Teaching Maternity Care in Family Medicine Residencies: What Factors Predict Graduate Continuation of Obstetrics? A 2013 CERA Program Directors Survey Mary Beth Sutter, MD Ramakrishna Prasad, MD, MPH Mary Roberts Susanna Magee, MD, MPH

Background 2011 AAFP survey: Only 10.1% had delivered a baby in the past year 1 Over time fewer FM and OB residents are choosing to deliver babies, leaving gaps in access to care 2 The decision to incorporate obstetrics declines most during end of residency 3 More FM faculty practicing and teaching OB increases grads continuing OB 4,5

To determine variables beyond number of deliveries that predict continuation of OB To explore importance of: FM faculty role models Resident autonomy Continuity deliveries MCH/ OB Fellowships Objectives

Part of the CERA annual program directors survey 2013 Analysis with descriptive statistics and Chi- square tests Response rate 56% (251/445 programs) 43% of PD’s reported at least 10% of grads continue OB Study Design

Table 1: Demographic program characteristics vs. percentage of graduates continuing OB in first job Results

Table 1: Demographic program characteristics vs. percentage of graduates continuing OB in first job Results

Table 2. Modifiable program characteristics versus percentage of graduates who continue OB in their first job following graduation Results

Table 2. Modifiable program characteristics versus percentage of graduates who continue OB in their first job following graduation Results

Table 2. Modifiable program characteristics versus percentage of graduates who continue OB in their first job following graduation Results

Table 2. Modifiable program characteristics versus percentage of graduates who continue OB in their first job following graduation Results

Conclusions More than 10% of recent FM graduates provide maternity care in their first job Positive predictive factors consistent with prior studies Geographic region High delivery numbers FM faculty supervision Novel positive predictive factors Greater resident independence Importance placed on continuity experiences

Conclusions Limitations 46% of PD responded Possible bias by PD for fear of low ACGME performance Future Directions Devote efforts into residents planning to offer maternity care early Emphasize quality, not quantity Explore tiered or tracked systems

Questions?