The Dobbs Decision and Undergraduate Medical Education: The Unintended Consequences and Strategies to Optimize Reproductive Health and a Competent Workforce for the Future

Abstract

The June 2022 U.S. Supreme Court decision on Dobbs v Jackson Women’s Health Organization resulted in state-specific differences in abortion care access across the country. The primary concern in the obstetrics and gynecology education community has been the impact on resident and fellowship training programs. However, the impact on undergraduate medical education and the broad implications for future generations of physicians are crucial to address. It is estimated that 48% of matriculants to MD-granting medical schools will receive their medical education in the 26 states with significant abortion restrictions or bans. Undergraduate medical educators need to continue to adequately teach the basic science, clinical care, and population health outcomes of reproductive medicine, including pregnancy and abortion. In addition, students in states with more restrictions on abortion will have less or no clinical exposure, and those in states with few restrictions may be excluded due to overcrowding of learners from restricted states. Students’ own health care also needs to be considered, as access to abortion care for themselves or their partners may create applicant pool demographic shifts by state as applicants consider options for where to pursue their medical education. It is important to ensure that teaching of foundational science of pregnancy, abortion, and reproductive health continues throughout the United States. Undergraduate and graduate medical educators will need to closely monitor the downstream impact of decreased clinical exposure of abortion. Further study of the personal health impact of abortion care access for medical students and awareness of the changing applicant pool demographics by state is needed.

Considering the Effects of the Dobbs Decision on Clinical Training and Practice and on the Lives of Medical Professionals

“…32 In light of such concerns, potential shifts in the health professions workforce away from reproductive health fields and other clinical fields have already been attributed to the Dobbs decision. [33][34][35] Two Commentaries in this issue of Academic Medicine reflect on how the U.S. Supreme Court decision affects OB/ GYN resident training, 36 undergraduate medical education, and the personal lives of medical students and applicants. 35 As noted by the authors in both commentaries, abortion remains a core competency for OB/GYN residency programs.…”

“…[33][34][35] Two Commentaries in this issue of Academic Medicine reflect on how the U.S. Supreme Court decision affects OB/ GYN resident training, 36 undergraduate medical education, and the personal lives of medical students and applicants. 35 As noted by the authors in both commentaries, abortion remains a core competency for OB/GYN residency programs. Accreditation Council for Graduate Medical Education (ACGME) program requirements for OB/GYN as of September 2022 state:…”

“…40(p31) Knowledge of abortion is also recognized as an important part of reproductive health education for medical students. 35 As of 2022, 48% of medical school matriculants and over 44% of residents will receive education in states with an abortion ban. 35,36 Dobbs-related tension between state laws and national certification and licensure processes may require that residents travel out of state to obtain competency and meet residency objectives.…”

“…32 In light of such concerns, potential shifts in the health professions workforce away from reproductive health fields and other clinical fields have already been attributed to the Dobbs decision. 33–35…”

“…Knowledge of abortion is also recognized as an important part of reproductive health education for medical students. 35…”