title: Tiered maternity care training in family medicine.
abstract: OBJECTIVE
  Maternity care training in family medicine is a major component of our specialty. The Association of Family Medicine Residency Directors (AFMRD) issued a position paper calling for a two-tiered system of training for family physicians based on concern that some residency programs are unable to meet the current Residency Committee-Family Medicine (RC-FM) requirements for maternity care training. This two-tiered system was also endorsed by other family medicine organizations, including the AAFP, ADFM, NAPCRG, and STFM. Despite this support of the new system, there remains concern among some family medicine educators about this two-tiered approach. The Society of Teachers of Family Medicine Group on Hospital Medicine and Procedural Training met in 2009 and 2010 to develop an alternative tiered system for the training of family medicine residents in maternity care.
  
  
  METHODS
  Working from previous requirements for maternity care training and the AFMRD document, the group used a multi-voting process to identify the tiers and their elements.
  
  
  RESULTS
  The group generated a three-tier system for maternity care training in family medicine residencies. These included curriculum, patient volume, faculty expectations, and institutional requirements.
  
  
  CONCLUSIONS
  The three tiers we propose address the importance of maternity care, the limitations that some residencies face in providing adequate patient volumes, and the need to teach more advanced skills to those family medicine residents who will work in rural and underserved areas upon graduation. We urge family medicine governing bodies to adopt this system and believe that it will help preserve the essential role that family physicians serve in the care of pregnant women starting with basic maternity care and extending to advanced roles including care of complicated pregnancies and cesarean delivery.
authors: North Colorado Family Medicine Residency, Banner Health, Greeley, CO 80634, USA. Aline.Coonrod@bannerhealth.com
authors: R Aline
authors: RA
authors: Coonrod
authors: Barbara F
authors: BF
authors: Kelly
authors: William
authors: W
authors: Ellert
authors: Scott F
authors: SF
authors: Loeliger
authors: William MacMillan
authors: WM
authors: Rodney
authors: Mark
authors: M
authors: Deutchman
mesh_terms: D002983:Clinical Competence; D003479:Curriculum; D005194:Family Practice / Q000193:education*; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D008427:Maternal Health Services / Q000592:standards*; D009774:Obstetrics / Q000193:education*; D010821:Physicians, Family / Q000193:education; D011247:Pregnancy; D011795:Surveys and Questionnaires; D014481:United States