Enhanced obstetrics training for family practice residents: a unique collaborative program.

Access to obstetric services in rural areas has been and continues to be a challenge. 4 When available, much of the obstetric care in these areas has been provided by family physicians. I ,5 Unfortunately, the number of family physicians who practice obstetrics has been in decline. In 1996 only 26% of active members of the American Academy of Family Physicians included obstetrics in their practice. Although rural family physicians are more likely than their urban counterparts to provide maternity care, less than one half perform routine deliveries. The obstetric services needed in rural areas include access to providers who can perform cesarean deliveries.7 Norris et al performed a survey of 41 rural hospitals in Washington State. They found that most of these hospitals depend on family physicians for this operative intervention. Furthermore, they found that a family physician's comfort in doing cesarean deliveries was closely related to their formal training during residency. Opportunities for advanced obstetric training have included the following: (1) an emphasis on obstetrics (including operative obstetrics) during residency training; (2) I-year fellowship programs (typically community-based programs that emphasize skills for rural practice including obstetrics)9,lo; (3) onthe-job training in the communities or in some other nonresidency setting; (4) rural training tracks with a strong emphasis on obstetrics ; and (5) combined family practice-obstetrics programsY Although the importance of having family physician educators to model advanced obstetric skills is critical, it is also important to improve educational ties between departments of family practice and obstetrics and gynecology. As stated by Caudle et aI, I "It is time for academic medical centers to