The recommended core educational guidelines for family practice residents in maternity and gynecologic care appear in this issue of American Family Physician,1 as well as a joint statement on cooperative practice and hospital privileges,2 both created by a joint task force of the American Academy of Family Physicians (AAFP) and the American College of Obstetricians and Gynecologists (ACOG). These two documents revise and update those first published in 1980.3
Originally published as AAFP Reprint No. 261, the core educational guidelines, then in obstetrics and gynecology, have served family medicine well. Family practice residency directors have been able to successfully negotiate curricula for their residents, and graduates of family practice residency programs have been able to successfully obtain privileges in practice based on the recommendations found in Reprint No. 261.
The current documents are the products of a year of face-to-face, open, good faith negotiation. Having succeeded in coming to agreement on the important issues of training and privileges, the task force continues to meet, highlighting the importance of interspecialty communication. While in the field there may be competition, the leaders of the specialties of family medicine and obstetrics and gynecology have demonstrated that they can work together for the good of patients.
In the spirit of cooperation, the document calls for curricula for family practice residents to be jointly crafted by family physicians and obstetricians, as well as taught by appropriately experienced physicians in both specialties. It calls on obstetricians to provide consultation and backup for family physicians who provide maternity care, while simultaneously calling for family physicians to exercise judgment to determine when timely consultation and/or referral may be appropriate.
The core educational guidelines outline a series of core skills that all family practice residents should experience. Advanced skills, such as loop electrosurgical excision procedures, ultrasound-guided amniocentesis, management of multiple gestation and performance of cesarean delivery, are outlined in the curriculum for family practice residents who are planning to practice in communities without readily available obstetric/gynecologic consultation and require special training. Importantly, advanced skills may be learned within the three-year family practice residency.
There are family practice residency programs awaiting the publication of these core educational guidelines so that they may successfully negotiate curricula and collaborative teaching relationships in maternity and gynecologic care for their family practice residents. There are individual family physicians awaiting the publication of the joint statement on cooperative practice and hospital privileges so that they may obtain privileges in maternity and gynecologic care with the support of the local departments of both family medicine and obstetrics and gynecology.
The original 1980 Reprint No. 261 has acquired an anecdotal reputation as the most powerful of the more than two dozen core educational guidelines, many also jointly developed, that have been published by the AAFP. Given the success of the joint AAFP/ACOG task force in revising, updating and publishing agreed-on educational and practice guidelines, it can be anticipated that the relationship between departments of family medicine and obstetrics and gynecology, and indeed individual family physicians and obstetricians/gynecologists, should reflect the collaborative relationship of physicians practicing together for the benefit of the nation's population.