Study authors associated with the Ryan Residency abortion training program have published a paper analyzing abortion training since the Dobbs decision overturning Roe v. Wade, noting that "programs are struggling to ensure this training, but some are unable to train residents to competence in all skills during the away rotation."

The study, "Navigating the Complexities of Out-of-State Abortion Training in the United States Post-Dobbs" published in AJOG Global Reports, (one of two companion titles to American Journal of Obstetrics and Gynecology) claimed to be the "first study assessing the barriers and firsthand experiences of trainees and faculty in the post-Dobbs abortion training landscape."

Key Takeaways:

• The Accreditation Council for Graduate Medical Education (ACGME) requires abortion training as part of OBGYN residency training.

• Study authors with the Ryan Residency abortion training program claim that though this training is required for residents, some students are unable to be trained "to competence in all skills" because they cannot obtain it in their states that have pro-life laws.

• While the authors encourage ACGME to continue requiring the training, they surveyed students who noted that "exposure" to abortions, rather than competency, appears to be the goal of the training.

The Details:

Abortion Training Landscape

Since Dobbs, "training programs in states with abortion bans are developing out-of-state training rotations by partnering with programs in abortion-accessible states," the authors wrote.

"In the United States, the Accreditation Council for Graduate Medical Education (ACGME) requires that abortion training be a part of OBGYN residency training. After the ACGME requirement was enacted, abortion training as a required experience increased from 12% of OBGYN programs in 1992 to 72% in 2020," they stated (emphasis added).

Authors noted that after the overturn of Roe v. Wade (emphasis added):

Thirteen states have since banned abortion at all gestations with varying, limited exceptions... These states house 54 OBGYN training programs and over 1200 trainees, making it challenging for these programs to meet ACGME requirements and prepare their trainees for future practice.

The ACGME continues to require training and states, “if a program is in a jurisdiction where resident access to this clinical experience is unlawful, the program must provide access to this clinical experience in a different jurisdiction where it is lawful.”

According to the National Abortion Federation (NAF), in 1995 the ACGME "acknowledged that abortion training opportunities had dropped to a dangerous level and adopted clear new guidelines that explicitly set forth the expectation that abortion training would be available to all ob-gyn residents..." (emphasis added).

That revision was an "outgrowth" of NAF's 1990 symposium, resulting in a final version adopted on July 31, 1995.

Competency 'Not the Goal' - Abortion 'Exposure' Is

"Trainees have expressed concerns about whether their training will be adequate to provide [abortion] care and have conflicting emotions about whether to train in and practice in states with restrictions," the study stated.

Authors noted that "ACGME continues to require abortion training within OBGYN residency programs" but acknowledged that training sites may be "unable to train visiting learners to a level of competency in all abortion skills."

However, they "encourage[d] the ACGME to continue to mandate training for OBGYN residents."

Authors cited those surveyed:

One trainee felt that gaining competency meant “that I could safely do a procedure and manage complications”

Another described competency as “ready to independently practice by yourself…and you are able to manage the complications associated with the procedure, that you also are able to adequately counsel your patients”

One participant said the obvious part out loud: that the goal of abortion training is not 'competency' but to 'expose' residents to abortion:

“I think it helps that their Ryan program director had sent me [their goals for the residents]. And she's like, ‘Obviously, they're not going to be competent in D&E, being there for two weeks, sharing procedures with your residents. That's not the goal… the goal is for them to be exposed to this stuff, to understand how it works, to do counseling, to do medication abortion, to feel like they get it, so that they know what it means.

They can counsel patients about what's going to happen when they go to other places. And they know enough to know that they want more training after residency.’ It was kind of just set up like, whatever you can do is great….

I think that, knowing that we're not solely responsible for training people to be able to provide care in just this little two-week snippet it makes it lower stakes. I think that really took a lot of the pressure off.”

Authors suggested that delicate abortion procedures could be practiced "using simulation."

The study referenced a previously published research letter describing another study involving 60 medical residents who traveled to other states for training. However, just 35 of those residents completed surveys. While residents reported feeling comfortable committing first-trimester medication and aspiration abortions, at least half seemed to be less than competent in committing the gruesome dismemberment D&E abortion procedure: "40.6% felt competent to 17 weeks of gestation, 46.7% from 18 to 20 weeks, and 12.5% from 21 to 23 weeks."

Additional Admissions

The study was "part of a larger landscape analysis conducted in 2023-2024 to understand US abortion training" and "included interviews with faculty that were sending and receiving trainees from states with abortion bans, the trainees themselves, abortion clinics that were engaged in clinical training and representatives from larger organizations that were involved in medical education that included abortion."

Participants "received a $50 gift card as compensation," authors stated, noting that they "sought to explore the challenges in training learners and establishing partnerships through interviewing faculty and trainees in programs in states with bans on abortion and those without bans."

They "interviewed 22 people including faculty" and "Over half of trainees interviewed had traveled for training."

They identified three themes (emphases added):

(1) uncertainty and pressure created by the Dobbs decision:

(2) navigation of complex logistics:

• One "described the malpractice being the hardest step: 'I think that figuring out the malpractice insurance, figuring out what paperwork everyone was going to require.'"

• "Some trainees and training sites had barriers so onerous that they could not overcome them. One program reported being unable to send residents because they could not navigate the legal barriers..."

(3) tension between rotation goals of exposure vs competency.

• "Exposure was considered to include minimal hands-on training deemed inadequate to achieve competency in abortion procedures."

• "Competency was interpreted as adequate clinical skills training for independent practice of procedural abortion after the rotation."

• "Many faculty described wanting the trainees to obtain a meaningful experience but were unclear whether the goal should be exposure or gaining competency to provide care without additional training."

The Background:

Ryan Residency

The Ryan residency program, named after the late Kenneth John Ryan, MD (who once called for private funds to experiment on aborted children), was formed in the mid-1990s in an attempt to counter the "greying" (aging) and shortage of abortionists.

In the past 20 years, the Ryan Residency Program, based at the Bixby Center for Global Health at the the taxpayer-funded University of California-San Francisco (UCSF), has reportedly trained over 7,000 OBGYNs to kill preborn children.

In 2026, its website claimed there were 122 Ryan Programs across the U.S.

Out of the 7,000+ residents trained, reportedly about 40% of them now “provide routine abortion care for their patients.”

One of the primary funders of the abortion training program has been the Susan Thompson Buffett Foundation, founded in 1964 by billionaire Warren Buffett, nicknamed the "Sugar Daddy of Abortion."

Despite Buffett’s efforts to frequently remain an “anonymous” donor, evidence shows that his dollars go directly to Ryan Residency programs.

A 2018 University of California report revealed that the Buffett Foundation gave $78 million to UC in past years, with $52 million for the Kenneth J. Ryan Residency Training Program, among other abortion endeavors.

Buffett often hides his abortion training grants. Yet, year after year, the Susan T. Buffett Foundation has granted millions to the Regents at UCSF for “program support.” Where that funding goes is not specified.

In addition, Buffett funds specific Ryan Residency programs at various universities.

According to 19thNews.org:

Between June 2022, when Roe was overturned, and the end of June 2023, 125 out-of-state doctors did residencies in programs that use the Ryan Residency Training Program model, according to Kristin Simonson, director of programs and operations.

Study Authors and Funding

Three study authors are members of the Ryan Program Curriculum Advisory Committee:

• Kristyn Brandi is a "former board member and the past Board Chair of Physicians for Reproductive Health, sits on several sub-committees for the Society of Family Planning and is a founding member of Centering Equity, Racial and Cultural Literacy in Family Planning (CERCL-FP)."

• Kristin Simonson is on staff at the Bixby Center and is Planned Parenthood’s director of programs and operations.

• Jody Steinauer is "Director of the Bixby Center for Global Reproductive Health and the Director of the Kenneth J. Ryan Residency Training Program in Family Planning."

Two others (Emily Claymore and Jema Turk) are on staff at the Bixby Center:

The study was ironically funded by an "anonymous donor."

Why It Matters

The Dobbs decision allows states to enforce laws protecting preborn life but forcing medical providers to receive abortion training, even if they have to travel, violates the Hippocratic Oath and the conscience of many who would pursue a career in medicine.

Medical Malpractice Attorney Michael Seibel, who operates AbortionInjury.com, told Live Action News:

"The fact that these young intelligent residents feel incompetent after their training in the Ryan Residency reflects poorly on the quality of their training program.

"Maybe ACGME should revisit their guidelines and remove the requirement for abortion training because these residents are being inadequately trained under the current University training structure.

"State and local legislatures should obviously look into why these students feel incompetent after training for abortion and remove the requirement, given there is no benefit to a large majority of students."