Is it time to update the FM curriculum?

[mwest]

I know many people may find this a bit radical, but it's just a thought:

Do we really need to have OB in our curriculum? Most FPs don't do OB bc it's so hard to get privileges at hospitals/get the volume to justify malpractice, and even keeping up with the very broad skills neccesary to be competent in OB ( along with adult medicine and peds). However there are other "Women's Health" issues that are very relevant to FPs-- things like osteoporosis, sle/rheumatological problems, menopause, post-partum issues, family planning, etc. and basically things that predominantly affect women.
Why can't the women's health component in the FP program tailored to address these issues rather than *just* OB, which a lot of us don't end up doing??? Shouldn't OB be made an optional track rather than compulsory?

Even the "women's health" fellowship is just more high-risk OB.

Just my $0.02 cents. Criticisms and support are both welcome.

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[EdibleEgg]

This is a tough subject and there seems to be a great divide in the FM community. There are few FP's who are still doing deliveries. I decided to give it up myself. As you mention, it's difficult to do enough to justify the added malpractice expense. However, there is a need and I know of several job opportunities for those who still possess the skills.

On one hand, given the breadth of FM, it would be very easy to fill in the extra time created with decreased OB experience. In quite a few FM residencies, the minimum standards aren't being met anyway.... so why not stop wasting time. Devote that time to more fruitful endeavors. Create an "OB track" that concentrates what OB exposure is available for those that want it, possibly with an extra year for added experience.

On the other hand, there are some aggresive FM programs that do give adequate OB exposure, within the traditional three year residency. If global standards are changed, will it negatively affect those programs that are doing the job properly in the first place? Given that the scope of practice for (at least some, note the outpatient only job opportunities) FP's is continually becoming more narrow, is it in the best interest to fuel to those who would happily further reduce that scope? I'm definitely not in favor of taking anything away unless it has a productive replacement. I don't know the right answer, but it's an interesting debate.

 

[MedicineDoc]

Im not for taking it out of the scope of practice. Things change rapidly especially with everything in flux right now. ER medicine may still require delivering a baby just as it does minor surgeries. I just put back together some guys tricep muscle last week as part of my ER rotation.

 

[deleted87716]

I think the current curriculum is fine. We shouldn't dilute the specialty down to the least common denominator. I'm speaking, of course, as somebody who does neither hospital nor OB, but sees the value in full-spectrum practice.

If you absolutely don't even want to learn how to do OB, I suggest you consider med-peds.

 

[lowbudget]

1. I agree with you that Women's Health includes more things than just obstetrics, but that being said, residents/medical students should be learning women's health as part of their regular family medicine experience (family medicine blocks and/or continuity clinic) or part of their internal medicine rotation.

If your program is counting on you to learn Women's Health during your OB/Gyn rotation, they're missing the boat and you may need to find a more... forward-thinking... like, welcome-to-circa-early-1990's residency program. With the number of female medical students and female residents in family medicine that far surpasses the generation before ours, I can't imagine how that kind of educational practice can be tolerated by residents of their program/curriculum director. But that being said, WTF do I know.


2. Rumor has it that AFMRD and STFM have already talked to RRC about changing the OB requirements to a 2-tiered system that will have 2 different sets of requirements.

In 05-06, RRC waterred down the Critical Care/ICU requirement to something we have now. First, ICU... then, OB... what's next?

Personally, it's a travesty. You will have programs that are inadequately training FM residents to meet the challenges and needs of a lot of communities, both in the US and around the world. You will be limited in the settings that you will be *allowed* to practice in (it'll no longer be a matter of choice; instead, you won't even have permission.)

I've long supported training residents in obstetrics, even if residents choose not to practice it when they get out. Every time I hear "Do we really need to know...", it reminds me of students in high school and college who raise their hands in the middle of class to ask "Will this be on the test?" It bothers me to no end because I wonder how can someone so smart and so gift be so unwilling and so incapable? I'm not saying that to be judgmental... it just really goes against how I was raised.

I think family doctors upon finishing training should be able to *choose* what they want to do and don't want to do. That's. The. Beauty. Of. Family. Medicine. And trust me, for someone who 2 seconds ago was filling out my privileging application, debating whether to ask for OB privileges, I can say that if I don't do OB ever, I'll be ok. It just seems like waste of my training. But that's a *choice* you make when you're an attending.

Imagine: THE perfect job. In THE perfect location/set up. For a bajillion dollars. The only thing is you'd have to do low-risk obstetrics. Would you take it?

For some, no. For some, no-brainer. For others, weighing the pro's and con's... fine, I'll take it. But shouldn't it be your *choice*? Shouldn't you be prepared to be in that position by virtue of your training... that there is NO QUESTION that you could do that job well?

It's a luxury to say I-could-but-I-won't. It's a sad, even pathetic, to say I-want-to-but-I-can't.

I can understand why AFMRD & STFM are moving towards changing the curriculum. When you have a teacher who's super-passionate about what they do and go out of their way to share that passion with the Resident, it can be really deflating when the Resident says, "Do I really need to know this?"...

As much as FM teachers want to keep the dream alive, I think they're being steamrolled by reality. Most of these dinosaurs are just getting too old to put up a fight. And that, to me, is really sad.

 

[deleted87716]

Every time I hear "Do we really need to know...", it reminds me of students in high school and college who raise their hands in the middle of class to ask "Will this be on the test?"...
I think family doctors upon finishing training should be able to *choose* what they want to do and don't want to do. That's. The. Beauty. Of. Family. Medicine.

Exactly.

 

[lowbudget]

Exactly.

Meh. I think I may have jumped down mwest's throat. Curriculum does deserve an update in more ways than one.