Residency Characteristics Associated With Pregnancy Care Among Graduates: A Family Medicine Residency Outcomes Project Study

Background and Objectives: The number of US family physicians providing pregnancy care continues to decline. The 2023 US family medicine training requirements increased flexibility for pregnancy care training. We aimed to evaluate the correlation between residency program structures and curriculum with graduate maternity care provision. Methods: Our prospective cohort study of family medicine graduates used the 2018 Council of Academic Family Medicine Educational Research Alliance (CERA) program director survey to measure program characteristics and maternity care curricular elements and the 2021 family medicine national graduate survey (NGS) of 2018 residency graduates to measure outcomes. Logistic regression determined the associations between residency elements and graduate provision of maternity care and deliveries. Results: The cohort included 779 graduates (48% of the NGS sample). A total of 28.5% reported providing maternity care (MC) and 13.2% reported performing deliveries. In adjusted models, performing more than 80 deliveries during residency (MC OR=4.70 [3.21, 6.88]; Deliveries OR=15.39 [8.21, 28.85]) and exposure to six or more faculty providing this care (MC OR=2.37 [1.62, 3.47]; Deliveries OR=4.75 [2.58, 8.72]) were associated with providing maternity care and deliveries in practice. Four or more months of obstetrics training was associated with performing deliveries only (OR=3.34, [1.98, 5.61]). Neither program characteristics nor a continuity delivery requirement was associated with providing maternity care or deliveries. Conclusions: In a large national cohort study, performing more than 80 deliveries during residency, exposure to six or more faculty delivering babies, and completing four or more months of obstetrics training (deliveries only) were associated with graduates providing maternity care and deliveries. These findings align with the 2023 Accreditation Council for Graduate Medical Education Family Medicine Residency Requirements for comprehensive pregnancy care training.