spend 17 days in clinics providing abortion or contraception care. During the rotation, residents offer complex contraceptive services, first-trimester manual and electric uterine aspirations, medication abortions and second-trimester dilation and evacuation procedures. Directors, department chairs and residency program directors described a variety of benefits including residents' increased skills in counseling, contraception, ultrasound, abortion and outpatient surgery. In addition to improved clinical competence, departments reported better continuity of care for patients and increased appeal of the residency programs to medical student applicants.
P15
http://dx.doi.org/10.1016/j.contraception.2016.07.052
P13 RESIDENT TRAINING IN ABORTION: SUMMARY OF RYAN PROGRAMS IN OB-GYN RESIDENCY PROGRAMS IN THE UNITED STATES AND CANADA
FACILITY STANDARDS FOR COMMON OUTPATIENT PROCEDURES: ARE THERE LESSONS LEARNED FOR ABORTION? Berglas N University of California, San Francisco/ANSIRH, Oakland, CA, USA Scott Jones B, Roberts S Objectives: State laws regulating abortion facilities are promoted as safeguarding women's health but are not supported by evidence showing an impact on patient safety. As other procedures have transitioned from hospitals to outpatient settings, questions of how best to ensure safety and facility standards have proliferated. This study examined how standards have been developed for procedures commonly performed in outpatient settings (endoscopy, gynecologic procedures, oral surgery, plastic surgery) and identified lessons learned for abortion. Methods: In-depth interviews (N=20) were conducted with experts involved in facility standards development across medical specialties about motivations for standards development, processes used to establish standards, types of evidence reviewed and decision making in the absence of evidence. Data were analyzed using an iterative coding process and identification of thematic patterns.
Abstracts / Contraception 94 (2016) 387–434
P12 THE EFFECT OF MEDICAID-FUNDED ABORTION ON THE LARC METHOD UPTAKE RATE IN THE DISTRICT OF COLUMBIA Sutherland M Medstar Washington Hospital Center, Washington, DC, USA
Conclusions: The Ryan Program has been successful in integrating abortion and family planning into 34% of all ob-gyn residency programs. These rotations have led to approximately 2750 ob-gyns graduating with proficiency in abortion and contraception care. http://dx.doi.org/10.1016/j.contraception.2016.07.053
Ye P, Moreno N, Van S
P14 Objectives: Every year since 1988, Congress has attached a rider to the city budget of the District of Columbia prohibiting the use of DC tax dollars to help women pay for abortions. This ban was briefly lifted between August 2010 and April 2011. During this time, Medicaid-eligible women could receive fully funded surgical or medical abortions at one academic center in Washington, DC. Incidentally, they were also eligible for free LARC method insertions through the Ryan Program. This study examined how the absence of financial barriers to abortion and LARC methods changed the LARC method uptake rates. Methods: In a retrospective chart review of 883 patients, this 8-month period of Medicaid-funded abortions was compared with the two adjacent 6-month intervals at an academic center in Washington, DC. Results: While the Medicaid ban was lifted, the number of Medicaid patients who presented to the academic institution increased significantly. Patients during this period had the same LARC method uptake rate as those seen during the adjacent time periods; however, at 31%, this was much higher than the national average. Because of the increased patient volume, twice as many LARC method insertions per month were performed while the Medicaid ban was lifted. Conclusions: The true benefit of the change in Medicaid funding laws may have been to draw patients from private clinics into an academic center where LARC methods were freely available. Future district-wide prospective trials are needed to clarify the effects of publicly funded abortions and LARC methods on unwanted pregnancy rates.
“YOU CAN’T GIVE THIS JOB AWAY”: BEING A LEADER IN ABORTION CARE Bennett AH Albert Einstein College of Medicine, Department of Family and Social Medicine, Bronx, NY, USA Seewald M, Hassinger JA, Harris LH, Martin LA, Gold M
Turk J University of California, San Francisco, San Francisco, CA, USA
Objectives: This study aimed to describe the experiences of leaders of abortion services. We sought to define the leadership role and explore leaders' motivations, challenges, sources of resilience, the impact of stigma on their lives and work and impressions of the future of abortion care leadership. Methods: We conducted in-depth interviews with 29 US abortion care leaders including clinic owners, administrators, CEOs and medical directors in several practice settings. Interviews were audio-recorded, transcribed and analyzed using a grounded theory approach. Results: Leaders had varied professional backgrounds, including business, nonprofit, social work and medicine. There was no consistent pathway to leadership. Leaders' roles included a wide range of activities; most had no “typical day.” All expressed passion for their work but described intense challenges. These included personal costs (financial and interpersonal), harassment and violence, stigma, isolation and lack of support, burnout, legislative burdens and constant scrutiny. Despite this, participants demonstrated humor and resilience. Regarding the future, most had no succession plan and believed that it would be hard to find their replacement. As one said, “You can’t give this job away.” Participants identified the lack of a “leadership pipeline” as a key challenge. Conclusions: A pipeline exists for sustaining a physician work force in abortion care, but no equivalent pipeline exists for leaders of abortion care organizations. Abortion care leadership is uniquely challenging, and training and preparation are needed. Movement-wide priorities need to expand beyond physician training to include the development and mentorship of new leaders in abortion care from a variety of disciplines.
Simonson K, Landy U, Steinauer J
http://dx.doi.org/10.1016/j.contraception.2016.07.054
Objectives: The Kenneth J. Ryan Residency Training Program in Abortion and Family Planning (Ryan Program) provides support for residency programs to comply with the Accreditation Council for Graduate Medical Education (ACGME) mandate to integrate abortion into training and enhance training in abortion and contraception. Since 1999, some 84 programs have been established in 33 states and two Canadian provinces. Our objective is to describe the impact on residents' clinical competence and the departments overall. Methods: All Ryan Programs are systematically reviewed through postrotation surveys completed by residents and through annual reports, site reviews and yearly surveys completed by Ryan Program directors, department chairs and residency program directors. Results: In 2015, a total of 254 (94%) residents completed postrotation surveys. In the same year, 22 of 23 (96%) directors, chairs and residency program directors of actively funded Ryan Programs completed their annual surveys. On average, residents spend 17 days in clinics providing abortion or contraception care. During the rotation, residents offer complex contraceptive services, first-trimester manual and electric uterine aspirations, medication abortions and second-trimester dilation and evacuation procedures. Directors, department chairs and residency program directors described a variety of benefits including residents' increased skills in counseling, contraception, ultrasound, abortion and outpatient surgery. In addition to improved clinical competence, departments reported better continuity of care for patients and increased appeal of the residency programs to medical student applicants.
P15
http://dx.doi.org/10.1016/j.contraception.2016.07.052
P13 RESIDENT TRAINING IN ABORTION: SUMMARY OF RYAN PROGRAMS IN OB-GYN RESIDENCY PROGRAMS IN THE UNITED STATES AND CANADA
FACILITY STANDARDS FOR COMMON OUTPATIENT PROCEDURES: ARE THERE LESSONS LEARNED FOR ABORTION? Berglas N University of California, San Francisco/ANSIRH, Oakland, CA, USA Scott Jones B, Roberts S Objectives: State laws regulating abortion facilities are promoted as safeguarding women's health but are not supported by evidence showing an impact on patient safety. As other procedures have transitioned from hospitals to outpatient settings, questions of how best to ensure safety and facility standards have proliferated. This study examined how standards have been developed for procedures commonly performed in outpatient settings (endoscopy, gynecologic procedures, oral surgery, plastic surgery) and identified lessons learned for abortion. Methods: In-depth interviews (N=20) were conducted with experts involved in facility standards development across medical specialties about motivations for standards development, processes used to establish standards, types of evidence reviewed and decision making in the absence of evidence. Data were analyzed using an iterative coding process and identification of thematic patterns.