My collegues and I agree with James Ruderman's assessment that several studies have now shown consistent results in the areas he mentioned. What we think was the most critical finding in our study is that while undergraduate experience is important and affected residents' stated intentions to practise obstetrics when they entered residency, something negative happens during the 2 years of residency. Fifty-two percent of residents planned to do obstetrics at the beginning of residency and only 17% by the end of residency. This needs to be addressed. We believe that streaming is one very important option, as Ruderman suggests. Rather than trying to get all residents to practise obstetrics, let's take the 50% who are so predisposed at the start of residency and make certain they have role models and mentors, experience continuity of care as practised by family physicians, and, most of all, get lots of experience in intrapartum obstetrics. As well, we should make certain this group has the opportunity to do the ALARM/ ALSO courses and, where available, a third year in obstetrics in which they learn to handle higher-risk cases and even do cesarian sections. Residents need to feel prepared to do obstetrics at the end of a 2-year residency. If we can keep the 50% of residents who start residency interested in obstetrics still wanting to deliver babies at the end of their residency, we will have increased the rate of new residents doing obstetrics by 3 times what it is now.
We thank Ruderman for his comments.
Marshall Godwin Associate Professor Director, Centre for Studies in Primary Care Department of Family Medicine Queen's University Kingston, Ont.