Development and Implementation of a Longitudinal Family Medicine Obstetrics Curriculum

Setting and Problem

Access to maternity care in the United States is declining, especially in rural and underserved areas. In Oklahoma, more than half of counties are maternity care deserts lacking obstetric (OB) physicians and essential services.¹ Family medicine (FM) physicians, often the only maternity care physicians in these regions, must manage pregnancy care and complications without obstetrician-gynecologist (OB-GYN) backup. Prior to 2021, FM residents at the University of Oklahoma School of Community Medicine (OU SCM) met the basic ambulatory maternity care requirements and lacked training for comprehensive pregnancy care or vaginal deliveries. In response, the OU SCM Departments of Family and Community Medicine (FCM) and OB-GYN developed the family medicine obstetrics (FMOB) curriculum to prepare FM residents for independent maternity care and strengthen the future OB workforce serving Oklahoma’s rural and underserved communities.

Intervention

Full implementation of the FMOB training curriculum began in July 2021. Developed collaboratively by faculty from FCM, OB-GYN, OU SCM leadership, and community partners, the curriculum spans the second and third years of residency and includes 3 components:

Didactic education: Monthly lectures covered topics such as fetal heart rate monitoring, gestational diabetes, and substance use disorder in pregnancy. Simulation-based training complemented lectures and focused on patient management scenarios and procedural skills for essential and non-essential procedures, including ultrasound, labor management, and repair techniques.

Clinical rotations: Residents completed the equivalent of 4 weeks of clinical rotations per year in outpatient clinics and in hospital-based labor and delivery units serving rural and underserved communities. In the first year, residents focused on foundational skills such as labor management, prenatal care, and basic ultrasound. In the second year, they advanced to managing pregnancy complications, hypertensive disorders, and higher-level ultrasound interpretation.

Telehealth training: The telehealth component included 3 sessions aligned with national telehealth competencies.² Each session began with a brief didactic overview followed by a simulated telehealth encounter with a standardized patient. Scenarios addressed common obstetric conditions such as gestational hypertension and medication management.

We evaluated the FMOB training curriculum from its inception to assess feasibility, acceptability, and early outcomes. We compared the number of OB procedures performed by FMOB residents (N=4) and FM residents (N=10) using descriptive statistics and Mann-Whitney U tests. Feedback was collected through interviews and open-ended surveys with residents and faculty. Cost and faculty effort were documented to assess implementation requirements and sustainability.

Outcomes to Date

Since the FMOB curriculum launch, FMOB residents have completed more than 370 hours of clinical OB training in underserved and rural clinics, hospitals, and community maternal health projects. Graduates have pursued maternity-focused careers: one entered an FMOB fellowship, one joined academic faculty practice providing OB care, and 2 began community practices offering deliveries. Compared to FM residents, FMOB residents performed significantly more vaginal deliveries (mean=71.8 vs 37.5; P=.02), intrapartum care procedures (71.8 vs 37.5; P=.02), and other procedures (Table).

Table.

Number of Procedures Completed by FMOB Residents Compared to FM Residents

Procedures	FMOB (n=4)	FM (n=10)	FMOB (n=4)	FM (n=10)	P value
	Mean (SD)		Median (IQR)
Continuity care (prenatal care, delivery, and hospital postpartum care)	13.5 (2.6)	7.6 (5.0)	13.0 (11.8-14.8)	6.0 (4.0-11.0)	.04
Intrapartum care (care of patients in labor)	71.8 (21.3)	37.5 (23.9)	81.0 (70.0-82.8)	26.0 (22.2-39.5)	.02
Vaginal deliveries	71.8 (21.3)	37.5 (23.9)	81.0 (70.0-82.8)	26.0 (22.2-39.5)	.02
Instrumental vaginal deliveries (vacuum or forceps)	0.5 (0.7)	0.3 (0.5)	0.5 (0.2-0.8)	0.0 (0.0-1.0)	.72
Inductions	13.2 (2.1)	7.2 (7.1)	13.5 (11.8-15.0)	7.0 (0.0-13.5)	.11
Vaginal laceration repairs	24.0 (11.1)	9.7 (9.5)	26.0 (19.5-30.5)	7.0 (3.0-9.0)	.03
Third/fourth degree laceration repairs	8.5 (2.4)	5.7 (4.0)	9.5 (8.0-10.0)	5.5 (2.2-9.0)	.13
Contraceptive counseling	25.0 (29.2)	8.3 (13.9)	14.0 (8.5-30.5)	5.0 (4.0-7.8)	.09
Intrauterine device placements	17.8 (19.8)	7.0 (9.4)	10.0 (7.0-20.8)	5.0 (4.0-7.5)	.11
Contractive implant insertion	16.5 (5.4)	9.5 (5.6)	16.5 (13.8-19.2)	9.0 (4.5-13.2)	.04
Contraceptive implant removal	11.2 (2.5)	8.5 (4.3)	10.0 (10.0-11.2)	9.0 (4.5-10.0)	.17

Abbreviations: FMOB, family medicine obstetrics; FM, family medicine.

Feedback supported the curriculum’s feasibility and acceptability. Residents highlighted its interdepartmental structure and instructions from FCM and OB-GYN faculty as key strengths. They found it well organized, manageable within residency schedules, and credited hands-on experience with diverse patients for increasing confidence in providing OB care after graduation. Faculty affirmed feasibility within existing resources and noted clear improvements in residents’ skills, confidence, and preparedness for independent practice.

Implementation required coordinated effort across departments but remained feasible and sustainable within existing resources. Faculty contributed 5% to 25% effort for curriculum design, supervision, and telehealth training. Annual maintenance costs ranged from $200,000 to $300,000 excluding salary effort. Shared leadership and institutional investment have sustained the FMOB curriculum as a permanent track within the OU SCM FM residency program.