2015 NCCL

Education-related Resolutions Aim to Improve Training, Patient Care

May 12, 2015 09:26 am Richard Espinoza Kansas City, Mo. –

Delegates representing AAFP member constituencies adopted a slate of measures during the National Conference of Constituency Leaders held here April 30-May 2 that aim to improve physician training and help family physicians care for marginalized patients.

Karla Booker, M.D., co-author of a resolution on the use of psychotropic medication during pregnancy, speaks to the Reference Committee on Education during the National Conference of Constituency Leaders.

The delegates, representatives of the five constituency groups -- women; minorities; new physicians; international medical graduates (IMGs); and gay lesbian, bisexual or transgender (GLBT) physicians or physicians who support GLBT issues -- approved resolutions that ranged from calling for educating family physicians on safely prescribing psychotropic medication to pregnant patients to letting members know which residency and other programs have religious affiliations that could limit the services they provide.

The Reference Committee on Education heard about 90 minutes of testimony on the issues, including personal stories that highlighted the need for action.

Karla Booker, M.D., a women's constituency delegate from Lawrenceville, Ga., introduced the measure asking for more education about the appropriate use of psychotropic medications during pregnancy to improve maternal-fetal outcomes. She told the reference committee she was inspired by what she saw when she served on Georgia's Maternal Mortality Review Committee, which studied deaths among women within a year of giving birth.

Story Highlights
  • Delegates at the 2015 National Conference of Constituency Leaders adopted, among other measures, a resolution calling for more physician education on the safe use of psychotropic prescription drugs during pregnancy.
  • Prospective medical students, residents and fellows should know when programs' religious affiliations could impact care, education and training, the delegates said.
  • Physicians spoke for 90 minutes at a hearing on these and other issues, many sharing personal stories.

More than 20 percent of the deaths she helped examine were among women who had been diagnosed with depression, she said. Often, treatment with medication had been stopped or wasn't started because of the pregnancy.

"What we believe is really behind this is that there's a litigious concern from the primary care physician who has a positive pregnancy test and then goes, 'Whoa, there's somebody I can't see in that body. I'm going to be responsible.'"

Shaista Qureshi, M.D., an IMG delegate from Naugatuck, Conn., supported the resolution. She told the reference committee that her experiences in high-risk obstetrics cases, including providing care to women who have mental illness, showed the importance of maintaining appropriate drug treatment.

"This is a huge part of taking care of the woman as a whole, not just during pregnancy," Qureshi said.

And Theresa Garcia, M.D., a GLBT delegate from Eagle River, Alaska, told the reference committee that pregnant women who need psychotropic medication were the responsibility of physicians like her, not other specialists.

"The people who need to be handling depressed women during pregnancy need to be family physicians," she said, "whether you do OB or don't do OB."

Transparency in Religious-affiliated Programs

Sarah Olsasky, D.O., a women's delegate from Milo, Iowa, testified that she co-wrote the resolution promoting transparency in the education, training and care offered by religious-affiliated programs because she wants residents to know when religious organizations might influence what they learn.

"That can restrict the education that the residents within the residency programs of these organizations are able to obtain, and also restrict their scope when they go out to practice," Olsasky said. "Then if you're the provider in that little area, it can restrict the access that your patients have to different types of health care."

Anne Montgomery, M.D., M.B.A., a general registrant from La Quinta, Calif., agreed that medical students and residents should know what training they'll receive and that religious affiliations should not limit patients' access to care, but she worried that transparency could actually lead to more limitation. She said she once worked in a Catholic-affiliated residency program that sent residents to Planned Parenthood for a family planning elective and to another office for vasectomies. That practice might have ended if it were widely known, she said.

"We had the full range of training available to our residents," said Montgomery. "But if we had to advertise that we had the full training available to our residents, I'm not sure our Catholic institution would have been very happy with us."

In the end, delegates voted to strongly encourage medical schools and graduate medical education programs to tell prospective students, residents and fellows about affiliations that could impact care, education and training.

Delegates also adopted resolutions asking the AAFP to

  • consider expanding its residency database to add program-specific family medicine board exam pass rates, graduate practice types, geographical distribution of graduates and other information;
  • investigate improper procedures regarding internationally funded positions in U.S residency and fellowship programs;
  • add information on fecal DNA testing to its colorectal cancer screening recommendation;
  • encourage members to lead anti-bullying efforts in their communities;
  • develop a policy statement and education on human trafficking;
  • create educational materials on GLBT health issues; and
  • work to ensure that mental illness isn't used as a proxy for impairment in physician licensing.