Factors Affecting Family Medicine Residents' Decision to Provide Obstetric Care: A Concept Mapping Study.

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.