Delivering Rural Obstetric Training for Family Medicine Residents

Abstract

Family physicians are the most common health professional providing rural OB care, but the number of family physicians practicing obstetrics is declining. To address parental and child health disparities in rural communities, family medicine must provide robust obstetric training to prepare family doctors to care for parent-newborn dyads in rural communities, and this mixed methods study aims to inform this commitment.

We surveyed 115 rural family medicine residency programs and conducted semi-structured interviews with ten rural family medicine residencies. All included rural programs provide at least 50% of their training in a rural location according to at least two federal definitions of rural. We calculated descriptive statistics and frequencies of survey responses. Through an iterative process, two authors conducted a directed content analysis of free-text survey responses and interviews. The survey yielded 59 responses (51.3%) with no significant difference between responders and non-responders across geography and program type. Most but not all programs (85.5%) trained residents to provide comprehensive prenatal and postpartum care. Continuity clinic sites were predominantly rural (at least 74.5%) and OB training was largely rural in PGY2 and PGY3 years. In designating barriers, almost half of programs listed “competition with other OB providers” (49.1%) and “shortage of family medicine faculty providing OB care” (47.3%) as major challenges. Programs listing challenges in one category more frequently acknowledged challenges within the same category and across other categories. In qualitative responses, common themes centered around faculty interest and skill, community and hospital support, volume, and relationships. To improve rural OB training, our findings support prioritizing relationships between family medicine and other OB clinicians, sustaining family medicine OB faculty, and developing creative solutions to address mismatches between volume and skill.