Complete Family-Planning Care

Residency program provides comprehensive abortion training

While all accredited obstetrics and gynecology residency programs are required to provide training in family planning, the Kenneth J. Ryan Residency Training Program in Abortion and Family Planning is a designation of excellence in this education.

For nearly 10 years, the Department of Obstetrics and Gynecology’s Ryan Program has elevated residents’ training for first- and second-trimester abortion care beyond the standard requirements of the Accreditation Council for Graduate Medical Education (ACGME). This exceptional training sets Dartmouth Health (DH) apart: Only 34% of OB/GYN residency programs across the country have implemented the Ryan Program. Residents with moral or religious objections to induced pregnancy termination can opt out of abortion training while still learning other important clinical family-planning skills.

“Some institutions have abortion training in one rotation as a normal part of a resident’s training in family planning,” says Amy Paris, MD, MS, the director of Family Planning. “The requirement for the Ryan Program is to have rotations to meet a minimum number of abortion care cases, as well as miscarriage and complex contraception care.”

The Ryan Program residents integrate evidence-based and patient-centered practices, such as first-trimester medication and office-based manual vacuum aspiration, and second-trimester dilation and evacuation. As with other clinical competencies, residents first learn by watching an attending perform the procedure. Then the resident assists, and later performs the abortion, all with increasing independence. The Ryan Program has been shown to improve residents’ competence in family-planning care, even for partially participating residents who opt out of abortion training.

Paris emphasizes that resident competence in abortion care will be more difficult to achieve in certain states since the U.S. Supreme Court’s ruling to overturn Roe v. Wade, the 1973 decision that women have a constitutional right to an abortion.

“The ruling makes it hard for residents where abortion is banned to become proficient in performing abor- tions,” Paris says, and adds that they will also be limited in the breadth of counseling they can give pregnant patients regarding available options in such states. “New Hampshire has few restrictions on abortion, and we’re able to train our residents very well. But nearly half of OB/GYN residents are in or expected to be in states that ban abortions, and that’s going to be a problem.”

In states where abortion is illegal, physicians still treat situations of miscarriage and fetal demise— competencies that are part of family-planning training. Paris notes that in states with abortion bans, there will be fewer uterine evacuations for residents to learn from, making it harder to complete their experience. Therefore, if residents cannot legally be trained in a certain state, the ACGME requires that they must have an out-of-state rotation to learn these family-planning skills—a costly challenge for residencies in those states.

The department at DH remains dedicated to the entire spectrum of reproductive justice.

“Reproductive justice is the human right to maintain bodily autonomy,” Paris says. “The idea isn’t just about abortion; it’s about deciding whether and when to have children. It’s also about having healthy families, healthcare, nutrition, and safe communities. Reproductive justice looks at the big picture.”