Shifts in Religious and Cultural Diversity Support Across ObGyn Residencies with a Focus on Abortion Training: A Two-Year Follow-Up
Authors: Hanners Jacqueline , Lemoine Steven , Wahl Heather , Zoorob Dani 
Published: July 2024

Introduction: The Accreditation Council for Graduate Medical Education (ACGME) has recognized cultural competency as part of three out of six core competencies residency programs provide training in. Religion and culture are interwoven, and efforts to increase inclusivity by incorporating religious and culturally competent medical education has become a vital aspect of residency training. Inclusivity in healthcare has enhanced the recruitment of a racially, religiously, and culturally diverse workforce overall, thus enhancing the patient-provider experience through representation. Similarly, diversity among residency candidates has also improved. While current literature highlights the steps taken to ensure various forms of equity, there is little focus on religious or cultural support provided to OB/GYN residents. More recently, access to abortion training may impact which residency programs a candidate chooses to apply to, as ACGME requires such training opportunities to be provided without implications unless precluded by religious restrictions. However, minimal data exists on the training provided, institutional or alternative (outsourced services), and the methodology for abstention from abortion education. As program websites are often the primary source of information for residency applicants, this study aimed to identify shifts in cultural and religious support depicted on OB/GYN residency websites in the past two years while assessing the publicly-listed abortion training variations among such programs. Methods: During April 2022 and April 2023, websites of ACGME-accredited OB/GYN residency programs in the United States were evaluated using a novel 20-attribute collector tool that objectively benchmarks programs from religious/cultural diversity and incorporation of corresponding competency training into resident education. A religiously representative diverse focus group developed our tool. Items assessed included holistic reviews of applications, explicit interest in the recruitment of residents from diverse religious/cultural backgrounds, presence of religious/ethnic indicators depicted on the website, reported support for those with religious obligations, and if cultural/religious or diversity, equity, and inclusion (DEI) competency were cited. Additionally, the 2023 data collection focused on abortion references with guided support per ACGME-required training while providing an overview of protections and restrictions using the Guttmacher Institute website. Results: A total of 576 websites were analyzed, with 285 websites accessible for review in 2022 and 291 in 2023. Due to the program count discrepancy across both years, percentages were used to compare the data (as a result of an increase in accredited programs and website accessibility). An increase of 2% was noted in referencing holistic reviews and ethnic/religious support. Additionally, a 12% increase in spiritual and cultural-focused research was noted on websites with an additional 8% verbalizing such support. A 9% reduction in overall inclusivity advocacy was listed on websites, while an additional 10% reduction was explicitly noted in cultural competency. A 1% reduction in referencing religious diversity and a 2% reduction in websites referencing time allocations for religious holidays were identified. Furthermore, 12% had fewer stated opt-out options for religious obligations. There was a 7% increase in the discussion of religious or ethnic support, with a 5% increase in the focus on race. However, there was a 5% decline in referencing either concept. Although ACGME specifically suggested having Opt-Out options for programs, 1% had the Opt-In option, 12% stated the Opt-Out, 19% vaguely referenced either, and 68% did not mention abortion abstinence options or support on their website. Only 2% of websites suggested alternative sites for residents’ training due to legislation, whereas 27% referenced fellowship and supplementary post-residency training opportunities. Regarding the concept of abortion, 14% stated support for abortion, 14% mentioned abortion but provided limited details, and 72% did not reference it on the website. Concerning current state-specific legislature, 41% are distinctly protective of abortion rights, 46% are restrictive, with the remaining having both protections and restrictions. Conclusion: Our study suggests that the overall focus on religious and cultural diversity across OB/GYN residencies websites has become slightly accentuated over the past two years. The investment or deference of abortion training has not been adequately referenced to permit making informed decisions by prospective trainees. Having cultural and religious congruency of residents with program offerings may potentiate resident success while training.