Tennessee universities won't detail how they'll offer abortion training amid new laws

Current and future medical professionals are raising the red flag about the ripple effects the Supreme Court's abortion ruling will have on medical students' training. But Tennessee universities aren't disclosing how they'll navigate the new laws and keep their programs in the good graces of accreditation systems.

Tennessee has banned abortions as early as six weeks into pregnancy, and soon, a near-total abortion ban will go into effect.

Abortion and abortion training is a complicated issue, especially when a medical school is state-funded. Medical schools in Tennessee are figuring out how to offer mandated abortion training as courts sort through how the laws apply to women and health care providers.

"That does put ... their residency program into a very compromising kind of position," said Dr. Kimberly Looney, a physician and assistant professor at Meharry Medical College and chief medical officer for Planned Parenthood of Tennessee and North Mississippi. "While your institution cannot participate in abortion care, you still have a charge to educate your residents wholly."

A lack of access to abortion training could mean fewer trained abortion health care providers in the state, less comprehensive care for patients, and could perpetuate a workforce shortage of OB-GYNs.

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Abortion training access is now limited

Because of the bans, obstetrics and gynecology residents in Tennessee will have fewer opportunities to learn abortion-related procedures as abortion providers suspend their services.

To maintain good standing, all obstetrics and gynecology residency programs must provide access to abortion training at some point during their program, according to the Accreditation Council for Graduate Medical Education.

But the medical school cannot require residents to participate in abortion training. Residents with "religious or moral objections" can opt-out.

Of the five medical schools in Tennessee, four have OB-GYN residency programs: East Tennessee State University, Meharry Medical College School of Medicine, the University of Tennessee Health Science Center, and Vanderbilt University. The UT Health Science Center offers OB-GYN residencies at its Chattanooga, Knoxville, Nashville, and Memphis campuses.

Since clinics are suspending abortion services following Tennessee's six-week ban, medical students and residents seeking training could have to travel across state lines to get it.

“I would now think that (medical schools) would have to extend their residents out to other states and hope that those states can accommodate them," Looney said.

Medical schools are giving few clues on how they'll actually get their residents the training that's required.

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When asked if its OB-GYN residency program will send residents interested in abortion training across state lines, East Tennessee State University said it plans to follow state laws and accreditation requirements from the Accreditation Council for Graduate Medical Education.

"We are still working through this issue," said Melissa Nipper, the director of marketing and communications at East Tennessee State University. "The accreditation bodies may possibly have advice for us as the situation develops."

Vanderbilt University Medical Center declined to answer questions about its OB-GYN program, but pointed to a statement sent June 24 saying it will comply with state and federal law but institute policy changes "intended to mitigate some of the health care and health equity concerns that are anticipated due to changes in the law."

The University of Tennessee Health Science Center "did not have a response" to potential changes to its OB-GYN residency programs across the state, according to a spokesperson.

Residents at Meharry Medical College receive extensive training in the management of miscarriages, abortions and pregnancy, Dr. Edward Hills, a professor in the department of obstetrics and gynecology at the historically Black college in Nashville, told Knox News.

Miscarriages are the loss of a fetus before the 20th week of pregnancy. Several of the procedures used to care for a pregnant person after a miscarriage are the same as those used during an abortion.

"The training for (miscarriages) and training for ... abortions is exactly the same training," Hills said.

Hills feels confident residents at Meharry will continue to be competent in abortion care because it's so much like miscarriage management.

"Residents who are interested or who may be coming and willing to provide those services are well-trained here with regard to dealing with the spontaneous immediate abortions, which, of course, were legal and continue to be legal in terms of their management, and management is the same,” Hills said.

Given almost half of the nation's OB-GYN residents will lack substantial access to abortion training because of bans, there could be fewer and fewer trained abortion providers to meet demand.

And even if residents in states where abortion is restricted have the means to travel to receive training, they could be putting more pressure on already stressed clinics caring for patients from out of state.

Following the Dobbs ruling, the Accreditation Council for Graduate Medical Education updated its requirements to address programs in states enforcing bans on abortions. Programs in those jurisdictions “must provide access to it in a jurisdiction where no such legal restriction is present and program support must be provided.” In cases where a resident can’t travel out of state to finish this training, their program has to provide “a combination of didactic activities, including simulation, and assessment on performing a uterine evacuation (surgical and medical)” as well as communicating pregnancy options, according to the new guidelines.

Stress on health care systems and abortion providers

Like OB-GYN residents traveling to learn abortion care, Tennesseans may travel across state lines to access that abortion care.

Right now, Illinois and North Carolina are the two states closest to Tennessee with clinics providing abortion services. Access to abortion remains popular in both states, but North Carolina requires patients to receive counseling that discourages them from having an abortion and wait 72 hours after an initial consultation.

While this may be a temporary solution, Looney says these extra patients could overload clinics.

“My concern is ... for patients seeking abortion care, we can only see so many people and handle so much workload in those haven states,” Looney said. “Someone is going to get left out of the game.”

Current and future OB-GYNs are worried they might not even be able to discuss abortion with their patients moving forward.

Threatening patient care and privacy

Hills said having private, accessible and educational conversations with patients about reproductive and contraceptive care is essential to his job as an obstetrician-gynecologist.

But abortion bans like Tennessee’s could threaten that doctor-patient relationship. Hills said many residents at Meharry Medical College's OB-GYN program are already worried they won't be able to talk about abortion during consultations with patients.

"Even though it may be illegal to have an abortion, can they discuss with (patients) what's involved, what to expect, where to go?" Hills said.

"We hope that's not going to be the case, but they don't know, and I don't know."

Without being able to discuss abortion options with patients, Hills fears pregnant women — particularly low-income people of color who have less access to resources outside of the state — might risk getting an abortion that is unsafe.

“This could lead to injury, infections, great psychological damage, and of course, death,” Hills said. “It’s going to happen because people who feel like they need an abortion, whatever their personal reasons are, are going to attempt to get them. That's just a fact of life. That's always been the case.”

Hills is worried about the health and safety of low-income people of color who are forced to carry their pregnancy to term. In Tennessee, non-Hispanic Black women were 2.5x more likely to die than white women from pregnancy-related causes between 2017 and 2020, according to the 2022 maternal mortality report from the Tennessee Department of Health.

“All of this weighs heavy on my mind,” Hills said.

The American South contributed to this report.

Becca Wright: Higher education reporter at Knox News
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This article originally appeared on Knoxville News Sentinel: Tennessee universities won't share details on abortion training