Assessing Family Medicine Obstetrics Training Needs to Strengthen Maternal Health in Underserved and Rural US Communities.

Abstract

Family medicine obstetricians (FMOBs) are essential for providing maternity care in underserved communities, yet their numbers have sharply declined, contributing to maternity care deserts and persistent inequities. To address the FMOB workforce gap, a large urban residency implemented the PROMOTE OB track (PRimary care Obstetrics and Maternal Outcomes Training Enhancement). We explored FMOB residents' training needs, practice barriers, and perceived patient needs from the perspectives of faculty and graduates involved in obstetrics training. We conducted 7 focus groups with university FMOB faculty, non-OB FM graduates, FMOB graduates, obstetrics and gynecology (OB/GYN) faculty and fellows, and maternal-fetal medicine (MFM) faculty and fellows. Discussions were guided by a semi-structured protocol exploring training gaps, collaborative care, structural and cultural barriers, and unmet patient needs. Focus groups were audio-recorded and transcribed verbatim, and transcripts were then analyzed thematically. During focus group discussions (n = 7), participants emphasized that FMOB training must go beyond procedural competencies to include cultural humility, structural competency, and interprofessional collaboration. Five thematic domains emerged: (1) FMOB training needs and curriculum gaps; (2) building collaborative care teams in residency; (3) preparing FMOBs to address structural barriers to care; (4) navigating cultural barriers to care; and (5) responding to unmet provider-perceived patient needs in underserved settings. FMOB training must prepare residents for the clinical and contextual realities of underserved maternity care. Programs should standardize competencies, expand mentorship, and ensure structured exposure to diverse care settings. Sustained policy-level investment is needed to strengthen training infrastructure and expand the FMOB workforce. Aligning curricula with community needs and national policy priorities may improve access to equitable, comprehensive maternity care.