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CHICAGO -- The American Medical Association (AMA) should be more supportive of efforts to provide training in abortion procedures to medical students and residents, said several members Saturday at the virtual November special meeting of the AMA House of Delegates.

"Like any other medical procedures, we believe that termination of pregnancy is a critical aspect of caring for our patients, particularly those who are childbearing," said Russyan Mark Mabeza, MD, an alternate delegate from California. Mabeza was speaking on behalf of the PacWest delegation in support of a resolution from the Medical Student Section calling for the AMA to support an "opt-out" curriculum for abortion training.

"Just like any other clinical indication for any medical procedure, who ends up needing this procedure is governed by social and structural determinants of health," he said. "Lack of access disproportionately impacts childbearing people of color from low income backgrounds. Supporting an 'opt-out' curriculum for every medical training program provides the least number of barriers to learning about this procedure, while still giving freedom for others whose religious beliefs preclude them from partaking in or observing this procedure."

Is It Mandating a Curriculum?

Seema Sidhu, MD, an alternate delegate and ob/gyn from California who said she was speaking for herself as well as the California and PacWest delegations, praised the resolution. "Our learners do have a right to acquire this knowledge should they want to learn it," she said. "This education goes beyond just performing a procedure -- learning about the indications, the counseling involved, and everything else that can be learned will be lost if this option is not available. I implore the AMA to step up and speak up to protect this education on behalf of our learners, and I ask our teaching institutions to come together and make this education available to them."

But Kelly Caverzagie, MD, a member of the Council on Medical Education who spoke on behalf of the council, had a different take. He said the council was "in overall support of the intent of [the resolution] but in opposition to it ... The AMA has a long-standing history of opposing curricular mandates, not just for this topic, but for any topic." Having an "opt-out" curriculum "in all reality, is still a curricular mandate," he said. "By definition, simply having the ability to opt out of a curriculum first requires there to be a curriculum to opt out of," which is a concern for faith-based institutions where such a curriculum would not be tenable. "I encourage us to reflect upon what we're trying to accomplish here: is it to insist on a mandate for a curriculum or instead to ensure that medical students have access to education regarding abortion?"

Ky Viet Quach, MD, an alternate delegate from the American Academy of Physical Medicine and Rehabilitation who was speaking for himself, offered an amendment changing the "opt-out" option to an "opt-in" option. "While I understand the sentiment of the others, I believe that an opt-out curriculum raises the sense of pressure and requirement that may compel medical students who otherwise are not comfortable with participating in abortion education to feel pressure to participate in such fashion, for fear of being negatively perceived by the faculty or fellow students as being lazy or uninterested, which may show up on their evaluations," he said. "An opt-in option enables students who want to participate, to actively sign up, and those who don't want to for whatever reason, whether it be personal, religious, or moral, to bypass without consequences."

Natasha McGlaun, MD, an alternate delegate from Nevada who was speaking for herself, said she wrote the resolution 3 years ago "out of concern for the lack of standardized education regarding abortion of my medical school -- which even as a publicly funded state school has a paucity of abortion curriculum -- [and after] discussion with many other medical students concerned about similar situations with their medical schools. Many of us, no matter what specialty we go into, are going to come into contact with patients seeking information on abortion, seeking to undergo an abortion or who have had an abortion. And we all need to be well rounded enough to speak on this topic, and the medicine and science behind it, intelligently in an objective manner."

"While I appreciate the physicians are still human beings and individuals who bring their own morals and values to their practice, we should not be allowed to impose restrictions on legal and evidence-based care for patients," she said. "There are many different religions, religious beliefs, and exclusionary views against various medical procedures, but for instance, if a medical school or training program was opened by a Jehovah's Witness and they refused to provide education on blood transfusions or organ transplants because of their own personally held religious views in opposition to those procedures, they would be very hard pressed to get accreditation, I'm sure. I don't understand why abortion is one of the very few exceptions we make in this field." She added that the resolution "isn't a mandate. This is just support for this type of education."

Assessing Late-Career Competency

Delegates also discussed a report from the AMA Council on Medical Education on appropriate criteria for assessing the competency of late-career physicians. outlined a set of "guiding principles" for institutions that are developing guidelines for assessment of late-career physicians. According to the report, the guidelines should be relevant, supportive, fair, equitable, and transparent, and not result in undue cost or burden to physicians.

Ken Blumenfeld, MD, a delegate from the American Association of Neurological Surgeons who was speaking for the delegation, said the report was "helpful and much needed" but that it needed to be strengthened; he proposed an amendment suggesting that "a physician subjected to screening and assessment must be afforded due process protections, including a fair and objective hearing, before any adverse action may be taken against the physician." The delegation believes such an amendment "will strengthen the report, and we urge the reference committee and House of Delegates to support the inclusion of our amendment in the final report," he said.

Maya Babu, MD, an alternate delegate for the Congress of Neurological Surgeons who was speaking for the delegation, applauded that idea. "What we're seeing anecdotally is that this is being weaponized against late-career surgeons in terms of trying to limit or exclude practice," she said. Meanwhile, "we often place the onus on the physician or the surgeon to acquire counsel, challenge medical staff bylaws, and challenge the process of screening him or herself. Not only is this onerous, but this especially at the end of one's career places undue burdens ... We request clear due process support from the American Medical Association."

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