Family Medicine Residents to Receive Extra OB Training

Family medicine residents who plan to offer obstetrics care are being offered an extra layer of training through a new program at the OU-TU School of Community Medicine.

Through the creation of an innovative new program, the OU-TU School of Community Medicine is providing an additional level of training for family medicine residents who plan to offer obstetrics care when they begin their own practices.

The program, made possible by a $2.6 million grant from the U.S. Health Resources and Services Administration, is a collaboration between the Department of Family and Community Medicine and the Department of Obstetrics and Gynecology. It sends family medicine residents into rural, tribal and underserved areas of Oklahoma to provide prenatal care under the supervision of attending physicians. Ultimately, the program aims to foster a desire among residents to practice in rural Oklahoma, and to give them the skills to provide the obstetrics care that is lacking in many areas of the state.

“Oftentimes, patients in rural areas receive almost no prenatal care,” said Karen Gold, M.D., chair of the Department of Obstetrics and Gynecology and principal investigator of the grant. “A lack of transportation or being unable to leave work often prevents them from driving to Tulsa for the approximately 10 visits they need from their first trimester through delivery. If we can offer these services in rural areas, we can detect problems before they have a chance to become bigger problems that could send them to the emergency room. Patients deserve to have access to prenatal care no matter where they live.”

A total of 16 family medicine obstetrics track residents will rotate through several clinical sites, including the Okmulgee Indian Health Center of the Muscogee (Creek) Nation; the college’s own sites on the Schusterman campus at 41st and

Viviane Sachs, M.D.

Yale, the OU Health Physicians clinic at 11th and Lewis, the Tisdale clinic in north Tulsa, and at Hillcrest Medical Center, where they will spend part of their time working in Labor and Delivery. Plans are underway to expand into other rural and tribal communities surrounding Tulsa. Didactic and simulation training will further immerse residents in obstetrics care for pregnant women with hypertension, preeclampsia, diabetes, substance use disorder, and other conditions that pose risks for both baby and mother.

“This program is not a fellowship. This is additional training that provides residents with the confidence and skills to provide basic obstetric care, typically non-operative, when they leave residency,” Gold said. “Family medicine residents receive training in many different areas, but we want to provide them another layer of training in obstetrics, which is one of the highest risk areas of medicine. Some may choose to offer prenatal care only in their practice and work with a hospitalist group to deliver babies, and others will choose to deliver babies themselves. We want them to feel comfortable and competent to do all of that.”

“In rural areas, residents will be exposed to a different type of care because they won’t have the same resources available to them as they do in urban areas,” said family medicine physician Viviane Sachs, M.D., associate principal investigator for the grant. “That can be challenging, but one of our goals is to give residents more tools to help patients in these populations.”

Among those tools are telehealth and teleconsults, which have become much more prevalent during the COVID-19 pandemic. While everything can’t be addressed virtually, much of the assessment, education and ordering of tests can be accomplished, and patients can go to labs near their homes for blood tests. If residents and attending physicians need additional help, they have 24/7 access to specialists on the Tulsa campus.

“Five years ago, we would never have imagined that we could manage a pregnant patient through telehealth, but in many cases, we can manage conditions while the patient is in her own community and not send her to the hospital every time something comes up,” Gold said. “Our hope is that we can save the patient some travel while still providing a high level of care that will detect any problems right away.”

The program will also connect participating residents with the work of doulas and the care they provide throughout a pregnancy. In addition, community outreach will be incorporated, introducing residents to programs like the Take Control Initiative, which provides education and free clinical services for long-acting reversible contraception in the Tulsa area, and Strong Tomorrows, which provides services to expectant and parenting teens at Tulsa Public Schools.

“We really want to cover the full gamut of prenatal care,” Sachs said. “Not only by providing exams and tests at clinics in patients’ communities, but also education on how to have a healthy pregnancy. These opportunities will put our residents ahead of the game in obstetrics as they finish their training and begin their careers.”