Outcomes of a rural-focussed family practice residency

Purpose: Family medicine  physicians play a crucial role in maternity care in community-based settings. However, residency graduates are decreasingly likely to provide delivery services. We explored residency training and graduates' inclusion of obstetrical care in practice by surveying graduates of the Duluth Family Medicine Residency, traditionally producing a high number of graduates serving rural communities and providing obstetrical care. Methods: Graduates (N=48) were surveyed about their provision of maternity care and perceptions of how well the residency prepared them to provide such services. Additional factors that impacted decisions to provide obstetric care (e.g., post-residency training, community size, and if there were obstetricians providing delivery services in their community) were evaluated. Findings: Nearly half of graduates (46%) were providing maternity services, most of whom provided perinatal clinical care (68% provided delivery care and 4% operative deliveries).  Seventy-one percent worked in a community with an available obstetrician. Graduates providing obstetric services were more likely to live in rural communities (66% vs 35%, p<0.01). Thirty percent of graduates received extra obstetrical training in residency. Graduates providing obstetric services were more likely to cite that their decision to practice obstetrics was influenced by the number of deliveries performed, interactions with attending obstetricians, and interactions with prenatal and laboring patients during residency compared to those not providing obstetric services. Conclusions: Residency training has an impact on provision of maternity care and potential practice of family physicians in rural communities. Attention to curricular support, particularly exposure to maternity patients, is important for resident comfort in obstetrics.