Comparison of Maternity Care Training in Family Medicine Residencies 2013 and 2019: A CERA Program Directors Study

Background and Objectives: Maternity care training is a standard requirement for all family medicine residents, and family physicians play a critical role in the US maternity care workforce. In 2014, the Accreditation Council for Graduate Medical Education (ACGME) updated the required obstetrical experience during family medicine residency training from a volume-based to a competency-based requirement of 200 hours (2 months rotation). This study aimed to determine if family medicine resident maternity care training experience differed after this change in requirements. Methods: A nationwide survey of family medicine program directors was conducted as part of the 2019 Council of Academic Family Medicine Educational Research Alliance (CERA) survey, replicating a 2013 CERA survey to determine if there was a change in family medicine resident maternity care experience after the ACGME requirements update. Results: The priority programs place on residents’ continuity deliveries and family medicine faculty attending deliveries decreased between 2013 and 2019. The reported number of continuity deliveries and vaginal deliveries performed by residents also decreased significantly between 2013 and 2019, yet the program directors’ estimate of the number of graduates going on to provide obstetric deliveries or pursue a maternity care fellowship did not change significantly. Programs reporting more than 25% of graduates continuing to conduct vaginal deliveries have reported similar numbers of vaginal deliveries per resident as in 2013. Conclusions: The majority of family medicine residents are graduating with less delivery experience, and residency programs are placing less priority on continuity deliveries and modeling by family physician faculty following the 2014 ACGME Family Medicine Requirements update. This trend may have major implications on the comprehensive nature of our specialty and further widen gaps in the maternity care workforce. Further studies are needed to determine the impact on the competency of graduating family medicine residents in providing maternity care and for the long-term effects on the maternity care workforce.