Medical education in a post-Roe world: student advocacy is patient advocacyBMJ 2022; 378 doi: https://doi.org/10.1136/bmj.o2011 (Published 12 August 2022) Cite this as: BMJ 2022;378:o2011
- Zachary Simpson, fourth year medical student,
- Christen Jarshaw, fourth year medical student
It was a shot heard around the world—the announcement earlier this summer declaring the dreaded but expected overturn of Roe v Wade, effectively ending access to safe, legal abortions in large swaths of the United States. As medical students, many of us are still grappling with the ramifications of this decision and the impact it will have on our future clinical practice and the core physician-patient relationship.
Committing to medical school is not an easy decision; it requires careful contemplation of a nearly decade-long sacrifice to train in the service of our future patients. Most of us make that decision eagerly, excited at the prospect of entering training programs that we believe will equip us with the tools we need to enter a profession we have long idealized. With this decision by the US Supreme Court, we now have to grapple with how this will affect not only our training but that of the next generation of physicians, who will be entering a vastly different landscape with dramatically more barriers than we had to face even three years ago when we matriculated. Medical students have been left re-evaluating the future of medical education, what it will look like for future generations, and what we can do about it.
Even before this decision, medical education on abortion across the US was deficient, a view supported by the American College of Obstetricians and Gynecologists.1 A 2005 national survey of obstetrics and gynecology clerkship directors of US medical schools revealed that only 45% of respondents offered a clinical experience on abortion during the third year rotations and a mere 32% offered “at least one lecture” on the topic. Overall, 17% offered no formal abortion education at all.2 Little seems to have changed in the intervening years. A 2021 survey found that 20% of medical schools offer no content on abortion in their curriculum, meaning that thousands of new doctors graduate each year who have no medical knowledge of miscarriage management or how to provide safe abortion services, with minimal skills on nondirective patient counseling.3 It is unlikely that this trend of churning out underprepared doctors will improve now that Roe v Wade has been overturned and in the wake of ongoing nationwide cuts to abortion access and training.
Despite these gaps in the curriculum, medical trainees are increasingly interested in learning about the full spectrum of reproductive healthcare.4 Yet, for years, hospital policies and state laws have impeded many students’ education, disproportionately affecting those in states with pre-existing abortion restrictions.5 Medical students should not receive less education based on the location of their institution. Now, in its decision to repeal Roe v Wade, the Supreme Court has even further infringed on the medical care doctors can provide. This blow makes it all the more important that medical students across the country support each other and advocate for appropriate and competitive curricula, including abortion training.
Even before Roe v Wade was overturned, our home state of Oklahoma faced extreme measures to limit virtually all abortions in the state, becoming one of the most anti-abortion states in the US.6 In a state that already had limited abortion training, the need for student-led advocacy to promote abortion education has become even more critical7 and existing efforts by students can serve as an example. Student leaders at the University of Oklahoma College of Medicine have organized the Reproductive Health Symposium, a student-led initiative aimed at providing a bevy of educational sessions on reproductive medicine.8 At other institutions, students have designed optional electives on reproductive health, for which students can receive course credit for their participation.9 Student-led initiatives like this are a vital component of medical education, shining light on essential medical information in environments that otherwise may minimize access to such training.
It is not certain how US medical schools will choose to respond to harsher abortion restrictions. Physicians in training need to act now to solidify our right to a sufficient and thorough reproductive health curriculum and advocate for this necessary training for our peers across the country. It is possible that more students will seek medical training outside of their state of residence, opting instead for education in states with less restrictive abortion bans, greatly increasing the already exorbitant cost of a medical degree with out-of-state tuition costs. This also means that there may be a flight of pro-choice medical allies from the very states that need them most. Students should not have to uproot their lives to receive appropriate training and to feel equipped to enter medical practice. Regardless of the specialties we are entering, this decision affects all of our future careers.
Aside from the immediate devastating consequences of the court’s decision for patients seeking necessary care, we as students are looking down the barrel at the current and future encroachment of abortion bans on medical education and on the physician-patient relationship. We need to protect this relationship at all costs, and that means banding together as students, creating our own educational experiences and advocating for our own education as well as colleagues’, so that we may all enter into the larger space of patient care and medical advocacy well equipped and well informed. As future physicians, we owe it to ourselves and to our future patients to advocate for holistic reproductive health education as a necessary component of our training. Now more than ever, we need inventive, dedicated, and capable physicians leading the charge to recapture access to reproductive healthcare. Advocacy for our future patients, and for our future careers, starts now.
Competing interests: Zachary Simpson and Christen Jarshaw are senior medical students and leaders of their campus’s chapter of Medical Students for Choice. Nothing further declared.
Provenance and peer review: not commissioned; not externally peer reviewed.