1. Supervising Attending Specialty and Resident Satisfaction with Maternity Care Training
S Hartman, MD; D Carter, MD; M Duggan, MD; M Fitzgerald; A Flaherty, MD; A Fletcher, MD; A Kolasa-Lenarz, MD; E Loomis, MD
Montefiore Medical Center Department of Family and Social Medicine and University of Rochester Department of Family Medicine
Background
Results: General Experience
Respondent Demographics
Curriculum Structure Before and After
Recent ACGME-RRC-FM guidelines reduced the required amount of maternity training for family medicine residents, but continue to require that all family medicine programs employ at least one family medicine faculty member with maternity privileges (1).
Changes to these requirements would negatively impact resident education in women’s reproductive health, even for those not intending to deliver babies after graduation (2).
Some studies show that family medicine residents are more likely to include maternity care in future practice if supervised by family medicine physicians (3-6).
Family physicians contribute significantly to the national maternity care workforce, achieve similar patient-oriented outcomes when compared with care delivered by obstetricians, and may offer a less “interventionist” approach associated with higher patient satisfaction (7).
Significant differences in overall experience, personal experience, learning environment, choosing the facility again, and recommending the program to peers.
Only category that did not exhibit significant change was satisfaction with clinical faculty/preceptors.
Survey Time 1 Total Respondents = 13
Survey Time 2 Total Respondents = 14
Focus Group Total Respondents = 12
PGY1
4 (30.1%)
4 (28.6%)
4 (33.3%)
PGY2
5 (38.5%)
5 (35.7%)
PGY3
4 (31%)
Gender
Female
9 (69%)
9 (64.3%)
7 (58.3%)
Transgender
Male
5 (41.7%)
Race
Asian
3 (23.1%)
Black or African American
3 (25%)
White
Other Race
Ethnicity
Hispanic or
Latino
3 (21.4%)
2 (16.7%)
Not Hispanic or Latino
10 (76.9%)
11 (78.6%)
10 (83.3%)
Resident Rotation
Content
FM Supervision1
time 12
FM Supervision time 23
R1 required maternity care rotation
2 months:
90% of time on L&D4
10% of time in prenatal care
5% of deliveries (remainder of deliveries with OB5)
30% of deliveries
R2 required maternal-child rotation
1 month:
60% nursery
10% prenatal care
30% continuity delivery time
5% of deliveries
5% of newborn rounds
20-30% of newborn rounds
Continuity deliveries
10 required
FM = family medicine faculty physicians
Time 1 = before July 1, 2012
Time 2 = after July 1, 2012
L&D = labor and delivery
OB = obstetricians - includes faculty physicians and senior level resident physicians
Z-tests of proportions of residents reporting “Satisfied” or “Very Satisfied” with clinical experiences before and after implementation of family medicine maternity service. *p<0.05 for all except clinical faculty p = 0.12
Conclusions
Results: Maternity Skills
Despite changing practice climates, the presence of family medicine maternity faculty provides residents with a more meaningful learning environment and role modeling for future practice.
RRC-FM should continue to require that all family medicine residency programs employ at least one faculty member with maternity privileges.
Majority of supervision was still provided by obstetrics faculty;
OB faculty may de-emphasize procedural training to family medicine residents, leading to smaller changes in resident satisfaction with procedural skill training.
OB faculty may have viewed cognitive skills training as more appropriate for family medicine trainees.
Mean scores for resident ratings of satisfaction with training increased significantly for all cognitive or mixed cognitive-procedural skill areas.
Only procedural skill showing a significant increase was “repair of first and second degree perineal lacerations”.
Cohen's d measure of effect size was calculated each skill area (d = 0.2 for small effect size, 0.5 for medium effect size, 0.8 for large effect size).
Large effect sizes in all cognitive and mixed skills, and in all procedural skills with the exception of performing amniotomy (medium effect size).
Thus, despite non-significant increases in mean satisfaction scores in procedural training areas, we found trends toward greater satisfaction.
Methods & Materials
A family medicine maternity service was established at Montefiore Medical Center in July Family Medicine faculty subsequently had greater autonomy and responsibility for patient care and resident supervision.
Family medicine residents were given surveys prior to and 6 months following establishment of the family medicine maternity service, to measure the impact of increased family medicine attending presence on resident learning and satisfaction with training.
Survey Measures
General experience of maternity training: Learner’s Perceptions Survey with questions pertaining to overall experience, clinical faculty, personal experience, learning environment, recommending the program to peers, and choosing the program again.
Maternity skills training: Learners rated experience in specific cognitive, procedural, or mixed cognitive-procedural skills in maternity care on a Likert Scale.
References
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T-test of means comparing resident ratings of training in each skill area before and after implementation of family medicine maternity service.
1= very satisfied, 2= somewhat satisfied, 3= neither, 4= somewhat dissatisfied, 5= very dissatisfied. *p<0.05 except where noted