Salter Cynthia L, Pingul-Ravano Rowena, Lama Claire, Bills Ryan
is an Assistant Professor of Public Health, Department of Behavioral and Community Health Sciences, The University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA.
is Chief, Division of Family Medicine, University of Pittsburgh Medical Center (UPMC) Magee Women's Hospital, Assistant Professor of Family Medicine and Director of Obstetrics, University of Pittsburgh School of Medicine, and Faculty, UPMC Shadyside Family Medicine Residency Program, Pittsburgh, Pennsylvania, USA.
J Grad Med Educ. 2025 Apr;17(2):172-181. doi: 10.4300/JGME-D-24-00541.1. Epub 2025 Apr 15.
Approximately 25% of family physicians provided obstetric (OB) delivery care in 2000, but today that proportion has declined to <7%, affecting availability of delivery care in rural areas. Prior research shows that training experiences influence residents' decision to include OB care in their post-training practice. To explore factors affecting family medicine (FM) residents' decision to provide OB delivery services in future practice and to use this information to strengthen residency OB training. This cross-sectional study used concept mapping, a participatory mixed-methods approach that produces a visual representation of key concepts. It included FM residents and recent graduates participating in 2022-2023 at 3 Mid-Atlantic programs that share a tertiary-level university-affiliated hospital as training site for OB deliveries. Eighteen of 60 eligible subjects (30%) completed the generation/brainstorming and structuring data collection steps online, and 36 (60%) completed an interpretation session. Eight clusters of factors emerged: (1) motivation to practice OB care/patient relationship; (2) supportive training and modeled practice; (3) competing interests and necessity of additional training; (4) location and needs of community; (5) burnout cluster; (6) challenges of long-term competency and skills; (7) lack of enough learning opportunities and support; (8) lack of respect and inclusion. Participants rated training factors as both highly important and highly changeable, including "fragmented teaching," "feeling inadequate or inadequately prepared," and "ease or difficulty getting the required number of deliveries." Based on these findings, participating residency programs have adjusted training structure, adding a faculty liaison who provides all OB rotation orientation. This study identified factors affecting FM residents' decision-making around providing OB care in their future practice, including supportiveness of training environment and adequacy of learning opportunities.
2000年，约25%的家庭医生提供产科接生服务，但如今这一比例已降至7%以下，影响了农村地区接生服务的可及性。先前的研究表明，培训经历会影响住院医师在培训后执业中纳入产科护理的决定。本研究旨在探索影响家庭医学住院医师未来执业中提供产科接生服务决定的因素，并利用这些信息加强住院医师产科培训。这项横断面研究采用了概念图法，这是一种参与性混合方法，可直观呈现关键概念。研究对象包括在2022 - 2023年参与3个大西洋中部地区项目的家庭医学住院医师和应届毕业生，这些项目共享一家三级大学附属医院作为产科接生培训地点。60名符合条件的受试者中有18名（30%）在线完成了生成/头脑风暴和构建数据收集步骤，36名（60%）完成了解释环节。共出现了八类因素：（1）从事产科护理的动机/医患关系；（2）支持性培训和示范实践；（3）竞争利益和额外培训的必要性；（4）社区位置和需求；（5）职业倦怠类；（6）长期能力和技能挑战；（7）学习机会和支持不足；（8）缺乏尊重和包容。参与者将培训因素评为既非常重要又非常容易改变，包括“教学零散”、“感觉不足或准备不充分”以及“获得所需接生数量的难易程度”。基于这些发现，参与项目的住院医师培训计划调整了培训结构，增设了一名教员联络人，负责提供所有产科轮转培训指导。本研究确定了影响家庭医学住院医师未来执业中提供产科护理决策的因素，包括培训环境的支持性和学习机会的充足性。
