ABSTRACT
BACKGROUND AND OBJECTIVES: Maternity care training in family medicine is a major component of our specialty. The Association of Family Medicine Residency Directors (AFMRD) issued a position paper calling for a two-tiered system of training for family physicians based on concern that some residency programs are unable to meet the current Residency Committee-Family Medicine (RC-FM) requirements for maternity care training. This two-tiered system was also endorsed by other family medicine organizations, including the AAFP, ADFM, NAPCRG, and STFM. Despite this support of the new system, there remains concern among some family medicine educators about this two-tiered approach. The Society of Teachers of Family Medicine Group on Hospital Medicine and Procedural Training met in 2009 and 2010 to develop an alternative tiered system for the training of family medicine residents in maternity care. METHODS: Working from previous requirements for maternity care training and the AFMRD document, the group used a multi-voting process to identify the tiers and their elements. RESULTS: The group generated a three-tier system for maternity care training in family medicine residencies. These included curriculum, patient volume, faculty expectations, and institutional requirements. CONCLUSIONS: The three tiers we propose address the importance of maternity care, the limitations that some residencies face in providing adequate patient volumes, and the need to teach more advanced skills to those family medicine residents who will work in rural and underserved areas upon graduation. We urge family medicine governing bodies to adopt this system and believe that it will help preserve the essential role that family physicians serve in the care of pregnant women starting with basic maternity care and extending to advanced roles including care of complicated pregnancies and cesarean delivery.
Subject(s)
Curriculum , Family Practice/education , Internship and Residency/organization & administration , Maternal Health Services/standards , Obstetrics/education , Clinical Competence , Female , Humans , Physicians, Family/education , Pregnancy , Surveys and Questionnaires , United StatesABSTRACT
At the beginning of the 21st century, community-based physicians have a technology which is safe, noninvasive and relatively inexpensive. It allows immediate access to visual data inside the body for the evaluation of health and disease. Prenatal ultrasound is vital for the efficient provision of preventive care even in community health centers, where physicians may not be the delivering physicians. To assess the frequency of this diagnostic technology, a longitudinal study of 36 months tabulated prenatal ultrasound scans performed in two community-based offices providing generalist healthcare from 2001 through 2003. Between the two offices, 68,938 patients were seen, 679 deliveries were attended and 1,286 medically indicated prenatal ultrasound examinations were performed. Prenatal ultrasound scans--compared to other common office procedures, such as electrocardiograms, chest radiographs, circumcisions, blood sugar checks, Papanicolaous and colposcopies--emerged as one of the most frequently preformed diagnostic tests in the office. Based on these results, medical educators preparing generalist physicians for community medicine may want to consider some training in prenatal ultrasound. Future research can confirm the generalizability of the findings of this pilot study in two urban health centers.
Subject(s)
Community Health Centers/statistics & numerical data , Community Medicine/statistics & numerical data , Practice Patterns, Physicians'/statistics & numerical data , Prenatal Care/methods , Ultrasonography, Prenatal/statistics & numerical data , Urban Health Services/statistics & numerical data , Adolescent , Adult , Aged , Child , Child, Preschool , Community Medicine/education , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Pilot Projects , Prenatal Care/statistics & numerical data , Tennessee , WisconsinSubject(s)
Diabetes Mellitus, Type 1/drug therapy , Diabetes, Gestational/therapy , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic use , Pregnancy in Diabetics/drug therapy , Dose-Response Relationship, Drug , Family Practice , Female , Fetal Macrosomia/prevention & control , Humans , Medically Uninsured , Pregnancy , Referral and ConsultationABSTRACT
Prenatal ultrasound is a powerful diagnostic tool, but there has been little research on how to teach ultrasound to family physicians. The available evidence supports teaching through didactics followed by supervised scanning. Didactic topics include physics and machine usage, indications, fetal biometry, anatomic survey, practice management, ethical issues, and resources. Supervised scanning reinforces the didactic components of training. A "hand-on-hand" supervised scanning technique is recommended for the transmission of psychomotor skills in these sessions. Curricula for teaching ultrasound should include information on which residents will be taught prenatal ultrasound, who will teach them, how to create time for learning ultrasound skills, and how to test for competency. The literature suggests that competency can be achieved within 25-50 supervised scans. Measures of competency include examination and qualitative analysis of scanning. Competency-based testing needs further development because no uniform standards have been established.
