The Attainment of Obstetrical Competency in Postgraduate Family Medicine Training: A Qualitative Study
Master of Clinical Science
Brown, Judith B.
University of Alberta
Aims: This study explored the Family Medicine resident experience in working towards their obstetrical competencies from the perspectives of residents and educators.
Methods: Using a qualitative descriptive design, semi-structured interviews were conducted with second-year Family Medicine residents and obstetrical supervisors from one Family Medicine program in Ontario, as well as key informants of Canadian Family Medicine maternity education. Interviews were audio-taped and professionally transcribed. Transcripts were coded and interpreted for common themes.
Findings: There was a disconnect between the intent of the College of Family Physicians of Canada Key Features document, and how it is applied at the ground level. Residents are graduating competent but are not confident in their skills. This is influenced by factors at micro, meso, and macro levels. Resident career decisions are most influenced by fulcrum points pre-residency.
Conclusions: This study offers insight to potential areas of intervention to improve the training experience in maternity care.
Summary for Lay Audience
Family doctors providing pregnancy care through to delivery have become less common in Canada, although their role is vital. One potential reason is that resident doctors training in Family Medicine are not comfortable with their skills after their two-year training program. This study sought to understand what the Family Medicine resident experience is working towards their pregnancy and delivery care skills, from the perspectives of the residents and their teachers. The goal was to understand how the residency experience may shape a resident’s decision to provide pregnancy care in their Family Medicine career. This study interviewed those involved in creating the national pregnancy care requirements (the Key Features of The College of Family Physicians of Canada) for the training programs to understand what the requirements are and how they came to be. Family Medicine residents in their final year of training at one program in Ontario along with their teachers were interviewed to understand what their experience was working toward their required pregnancy skills. The interviews were reviewed by the researchers for common themes.
The Key Features document is often mistaken by learners and teachers as a checklist of skills. The intention was to use the document as a guide to understand the resident’s skills as a doctor at a more general level. Most participants felt that Family Medicine residents should focus on the skills surrounding delivery, such as fertility, early pregnancy, after the pregnancy, and newborn care. They did feel however, that all residents should and are graduating able to deliver a baby when it is very straightforward and in an emergency setting. Although residents knew how to perform pregnancy-related skills, this often did not mean that they were confident in their skills. This was affected by different levels of factors including the learner themselves, their training program, and the overall landscape of Family Medicine. Residents also made career decisions about pregnancy care before they started their training. Understanding these factors influencing their learning experience can be helpful to know where we can improve pregnancy care training and ultimately increase the number of family doctors comfortable delivering babies.
Arora, Nisha, "The Attainment of Obstetrical Competency in Postgraduate Family Medicine Training: A Qualitative Study" (2023). Electronic Thesis and Dissertation Repository. 9145.
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