This document was developed by a joint task force of the American Academy of Family Physicians and the American College of Obstetricians and Gynecologists.
These core educational guidelines in maternity and gynecologic care for family practice residents are intended to aid residency directors in developing curricula and to assist residents in identifying areas of necessary training. Following these recommendations, which are designed as curricular guidelines rather than as residency program requirements, should result in graduates of family practice residency programs who are well-prepared to provide quality medical care in the areas of maternity care, labor and delivery, and the female reproductive system. These curricular guidelines are not intended to serve as criteria for hospital privileging or credentialing. The assignment of hospital privileges is a local responsibility and is based on training, experience and current competence.
Curriculum
Core knowledge and skills should require a minimum of three months of experience in a structured obstetric-gynecologic educational program, with adequate emphasis on ambulatory and hospital care. Residents will obtain substantial additional obstetric-gynecologic experience throughout the three years of their experience in family practice centers and in their continuity practices. Residents will return to the family practice centers for their scheduled continuity clinics.
The most important objective in family practice residency training should be to provide consistent, quality, evidence-based care. While there may be different approaches to patient care, in all cases, social and psychologic aspects of care, as well as an appropriate history and physical examination, must be an integral part of training. The knowledge, skills and judgment required in residency training are a necessary base, although they might not necessarily translate into the practice of every family physician.
Programs for family practice residents should have a joint training committee composed of obstetrician-gynecologists and family physicians, with members of the committee approved by the chairs of the respective departments in the sponsoring educational institution. It shall be the responsibility of the joint training committee to develop objectives commensurate with the goals of the training program, to monitor residents' experience and to assist in the evaluation of faculty teaching skills. Educational institutions sponsoring graduate medical education should assume corporate responsibility for the overall program.
Family physicians and obstetricians should collaborate on the design, implementation and evaluation of the training of family practice residents in obstetrics-gynecology. A curriculum in obstetrics-gynecology for family practice residents should incorporate knowledge of diagnosis and management, core skills and advanced skills. In this document, management implies responsibility for and provision of care and, when necessary, consultation and/or referral.
- Knowledge of diagnosis and management Normal female growth and development, and variants
Appropriate history and physical examination for all age groups
Gynecology
Disease prevention/health promotion and periodic health evaluation
Physiology of menstruation
Abnormal uterine bleeding
Gynecologic problems of children
Infections and diseases of the female reproductive and urinary systems
Breast health and diseases of the breast
Sexual assault
Domestic violence
Trauma to the reproductive system
Pelvic pain
Benign and malignant neoplasms of the female reproductive system
Menopause and geriatric gynecology
Indications for surgical intervention
Cervical lesions and abnormal cytology
Ectopic pregnancy
Obstetrics
Prepregnancy planning and counseling
Prenatal care, including risk assessment
Labor and delivery
Postpartum care
Care of the normal newborn
Common neonatal problems
Analgesia and anesthesia for labor and delivery
Indications for cesarean delivery
Obstetric complications and emergencies
Lactation
Family life education
Family planning
Fertility problems
Interconceptional care
Family and sexual counseling
Consultation and referral
The role of the obstetrician, gynecologist and subspecialist
Women's health care delivery systems
Regionalized perinatal care for high-risk pregnancies
Collaboration with other health care providers (i.e., nutritionist, dietitian, childbirth educator, lactation consultant, certified nurse midwife, nurse practitioner, etc.)
- Core skillsEmotional preparation for, and a sensitive, thorough performance of, the gynecologic examination in patients of all ages. Gynecology Appropriate screening examination of the female, including breast examination
Obtaining vaginal and cervical cytology
Colposcopy
Cervical biopsy, polypectomy
Endometrial biopsy
Culdocentesis
Cryosurgery/cautery for benign disease
Microscopic diagnosis of urine and vaginal smears
Bartholin duct cyst drainage or marsupialization
Dilation and curettage for incomplete abortion
Family planning and contraception
Oral contraceptive counseling and prescribing
Intrauterine contraceptive device counseling, insertion and removal
Diaphragm fitting and counseling
Insertion and removal of subcutaneous contraceptive implants and counseling
Injectable long-term contraceptives and counseling
- Pregnancy Prepregnancy evaluation
Initial pregnancy visit
Risk assessment
History, physical examination, laboratory monitoring, and counseling throughout pregnancy
Noninvasive evaluation of fetal gestational age and fetoplacental adequacy, including limited obstetric ultrasound examination
Management of labor
Pudendal and local block anesthesia
Fetal assessment, antepartum and intrapartum, including limited obstetric ultrasound examination
Induction of labor
Internal fetal monitoring
Normal cephalic delivery including use of vacuum extraction and outlet forceps
Episiotomy and repair, including third-degree lacerations
Management of common intrapartum problems (e.g., hypertension, mild pre-eclampsia, fever, infection, nonreassuring fetal status, unanticipated shoulder dystocia, manual removal of placenta)
Exploration of vagina, cervix, uterus
Emergency breech delivery
Neonatal resuscitation
Management of common postpartum problems (e.g., hemorrhage, endometritis)
First-assist at cesarean delivery
Vaginal delivery after previous cesarean delivery
- Surgery Assist at common major surgical procedures
- Advanced skillsFor family practice residents who are planning to practice in communities without readily available obstetric-gynecologic consultation and who need to provide a more complete level of obstetric-gynecologic services for the proper care of patients, additional, intensified experience is recommended. This experience should be agreed on by the joint training committee and tailored to the needs of the resident's intended practice; it may occur within the three-year family practice residency.Family practice residents planning to include the following in their practices should obtain additional intensified experience taught by or in collaboration with obstetrician-gynecologists. In programs where obstetrician-gynecologists are not available, these skills should be taught by appropriately skilled family physicians. Gynecology Loop electrosurgical excision procedures
Family planning and contraception
Voluntary interruption of pregnancy up to 10 weeks of gestation
Pregnancy
Ultrasound-guided amniocentesis, mid- and third-trimester
Conduction anesthesia and analgesia (not routinely taught by obstetrician-gynecologists)
Management of preterm labor
Management of multiple gestation
Management of breech delivery
External cephalic version
Amnioinfusion
Use of low forceps
Fourth-degree lacerations
Severe pre-eclampsia
Performance of cesarean delivery
Management of complications of vaginal birth after previous cesarean delivery
Surgery
Tubal ligation, postpartum and with cesarean delivery
