Gynecologic Training Research Articles

The role of clinical exchange programs in postgraduate obgyn training: A case-study of the FIGO-WATOG One World Exchange.

To evaluate the role of clinical exchange programs in postgraduate obgyn training using the International Federation of Gynecology and Obstetrics (FIGO)-World Association of Trainees in Obstetrics and Gynecology (WATOG) One World Exchange (OWE), a clinical exchange program held in France in October 2023, as a case-study. This was a cross-sectional study. A 31-item structured questionnaire designed with Google Forms was electronically distributed to the 51 obgyn postgraduate trainees (OWE fellows) who participated in the OWE, to collect information about the exchange. Collected data was analyzed using IBM Statistical Product and Service Solutions (SPSS) Statistics for Windows. The survey response rate was 68.6%. The mean age of the respondents was 33.0 ± 4.0 years. Majority of the them were females (26, 74.3%), married (19, 54.3%), at least in their third year of training (30, 85.7%) and from Africa (11, 31.4%). During the period of the exchange program, fellows observed various obstetric and gynecologic procedures, including open and minimal access procedures, with more than one-fifth (8, 22.9%) of them reporting that they were allowed to assist in some of these procedures. The fellows noted salient differences in practice between their exchange hospitals and their home countries. An overwhelming majority (30, 85.7%) of the fellows believed the OWE was beneficial and would positively impact their clinical practices back in their home countries. Clinical exchange programs like the OWE provide valuable benefits in improving the clinical knowledge and skills of postgraduate obgyn trainees.

Approaches to a crisis in early pregnancy: an explorative qualitative study of medical students and doctors in training in Ireland, using a story completion model

A crisis in early pregnancy can be due to an unplanned pregnancy or a suspected abnormality. Pregnant people have the right to unbiased and comprehensive advice of all options from healthcare providers. Using story completion models (SCM), the aim of this qualitative study was to explore the attitudes of medical students and doctors in training towards crisis pregnancy, specifically two scenarios: early unplanned pregnancy and fatal fetal abnormality (anencephaly). Participants were invited from medical students attending University College Dublin (UCD) and trainees in Obstetrics and Gynaecology in the Royal College of Physicians of Ireland (RCPI) from July to December 2022. SCM involve giving the consenting participant an introduction to a hypothetical situation that acts as the beginning of a story and asking them to complete it. Stories were compiled and analysed using thematic analysis. Research Ethics Committee approval was given by both UCD and the RCPI. The standards for reporting of qualitative research guidelines were followed. Eight doctors in training and six medical students consented to participate in the study; all but two medical students completed both stories to the required word count, giving 25 stories for analysis. For both situations, stories described a variety of approaches, all of which were based on the person, or couples wishes, from continuing in pregnancy to deciding to end the pregnancy. SCM allowed detailed analysis of potentially sensitive subjects such as pregnancy options. This study showed that participating medical students and doctors in training recognise that pregnant people have the right to all choices in crisis pregnancy.

Effects of Postpartum Web-Based Breastmilk and Breastfeeding Education: A Quasi-Experimental Study

Objective: The aim of the study was to examine the effect of web-based breastfeeding education applied to postpartum primiparous women on breastmilk, breastfeeding knowledge and self-efficacy. Methods: This quasi-experimental study was conducted with 73 participants (experimental group=37; control group=36) at the Zeynep Kamil Gynecology and Pediatrics Training and Research Hospital in Istanbul, Türkiye. The study was at postpartum services between June 2018 and October 2019. The participants in the experimental group attended the internet-based breastmilk and breastfeeding education program; where as those in the control group received routine care. Data were collected pre and post training using the demographic information form, Breastmilk and Breastfeeding Knowledge Test and Breastfeeding Self-Efficacy Scale. Results: Our result showed that there was no significant difference found between the experimental and control groups on post-training on Breastmilk and Breastfeeding Knowledge Test (p>.05). On the other hand, there was significant difference between the experimental and control groups on post-training on Breastfeeding Self-Efficacy Scale (p

Exploring global barriers to optimal ovarian cancer care: thematic analysis

ObjectiveTo explore the barriers to ovarian cancer care, as reported in the open ended responses of a global expert opinion survey, highlighting areas for improvement in global ovarian cancer care....

The Impact of Minimally Invasive Gynecologic Surgery Subspecialty Training on Outcomes of Benign Laparoscopic Hysterectomy: A Retrospective Cohort Study

Study ObjectiveTo compare surgical outcomes among patients undergoing minimally invasive hysterectomy (MIH), laparoscopic or robotic, with minimally invasive gynecologic surgery (MIGS) subspecialists, gynecologic oncologists (GO), or general obstetrician/gynecologists (OB/GYN). DesignRetrospective cohort study. SettingQuaternary care academic hospital. Patients or participantsPatients undergoing MIH for benign indications from 3/2015 to 3/2020 were included. InterventionsMIH. Measurements and Main ResultsThe primary outcome was the odds of a composite of any intra- or postoperative complications within 30 days of surgery by surgeons’ group.A total of 728 MIHs were performed during the study period and constituted the cohort, of which 368 (50.5%) were performed by MIGSs, 144 (19.8%) by GOs, and 216 (29.7%) by OB/GYNs.Intra- and postoperative complications occurred in 11.7% of the MIGS group, 22.9% of the GO group (OR 2.25, 95%CI 1.36-3.71) and 25.9% of the OB/GYN group (OR 2.65, 95%CI 1.70-4.12). Major intra- or postoperative complications were associated with surgeons’ groups (OR 7.02 95%CI 2.67-18.47, and 6.84 95%CI 2.73-17.16 for GO and OB/GYN compared with MIGS, respectively). Intraoperative complication rates were significantly lower for MIGS surgeons (1.4%) than for GOs (9.0%, OR 7.21 95%CI 2.52-20.60) and OB/GYNs (9.7%, OR 7.82 95%CI 2.90-21.06). There was a higher odd of postoperative complications for OB/GYNs compared with MIGS (18.5% vs. 10.9%, OR 1.86 95%CI 1.16-3.00). Rates of conversion to laparotomy were lowest among MIGS surgeons (0.3%) compared to GOs (7.6%) and OB/GYNs (7.9%). Estimated blood loss 90th percentile or higher and surgery time 90th percentile or higher were more common for OB/GYNs compared with MIGS surgeons (OR 2.12 95%CI 1.07-4.22; OR 2.48 95%CI 1.49-4.12, respectively). ConclusionFellowship trained MIGS subspecialists had improved surgical outcomes for benign MIH compared with GOs and OB/GYNs, with lower rates of perioperative complications and fewer conversions to laparotomy.

Improving Diversity in a Rural Academic Obstetrics and Gynecology Training Program

Both the Accreditation Council for Graduate Medical Education and the American College of Obstetricians and Gynecologists advocate for greater diversity within our workforce, which starts with recruiting and retaining a diverse residency pool. Historically, applicants who are underrepresented in medicine have been more likely to apply to residency programs located in urban locations, as opposed to a rural training environment. In this commentary, we discuss a novel strategy used to attract underrepresented in medicine applicants to a rural academic obstetrics and gynecology training program. The strategy encompassed a virtual weeklong elective with the goals of bolstering their residency applications and showcasing our faculty and residency training.

Health Literacy Levels of Women Attending a Perinatology Outpatient Clinic for High-Risk Pregnancy Follow-Up.

Health literacy, defined as the ability to obtain, understand, evaluate, and apply health information with knowledge, motivation, and skills, is crucial for maintaining and improving quality of life. Despite the availability of health information, limited health literacy is linked to health disparities, inadequate self-management of chronic diseases, and poorer health outcomes. The purpose of this study is to assess the health literacy of pregnant women who visit the Perinatology Outpatient Clinic for follow-up care. It seeks to identify gaps in knowledge and understanding that may impede effective healthcare delivery and inform targeted health education and public awareness programs to enhance health literacy. This prospective survey study included 210 pregnant women aged 18 to 40 years attending the Perinatology Outpatient Clinic at Giresun Obstetrics and Gynecology Training and Research Hospital, Turkey. Participants completed a questionnaire on health literacy, sociodemographics, and basic health status via Google Forms (Google Inc., Mountain View, CA, USA). Statistical analysis was performed using SPSS Statistics version 26.0 (IBM Corp., Armonk, NY, USA), employing tests such as Kolmogorov-Smirnov, Mann-Whitney U, Kruskal-Wallis, Student's t-test, ANOVA, Spearman, and Pearson correlation, and multivariate linear regression analysis. The mean age of participants was 29.97±5.44 years, with a mean health literacy score of 29.89±7.05. Education level and living place significantly influenced health literacy scores, with higher scores among those with higher education and urban living (p = 0.014 and p = 0.038, respectively). Economic status also significantly impacted health literacy, with lower scores among those with poor economic status (p<0.001). Health literacy scores were higher among those receiving health information from healthcare professionals (p = 0.006) and lower among those finding medical information from doctors insufficient (p = 0.008). Health literacy is significantly influenced by education level, living place, and economic status. The study emphasizes the necessity of focused health education initiatives, especially for individuals with lower educational attainment and those residing in rural regions. Improving health literacy via efficient communication from medical professionals can benefit expectant mothers and their unborn children by lowering medical expenses and improving health outcomes.

699: Gynecological brachytherapy hybrid training: The Tata Memorial Centre and BrachyAcademy experience

699: Gynecological brachytherapy hybrid training: The Tata Memorial Centre and BrachyAcademy experience

Impact of COVID-19 pandemic on specialty training in obstetrics and gynaecology in Hong Kong: is there a concern about the future prospect?

IntroductionThe COVID-19 pandemic in the past few years led to major adjustments in the provision of healthcare. This study aimed to investigate trainees’ perception of impact of the pandemic on specialty training in Obstetrics & Gynaecology (O&G) in Hong Kong.MethodsA cross-sectional questionnaire survey was performed on all the O&G trainees and the young fellows of the Hong Kong College of Obstetricians and Gynaecologists (HKCOG). The questionnaires included 5 parts: demographic data, impact on clinical activities, redeployment, educational activities and career progression.ResultsA total of 104 questionnaires (92.9%) were received for final analysis. The majority of the participants had reductions in elective and emergency operations, as well as exposure to in-patient admissions and out-patient clinics in both obstetrics and gynaecology. The reduction was most significant in elective gynaecology operations. One-third (34.6%) of the participants had been redeployed to other departments, and educational activities were reduced during the pandemic. Around 58% of the trainees were concerned with the reduction in clinical exposure, and 78% worried they would not be able to log sufficient number of surgical procedures. Basic trainees were significantly more worried than higher trainees. Around half of the trainees had doubts or regrets about choosing to undergo O&G specialty training.ConclusionThe O&G trainees in Hong Kong perceived that the COVID-19 pandemic had significant negative impacts on their training. Many trainees were worried they would not be able to attain the required level of competence when they complete their specialist training.

Optimizing resident training in obstetrics and gynecology: a new perspective on the refined Peyton four-step teaching method

ObjectiveIn the surgery-focused field of obstetrics and gynecology (OB-GYN), the development of residents’ skills is paramount. This study aims to evaluate the impact of an enhanced Peyton Four-Step Teaching Model on the foundational skill training of first-year OB-GYN residents.MethodsUtilizing a cohort study design, we assessed 116 first-year residents from the OB-GYN residency program at Shengjing Hospital of China Medical University from June 2021 to June 2023. The 57 residents beginning their training in 2022 were part of the Refined Peyton (RP) group, introduced to the RP method; the 59 residents from 2021 served as the Traditional Teaching-mode (TTM) group, receiving conventional simulation-based instruction. Teaching effectiveness was assessed by comparing theoretical knowledge and skill performance assessments, National Medical Licensing Examination (NMLE) pass rates, direct observation of procedural skills (DOPS) one year post-training, and survey feedback.ResultsThe theoretical knowledge scores for both groups were comparable at 78.78 ± 4.08 and 78.70 ± 3.83, with no significant difference (P = 0.76). However, the experimental group demonstrated superior performance in skill operation assessments, first-time NMLE pass rates, and DOPS evaluations one year after training [(77.05 ± 5.39) vs. (84.60 ± 5.65), 100.0% (57/57) vs. 86.4% (51/59), and (75.22 ± 3.56) vs. (82.54 ± 3.43)], as well as higher teaching satisfaction scores [(4.63 ± 0.46) vs. (3.92 ± 0.62)], with all differences being statistically significant (P < 0.05).ConclusionThe refined Peyton Four-Step Teaching Model significantly improves the immediate acquisition and long-term retention of clinical basic skills among OB-GYN residents, enhancing both teaching efficacy and resident satisfaction.

Experience of Using Biomodeling in Training Obstetricians and Gynecologists in the Technique of Office Hysteroscopy

The leading place in the structure of gynecological diseases is occupied by intrauterine pathology, the "gold standard" of treatment of which is therapeutic hysteroscopy. Conducting hysteroscopy in outpatient conditions in the absence of anesthesia significantly reduces the workload of the inpatient unit, but requires high-quality training of specialists due to the labor intensity of the manipulation and the lack of opportunity to acquire skills intraoperatively. The use of biomodels for training allows specialists to master this technique in a short time.

Redefining the Professional Identity of the Surgeon by Reflecting on Critical Incidents in London, United Kingdom

INTRODUCTION: Critical incidents are increasingly prevalent documented events in National Health Service (NHS) hospitals in the United Kingdom. Claims are made against the NHS in cases of medical negligence, with Obstetrics and Gynaecology accounting for 15% of the total claims, the second highest among all specialties.&amp;nbsp; OBJECTIVE: To understand the impact of critical incidents on the developing surgical identity of Obstetric and Gynaecological trainees in London, United Kingdom. METHODS: A Qualitative study using semi-structured styled interviews. The interviews were audio-recorded and subsequently transcribed. The data was then analysed. Six trainees, of specialist trainee level three to seven were interviewed separately. This consisted of five female and one male doctors. This is within the current gender ratio difference in London. RESULTS: Undergoing a critical incident was felt to be a traumatic experience for all trainees involved. The incident itself and its management by the department, hospital or deanery had a significant impact on the psycho-social well-being of the doctor involved. Critical incidents can negatively affect the professional development of the surgeon. Surgical identity is an area that appears to be in the hidden curriculum, however many trainees struggled to define what their surgical identity was and how it may have been affected. CONCLUSION: Critical incidents cause significant psycho-social distress for the developing surgeon. Surgical identity should be implicitly understood within medical education. This study highlights the urgent need for those writing medical curricula; both undergraduate and postgraduate to make the implicit explicit. Surgical identity discourse must be a priority for the new curriculum. Professionalism and an ability to endure the psychological stress caused by undergoing critical incidents is likely to be enhanced, by creating a strong sense of belonging within the surgical profession. The loss of the traditional apprenticeship model and its mentors must be considered within the new design.&amp;nbsp;

Cosmetic Gynecology: Is There Enough Exposure in the Obstetrics and Gynecology Residency?

Introduction While cosmetic gynecology has gained popularity, the training experience for obstetrics and gynecology residents in this area is limited and not standardized. The primary objective was to investigate the exposure of obstetrics and gynecology residents to cosmetic gynecologic procedures including hymenoplasty, labia majora reduction, vaginoplasty, G-spot amplification, labiaplasty, clitoral hood reduction, and vaginal laser therapy. The secondary objective was to assess their comfort in performing the procedures after graduation. Methods This is a non-validated cross-sectional survey of obstetrics and gynecology residents and their exposure to cosmetic gynecology procedures. Using the Fellowship and Residency Electronic Interactive Database Access System, the Accreditation Council for Graduate Medical Education-accredited Obstetrics and Gynecology residency programs in the United States were identified, and the residency program coordinators were asked to distribute the survey. Data regarding demographics, program-specific characteristics, and exposure to certain cosmetic gynecology procedures were obtained and reviewed. Participants' reported comfort with the independent practice of certain cosmetic gynecology procedures after graduation was also obtained. Descriptive statistics were completed. Results A total of 96 responses were received. Approximately 50% of participants were exposed to cosmetic gynecology during training. Moreover, 70.9% of residents disagreed that they would feel confident in defining the included procedures. Furthermore, 87.5% disagreed that they would feel comfortable performing the procedures independently. A minority of participants were also unsure of the indication for cosmetic gynecology procedures, with 15.4%, 7.1%, 5.7%, and 4% unaware of the surgical indication for hymenoplasty, vaginoplasty, labiaplasty, and labia majora reduction, respectively. No participant knew the indication of surgery for vaginal laser therapy or clitoral hood reduction. Conclusions In the setting of current cosmetic gynecology training, nearly 90% of residents were not comfortable with these surgeries after graduation. Exposure to cosmetic gynecology for obstetrics and gynecology residents was limited. Without adequate exposure, residents may face difficulty performing procedures and managing complications after graduation. Therefore, standardizing resident training for cosmetic gynecology should be considered.

The effects of climate change and environmental pollution on human reproduction: A scientific review commissioned by the European Board and College of Obstetrics and Gynaecology (EBCOG)

The European Board and College of Obstetrics and Gynaecology (EBCOG) and the European Network of Trainees in Obstetrics and Gynaecology (ENTOG) express their concerns on the effect of climate change and environmental pollution. This paper reviews the impact on reproductive health and the contribution to climate change by the field of obstetrics and gynaecology. It concludes that its contributors and the effects of climate change cause definite adverse consequences to fertility and adverse obstetric outcomes. Mankind, and obstetrics and gynaecology personnel as well, must be aware and responsible of its contribution to climate change and consider the impact of their actions and interventions.

Two years in a post-Dobbs world: clinical, social and professional consequences.

Dobbs v Jackson Women's Health Organization revoked the decades-old precedent that pregnancy termination is a constitutional right. This review article explores the research landscape describing the consequences of overturning Roe v Wade for patients and providers. To date, fourteen states have enforced total bans on abortion, with seven more restricting abortion access to levels not seen since before Roe. Dobbs has had immediate and swift consequences from clinical, social and professional perspectives, with increases in maternal mortality and demand for long-acting and permanent contraception, matched by declines in both access to methotrexate and applications to Obstetrics & Gynecology training programs. Eighteen million patients now live in states where abortion access is highly if not completely inaccessible. Abortion restrictions have profound implications beyond those desiring pregnancy termination; future research should continue to explore the ways Dobbs has affected clinical care, public health and social practices.

A national survey on the impact of the coronavirus pandemic on gynecologic surgical training.

The objective of this study was to assess the impact of the coronavirus pandemic on gynecology surgical training. A national cross-sectional online survey was distributed to all trainees and trainers in the higher specialist training program for obstetrics and gynecology in Ireland. The survey consisted of questions on topics which included: the volume of surgical procedures performed before and since the pandemic, confidence in performing various gynecologic procedures before and since the pandemic and questions regarding the impact of the pandemic on wellbeing and work practices. Trainers and trainees experienced a significant reduction in operative volumes for most procedure types. Analysis showed a significant reduction in the number of minor procedures performed by trainees (z = -2.7, P = 0.007) and a significant reduction in the number of all procedure types performed by trainers (minor procedures z = -3.78, P = <0.001; intermediate procedures z = -4.48, P = < 0.001; major procedures z = -3.69, P = < 0.001). Respondents reported they had less time for research and audit, were less able to attend courses or conferences and worried about the impact of their work on their families. In conclusion, this study has highlighted the current difficulties facing surgical trainees in gynecology because of the COVID-19 pandemic. These challenges have compounded an already challenging training environment for gynecology trainees. Efforts must be made to continue to provide high-quality tailored training to ensure the development of the next generation of gynecologic surgeons.

Validation of the IOTA ADNEX Model Among Japanese Women Performed by Gynecology Trainees and Ultrasound Specialists: A Retrospective Diagnostic Accuracy Study.

This study aimed to validate the diagnostic accuracy of the International Ovarian Tumor Analysis (IOTA) Assessment of Different NEoplasias in the adneXa (ADNEX) model in Japanese women, population with a distinct adnexal mass distribution compared with European women, and to evaluate the model's utility by gynecology trainees and ultrasound specialists. This single-center, retrospective study analyzed ultrasound data from January 2017 to March 2020 of 206 women with adnexal masses. Patients who underwent ultrasonography and serum CA-125 measurement and received postsurgery histological diagnosis were included. The ADNEX model's diagnostic performance was evaluated by two trainees and two specialists using the area under the receiver operating characteristic curve (AUC) and measures of accuracy, sensitivity, specificity, and predictive values for overall performance and each examiner. Of the 206 included Japanese women, the prevalence of malignancy was 30.1%, including borderline cases. The overall AUC for distinguishing malignancy was 0.848 (95% confidence interval [CI]: 0.817-0.880). The AUC for each examiner ranged from 0.791 to 0.898, with Specialist 2 showing the highest accuracy and sensitivity varying between 0.677 and 0.839. A moderate degree of agreement was noted among the four examiners (Fleiss' kappa was 0.586). The performance of trainees and specialists differed significantly in evaluating the solid tissue and the papillary projections in both malignant and benign groups (P < .001). The IOTA ADNEX model effectively differentiates benign and malignant adnexal masses in Japanese women. Although the accuracy matched up moderately among the four examiners, better accuracy is expected with training in evaluating solid tissue and papillary projections.

Prestimulation parameters predicting the pregnancy outcomes after IVF-ET in patients with unexplained infertility.

Assisted Reproductive Technologies (ART) are considered to be the most effective treatment option for unexplained infertility. This study aims to investigate the pregnancy outcomes of women who received in-vitro fertilization-embryo transfer (IVF-ET) treatment for unexplained infertility and the contributing factors affecting these outcomes. The present study included 789 consecutive women with unexplained infertility who were treated with IVF-ET at the ART Clinic of the Health Sciences University, Ankara Etlik Zübeyde Hanım Gynecology Training and Research Hospital between January 2007 and December 2019. The contributing factors affecting these outcomes, such as body mass index (BMI), basal follicle-stimulating hormone (FSH), and antimullerian hormone (AMH), were evaluated retrospectively. Clinical pregnancy per cycle was 19.8% among patients recruited. No statistically significant difference was detected in terms of age, infertility duration, and BMI of the patients who achieved pregnancy and who failed to get pregnant after IVF-ET treatment. The basal FSH level was found to be significantly lower (p=0.001), and the AMH level was significantly higher in patients who had clinical pregnancy (p=0.001). The basal AMH cut-off value was calculated to be 3.34 ng/mL, and the basal FSH cut-off value was calculated as 7.26 IU/L for the prediction of clinical pregnancy. IVF-ET treatment can be applied as a successful treatment option in unexplained infertility cases. Although the basal FSH and AMH values ​are not the cut-off values that have high sensitivity and specificity, they are considered to be associated with pregnancy rates.

(071) IMPROVING TRAINEE COMFORT IN ASSESSMENT AND MANAGEMENT OF FEMALE SEXUAL HEALTH AND MENOPAUSE THROUGH AN INTERACTIVE WORKSHOP

Abstract Introduction Concerns related to female sexual health and menopause are common in clinical practice, but these topics are often inadequately covered during training. Many medical schools and residency programs lack a formal curriculum, and trainees in internal medicine, family medicine, and obstetrics and gynecology often graduate feeling uncertain in their management of these conditions. Objective Improve resident comfort with assessment and management of female sexual health and menopause through an interactive workshop. Methods We created a 90-minute, interactive workshop focused on female sexual health and menopause. Residents in internal medicine at a large academic medical center were invited to participate. A multidisciplinary group including physicians, advanced practice providers, registered nurses and a certified sex therapist were recruited to lead the workshop. Results Participants rotate through three 30-minute sessions targeted to learning objectives. One session focuses on conducting a symptom-based pelvic exam. A 3-dimensional model is used to review the anatomy of the female pelvic floor and demonstrate physical exam techniques to evaluate vaginal and vulvar symptoms, pelvic pain, and dyspareunia. Diagnostic skills include vulvar inspection to assess for skin and mucosal changes, cotton swab test of the vestibule, and assessment of pelvic floor musculature. A second session focuses on the genitourinary syndrome of menopause (GSM). The pathophysiology, presentation and treatment of GSM is introduced. Next, registered nurses with expertise in female sexual health and menopause lead an interactive demonstration of vaginal moisturizers and lubricants. Advice for counseling patients on the proper use and application of vaginal estrogens is also reviewed. The final session focuses on sexual health counseling, including sexual history-taking skills. Participants are taught about the domains of sexual function, female sexual response cycle, types of desire, patient resources, and sexual aids. Feedback following the initial iteration of this workshop was very positive. All participants felt that the experience was an effective use of time, would recommend it to others, and were confident in their ability to apply skills to their clinical practice. Conclusions This interactive workshop led by a multidisciplinary group of providers aims to improve trainee comfort in evaluation and management of female sexual health and menopause. Given the commonplace nature of these topics in primary care and paucity of existing curricula, consideration could be given to the inclusion of a similar educational experience into internal medicine, family medicine and/or obstetrics and gynecology residency programs. Disclosure No.

The importance of abortion training for obstetrician-gynecologists: A comparison of the United States, Sweden, and Ghana.

Since 2020, World Health Organization guidelines state that universal access to abortion care is critical for individual and community health, and for the realization of human rights. Yet the right to access safe abortion care is severely restricted in many countries. This article outlines institutional and educational systems in the USA, Sweden, and Ghana, which all require obstetrics and gynecology (ob-gyn) training to include abortion care but vary in implementation. It argues that regardless of the political environment, the specialty should protect abortion training worldwide. In Sweden and Ghana, ob-gyn residents are required to participate in abortion training, while in the USA they are permitted to opt out. In Sweden, practicing ob-gyn specialists are required to provide abortion care, whereas in Ghana and the USA, this care is optional, leading to geographic disparities in abortion care access in these two countries. In the USA, the Supreme Court's Dobbs ruling jeopardizes programs' abilities to meet the training mandate, a requirement that was insufficiently implemented even before the ruling. It is critical that all clinicians are well-equipped to provide accurate information to their patients and provide pre- and post-abortion care. For this reason, we recommend that abortion is included in all undergraduate medical education programs in accordance with the recommendations of FIGO (the International Federation of Gynecology & Obstetrics). To meet WHO guidelines that require ob-gyn specialists to provide abortion care in an emergency, we urge FIGO to create a guideline about expectations for abortion training integration in obstetrics and gynecology.