LETTERS TO THE EDITOR

Prioritize Comprehensive Women’s Health Training, Protect Our Communities

Keyona Oni, MD | Kari-Claudia Allen, MD | Judy Washington, MD

Fam Med. 2022;54(8):658-659.

DOI: 10.22454/FamMed.2022.203722

To the Editor:

As family physicians with maternity care experience in both rural and urban academic settings, we have witnessed multiple threats to the women’s health competency of the graduating family physicians. “Comparison of Maternity Care Training in Family Medicine Residencies 2013 and 2019: A CERA Program Directors Study” uncovered the core of what is actively dismantling the practice of women’s health amongst family physicians. This well-performed study compared provisions of maternity care by resident graduates after the 2014 change in Accreditation Council for Graduate Medical Education (ACGME) requirements—a shift from quantitative targets to competency-based learning in perinatal care. The data predictably illustrates a significant decline in the volume of maternity patients cared for by residents during their training.1 The adjusted ACGME requirements created a deficit within resident education that threatens the well-being of our patients. The byproduct challenges family medicine’s delivery of perinatal care and, inescapably, women’s health primary care to our most vulnerable populations.

When we dilute maternal health training for residents, we invariably leave voids in the totality of our women’s health primary care curricula. In a short 6-year span, we have seen far less time devoted to teaching maternity skills, and the precious time needed to become proficient physicians for the care of women was reallocated elsewhere in our programs. This monumental shift will exacerbate the known gap of residency preparedness and practice implementation in women’s health primary care previously attributed to health systems.2 Now, family medicine graduates are at great risk of feeling ill-prepared and failing to deliver health care for women in all phases of their lives.

Threats to resident competency are multifactorial, extending beyond ACGME maternity care requirements. Nearly one-quarter of family medicine in-training examination questions stem from women’s health, with a predominant reproductive and perinatal care footprint.3 Unfortunately, we neglect to test on preventative and longitudinal care of women, which are a cornerstone of primary care. Clinical exposure is further challenged by reproductive-age women choosing Ob-Gyn for preventative visits.4 Primary prevention and chronic disease management are core to family medicine and instrumental in reducing severe maternal morbidity.5 Enhancement of and adherence to comprehensive women’s health and perinatal training are fundamental to maintaining our unique ability to deliver evidence-based and family-centered interconception care.

A broadened competency requirement for family medicine residents will support the necessary skills to comprehensively care for women at all stages of life. Neglecting gaps in women’s health curricula only contributes to the grim mortality affecting women today,6 especially Black and poorly resourced communities largely cared for by our family medicine colleagues. It is now vital for us to push the ACGME and the American Board of Family Medicine to reprioritize comprehensive women’s health care by reinstating more rigorous and quantitative gynecological and perinatal care curricula requirements centered on the care and protection of women. By taking bold and necessary action, we answer the beckoning call from our learners and the communities we serve, some of whom are grieving immeasurable losses from this preventable maternal health crisis.

References

  1. Fashner J. Comparison of maternity care training in family medicine residencies 2013 and 2019: a CERA program directors study. Fam Med. 2021;53(5):331-337.
  2. Peterson LE. Wide gap between preparation and scope of practice of early career family physicians. J Am Board Fam Med. 2018;31(2):181-182.
  3. Williams RA. Women's health content validity of the family medicine in-training examination. Fam Med. 2007;39(8):572-577. 
  4. Stormo AR. Women's clinical preventive services in the United States: who Is doing what? JAMA Intern Med. 2014;174(9):1512–1514.
  5. Admon LK. Racial and ethnic disparities in the incidence of severe maternal morbidity in the United States, 2012-2015. Obstet Gynecol. 2018;132(5):1158-1166.
  6. Pregnancy mortality surveillance system. Centers for Disease Control and Prevention. Updated April 13, 2022. Accessed June 4, 2021. https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm

Lead Author

Keyona Oni, MD

Affiliations: Atrium Health Family Medicine Residency Program, Charlotte, NC

Co-Authors

Kari-Claudia Allen, MD - Prisma Health-University of South Carolina Family Medicine Residency Program, Columbia, SC

Judy Washington, MD - Overlook Family Medicine Residency Program, Summit, NJ

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Fashner J, Cavanagh C, Eden A. Comparison of Maternity Care Training in Family Medicine Residencies 2013 and 2019: A CERA Program Directors Study. Fam Med. 2021;53(5):331-337. https://doi.org/10.22454/FamMed.2021.752892.

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