Dutiful delivery

As someone committed to the education of family practitioners, and who also chairs the Committee on Accreditation of the College of Family Physicians of Canada, I read with interest the commentary by Dr Susan MacDonald, “Duty to Deliver,” in the January 2007 issue.1

As Dr MacDonald indicates, there is a serious problem with the falling numbers of family physician accoucheurs in this country. She correctly suggests that it is the duty of the Committee on Accreditation, which sets the standards for postgraduate education programs in family medicine, to encourage residency programs to develop new models of providing obstetric care in Canada. Beyond this, however, the Committee must also give residency programs, through the accreditation process, the clout to go to hospitals and other funding bodies for the resources to do so.

I could not agree more about the importance of finding innovative models of providing obstetric care to family medicine patients and of incorporating family medicine residents into those models. In some programs and in some settings, the traditional model of family physicians providing full obstetric care to patients in their personal practices with minimal sign out can be adapted to resident training; in others it is simply not feasible, and other formats are developed. Dr MacDonald mentions the Maternity Centre in Hamilton, Ont, on which some sites of McMaster’s residency program rely for family medicine obstetric experience. Another example can be found at the University of Alberta, where teaching units have partnered with low-risk obstetric groups to provide a solid family medicine obstetric experience. Other examples exist across the country. Innovative models and the integration of family medicine residents within them are supported by accreditors, and such programs are fully approved by the accreditation process. The programs in serious accreditation difficulty in this area are those with sites in which family medicine residents are not able to provide intrapartum obstetric care for family medicine patients, particularly when there are no efforts being made to develop new models or when that obstetric experience is very scanty and offers few family physician role models.

Written accreditation standards can sometimes appear inflexible and, by their nature, might appear to inhibit innovation. The Committee on Accreditation is sensitive to the tension between the standards and the changing environment and resources with which residency programs struggle and is open to discuss and put into context any standard that is questioned. Although we have endeavoured to interpret the current standards with flexibility, it is clear this particular one should be reviewed and updated so that it is clearly consistent with what is now common practice for both the programs and the committee.

I thank Dr MacDonald for her interest in and concern for this important area of family medicine education.

• Copyright© the College of Family Physicians of Canada