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    Obstetrics in FM and EM Courses

    Discussions about whether to include obstetrics content in EM and FM residency curricula, including in Challenger’s courses, has led to some lively discussions in the past. At least a couple of times a year we get a dramatic declaration like ”You don’t even conform to the EM Model, no real residency would have…”. People get excited about their curricula. 😀

    Neither FM nor EM board exams include obstetrics. Both exams have 3% of their score determined by questions we’d categorize as Women’s Health.

    It actually is a complicated problem, whether to include or exclude obstetrics content. The number of FM doctors conducting deliveries is declining - for several reasons, ranging from malpractice costs to higher rates of urban practice. On the other hand, physicians doing deliveries in rural environments are seeing upticks, as feeder hospitals get closed in favor of more centralized urban care delivery. New(er) specialty certifications like the Board Certification in Family Medicine Obstetrics (2009) have been created, though most FM physicians appear to be doing the CAQ for advanced OB still.

    FM doctors routinely performing deliveries has dropped to 6.7% of practicing family medicine physicians.

    On the EM side, closure of labor and delivery units, a trend toward facility specialization with larger healthcare corporations and higher knowledge expectations may or may not be leading to more ED’s turning away deliveries. Depends on who you ask.

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    There’s also a trend away from some primary care specialties.  With OBGYN it is so far just the past year, and probably explainable by politicization.  In FM slots there’s a general shift away from primary care.  EM slots last year were a perfect storm of unfilled positions from the prior year, AOA merger, small size, and general dissatisfaction with practice environment for EM.

    With all that in mind, we continue to support the OBGYN rotations for residencies.  Our courses contain more OBGYN content than is covered in the exam - and we’ve made it suitable for rotation study inside an EM or FM residency.  We also have separate courses for ABOG certification, and add-ons like our Cesarean Delivery course.  

    But on the exam simulations, the questions are pulled in the same percentage as you’ll see on your exam - 3% for FM and EM.  If you run an exam simulator on Challenger, you’re seeing the appropriate blueprint for your specialty.


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