Study Examines Challenges of Rural Obstetric Training
Authors Stress Importance of Family Physicians in Providing Care
June 22, 2023, News Staff — Research published in the June issue of Family Medicine provides new insight into the crucial role family physicians play in providing rural obstetric care. The findings, based on a combination of survey results and interview responses, also illustrate the challenges rural family medicine residency programs face and offer potential solutions to ensure residents in these programs continue to receive rigorous OB training
Researchers from the University of Washington School of Medicine sent surveys to 115 accredited rural family medicine residency programs (both integrated rural training tracks and non-RTT programs) identified by the RTT Collaborative, a nonprofit cooperative that supports health professions education in rural areas. In addition to basic program information, the survey asked about OB training locations, OB competencies, and the extent to which programs experienced challenges in providing robust OB training.
The researchers also invited personnel from some of the residencies to participate in semistructured interviews to obtain additional information, such as the model of OB training used and factors that affected the program’s ability to provide training. Altogether, 59 programs responded to the survey, and personnel from 10 residencies were interviewed.
Results
A slight majority of the residency programs (~52%) were community-based and affiliated with a medical school. Most programs (~64%) identified training rural family medicine OB physicians as part of their mission. Most OB training locations were in large rural areas, with just over one-third of obstetric training sites located at federally qualified health centers, followed by critical-access hospitals (27.1%) and rural health clinics (23.7%).
In terms of competencies, more than 85% of programs reported training residents to provide comprehensive prenatal and postpartum care, and more than half trained residents in OB ultrasound. Less than 30% of programs provided training that would enable residents to perform operative deliveries such as Cesarean section, however, and less than 22% taught surgical gynecologic procedures. Overall, programs required a median total of 16 weeks of OB time across all years of residency training, and more than 85% offered additional optional training.
Story Highlights
Programs reported numerous challenges to providing robust OB training, with the biggest challenges including
- competition with other OB providers,
- a shortage of family medicine faculty providing OB care,
- a shortage of interested or willing faculty,
- lack of community awareness regarding family physicians’ scope of practice, and
- lack of resident interest in OB.
The researchers observed that challenges often occurred in clusters comprising two general categories: community factors (e.g., competition with other clinicians, patient outmigration to urban facilities, a declining OB patient population and lack of awareness of FP scope of practice), and personnel factors (e.g., a shortage of faculty to provide OB care, lack of resident interest, nursing discomfort with resident involvement and lack of OB-trained outpatient clinic staff).
Content analysis of qualitative survey data revealed themes such as institutional culture and support, relationships between the residency program and other OB partners, patient volume, and presence of family medicine OB faculty as keys to robust training. Interview responses from residency program personnel also identified several common themes as either barriers or facilitators, including accreditation requirements, the role and importance of faculty with OB skills, and resident interest in OB care.
Observations and Conclusions
For many family medicine residences, “rural OB training is influenced by complex and interrelated factors,” said researchers. Recruiting and retaining qualified faculty, especially family physicians training in OB care, is essential in determining the success of rural OB training, as are positive relationships between residency personnel, local OB clinicians, nurses and the community.
Study limitations included small sample size and potential bias related to self-reported data. In addition, interviews were completed primarily by program directors and site directors, so the perspectives of residents, other faculty members and community partners might not be represented. Despite these limits, the authors said that many of their findings were consistent with other studies. Future research should examine the influence of policy changes on the number of residents prepared to provide OB care, as well as the relationship between family medicine residences that provide OB training and communities with weaker support for OB services or hospitals vulnerable to closure.
“Our findings support prioritizing relationships between family medicine and other OB clinicians, focusing on developing and sustaining family medicine OB faculty, and developing creating solutions to teach and maintain advanced skills in lower-volume settings,” the authors concluded. “Understanding the complexities faced by rural residency programs in providing OB training can augment the work of communities, institutions and policymakers to improve care delivery for rural patients.”