Research ArticleFamily Medicine UpdatesF

A PROCESS FOR CHANGE: A METHODOLOGY FOR ACADEMIC FAMILY MEDICINE

Stoney Abercrombie, Paul Callaway, Peter Carek, Sandra Carr, Gretchen Dickson, Joseph Gravel, Karen Hall, Sam Jones, Stanley Kozakowski, Elissa Palmer, Mark Robinson and Martin Wieschhaus
The Annals of Family Medicine November 2008, 6 (6) 569-570; DOI: https://doi.org/10.1370/afm.930

The Association of Family Medicine Residency Directors (AFMRD) Board of Directors recently rekindled the discussion pertaining to maternity care education in family medicine residency programs. At present, the ACGME-RRC for family medicine requires programs to provide 2 months of educational experience in maternity care as well as delivery experience that entails a minimum of 40 deliveries by each resident over the 3-year program, of which a minimum of 10 must be continuity deliveries. At least 30 of the total deliveries must be vaginal deliveries. The current discussion is meant to address the following issues:

  1. A decreasing number of physicians in active practice and who graduated from a family medicine residency program provide maternity care. Many programs are concerned that they are being required to provide an experience that a majority of the graduates will not use upon graduation.

  2. Many programs have difficulty meeting RRC-FM requirements for maternity care education. Maternity care is the most frequently cited curricular area noted by the RRC-FM. The RRC-FM issued an average of 6.6 citations per program. Maternity care, family medicine center patient encounters, and gynecology curricula were the most common areas of noncompliance citations. In addition to meeting minimal delivery requirements, a majority (58%) of programs responding to a questionnaire stated that they had difficulty in recruiting a faculty member with delivery skills. With this high rate of citations, the quality of education in maternity care for family medicine residents is inconsistent.

In order to provide a position statement that best reflects the experience and expertise of its membership, the AFMRD Board of Directors conducted a process that would allow a significant amount of input from program directors as well as information from other sources.

As an initial step in addressing the above issues, the AFMRD surveyed its membership regarding maternity care. Specifically, this survey examined such issues as whether a change in ACGME- Residency Review Committee for Family Medicine (RRC-FM) requirements for maternity care was desired, do programs have difficulty meeting RRC-FM Requirements for maternity care, should all family medicine residents have at least some required maternity care experience, and recommendations regarding number of total deliveries needed to better insure competence for a family medicine resident planning on providing maternity care in practice.

To augment the data provided by the survey, a literature review was conducted to provide additional information to AFMRD members in preparation for a discussion forum regarding maternity care and family medicine conducted during the Annual Program Directors Workshop. The literature review provided information regarding issues regarding maternity care in family medicine residency programs, information regarding family medicine residency program graduates and maternity care, the experience of practicing family medicine physicians who are providing maternity care to their patients, and student interest in maternity care.

Next, a facilitated discussion forum regarding maternity care and family medicine was conducted during the Annual Program Directors Workshop in Leawood, Kansas on June 8th, 2008. Using data collected from the previously described survey, 4 program directors were selected to present differing positions on this subject. Following these presentations, an open forum with opinions from the audience was conducted. In particular, specific suggestions to RRC-FM guidelines were requested. During this entire session, information and opinions presented were extracted, reviewed and summarized by members of the AFRMD Board of Directors.

Using the 3 sources of information described above, an initial draft of a Maternity Care Position Statement was developed. This draft statement was presented to the AFMRD membership as well as to representatives from the Society of Teachers of Family Medicine, the Association of Departments of Family Medicine, the North American Primary Care Research Group, and the American Academy of Family Physicians for their review and comment. These comments were collated and presented during an AFMRD Board of Directors meeting. The Board members reviewed and extensively discussed the comments received. Following this meeting, the Position Statement has recently been again revised.

The final version of the Maternity Care Position Statement by the Board of Directors of AFMRD will be forwarded to the Commission on Education (COE) of the AAFP for further review and vetting. The COE will present the final recommendation to the RRC-FFM.

The process used to develop the final position statement to the COE has been deliberate, thoughtful, collaborative, balanced, and methodical. This method is presented as an example of a rational methodology to address significant issues currently present in family medicine education and hopefully will serve as a template for future such deliberations.