Jema Turk et al.


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    Implementing Resident Training in Abortion: Summary of Ryan Programs in Ob-Gyn Residency Programs in the US and Canada

    Jema Turk, F.Preskill, G.Patel, U.Landy and J.Steinauer, USA/Canada

    Objectives: The Kenneth J. Ryan Residency Training Program in Abortion and Family Planning (Ryan Program) provides technical and financial support to help US and Canadian obstetrics and gynecology (ob-gyn) residency programs comply with the Accreditation Council for Graduate Medical Education mandate to integrate abortion into training.  Since 1999, 54 Ryan Programs have been established in 28 states and in two Canadian provinces.  A total of approximately 1600 residents have been trained through the Ryan Program since its inception. Our objective was to describe the clinical and departmental impacts in the Ryan Programs.

    Methods: All 54 Ryan training programs are systematically reviewed through pre- and post-rotation surveys completed by residents, and through annual reports, site reviews, and yearly on-line surveys completed by Ryan Program directors, department chairs, and residency program directors. Programs and residents undergo extensive evaluation during the first two years of active funding. Thus, the data discussed here represent evaluation pursued in the first two years of program existence.

    Results: A total of 746 residents have completed pre- and post- rotation surveys to date, giving a total response rate of 70%. On average, residents spend 15 days in clinics providing abortion and/or contraception care.  The location of training varies between in-hospital clinics (45%), out-of-hospital clinics (40%), and a combination (15%).  During the Ryan Program rotation, residents provide pregnancy options counseling, routine and complex contraceptive services, cervical preparation, and perform first-trimester manual uterine aspirations and electric uterine aspirations, medication abortions, and second-trimester dilation and evacuation procedures.  Comparing pre- with post-rotation surveys, residents’ self-assessed competence in first and second-trimester uterine aspiration increases significantly, as well as the intention to provide all techniques of abortion after residency.  In addition, residents, Ryan Program directors, department chairs and residency program directors describe a variety of benefits beyond residents’ skills in abortion care.  These include residents’ skills in counseling, contraception, ultrasound, and outpatient surgery; improved continuity of care for patients; and improved appeal of the residency programs to medical student applicants.

    Conclusions:  The Ryan Program has been successful in integrating abortion and family planning into 54 (21% of all) US and Canadian ob-gyn residency programs. These rotations have led to approximately 1300 ob-gyns graduating with proficiency in abortion care, and over 75 percent plan to include these skills in their subsequent practice.  In addition, the Ryan Program’s successes have contributed to reinforcing the importance of training in family planning as a central part of obstetrics and gynecology

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    The impact of US Fellowship in family planning

    Jema Turk, H.Steele, M.Fulton, U.Landy and J.Steinauer, USA/Canada

    Objectives: To describe the US-based fellowship in family planning.

    Background: In 1991, the Fellowship in Family Planning was established at the University of California, San Francisco to promote advanced training in contraception and abortion. The Fellowship in Family Planning provides two years of post-residency training in clinical care, research and policy training.  The fellowship also requires an international placement in a low-resource setting and completion of a masters degree in clinical research or public health and is available to graduates of either obstetrics-gynecology or family medicine residency training.

    Methods: The fellowship is assessed yearly through annual reports completed by faculty and fellows, bi-yearly site visits, and regular audits of fellowship publications. 

    Results: The Fellowship in Family Planning has grown to include 21 medical schools throughout the United States. To date there are 118 graduated fellows and 38 fellows currently in training. Fellows develop expertise in abortion care and complete a median of 168 first-trimester uterine aspiration and 102 second-trimester D&E procedures over two years, in addition to developing skills in contraception and maintaining non-family planning skills. Fellowship directors and graduated fellows have generated a wealth of research addressing some of the most critical questions in family planning, with over 120 peer-reviewed publications in 2009.  Fellows have participated in international placements in 39 countries in four continents.  Twenty-four (20%) graduated fellows have gone on to direct abortion training programs in residency programs.

    Conclusions: The development of a fellowship in family planning in the US has led to a cadre of subspecialists and consultants in abortion and family planning clinical care and research who have become the leaders in training and research in the US.