Abortion-related training in maternal-fetal medicine fellowship: A national survey of program directors and fellows.

Introduction: Policies that restrict abortion access not only create unnecessary and dangerous barriers to care for patients but also disrupt evidence-based medical training in residency and subspecialty training. Previous studies indicate that exposure to abortion procedures during residency is directly linked to interest in pursuing abortion-related training in maternal-fetal medicine (MFM) fellowship and subsequent clinical practice. However, limited data exist regarding whether MFM trainees and program directors (PDs) share similar views on abortion-related training objectives. This study aims to identify differences in perspectives between MFM fellows and PDs regarding the importance of abortion training during fellowship. Our secondary objective is to evaluate whether perspectives differ based on the state-based abortion restrictions. Methods: A web-based cross-sectional survey was conducted in June 2022, targeting MFM PDs and fellows to evaluate the importance participants placed on access and exposure to training in procedures related to abortion. These procedures included dilation and curettage (D&C), dilation and evacuation (D&E), induction termination of fetuses with cardiac activity (i.e., induction termination), and induction of fetal asystole (i.e., feticidal injection) during fellowship. Additionally, the survey explored attitudes regarding the importance of specific abortion and reproductive health-related skills post-fellowship. All attitudes were measured on a continuous sliding scale from 0 to 100, where 0 indicates "not at all important" and 100 signifies "very important." Results: Our findings indicate that fellows in abortion-restrictive states placed lower importance on most abortion-related training during fellowship compared to PDs. In abortion-protective states, there were no differences in importance rated by PDs and fellows regarding abortion-related training and competency in these skills post-fellowship. Fellows in abortion-protective states placed significantly more importance on all skills compared to fellows in abortion-restrictive states. At the same time, there was no difference between PDs in abortion-protective or abortion-restrictive states. Conclusion: Our findings show that the changing importance of abortion-related training in this subspecialty is creating both a regional and generational divide in perceptions of what falls within the scope of MFM practice.