Family Medicine Obstetrics Examination Description

Updated July 2021

Physicians certified in Family Medicine Obstetrics must successfully complete a computer-based (written) and oral examination. The oral component is taken after the candidate has passed the written examination. Physicians recertifying in Family Medicine Obstetrics are only required to successfully complete a computer-based (written) examination.

The Written Examination

The written certification examination consists of 200 multiple-choice items and is administered over a four-hour session. The written recertification examination consists of 100 multiple-choice items and is administered over a two-hour session. Each question has four potential responses, but only one correct answer. Each response to a question is scored as correct or not correct.

The outline below provides details of the subject areas (domains) covered on the examinations and the approximate percentage of items from each area. This domain listing is provided to help candidates prepare for the examination and is based on a comprehensive practice analysis of the key topics and knowledge in the specialty, as identified by practitioners, instructors, and other leaders in family medicine obstetrics. Candidates should review this outline carefully and focus study on the areas listed. Each item on the examination is linked to a specific domain. The information in the outline is meant to serve as a study aid only and not as a guarantee of success in taking the examination.

  1. Perform a comprehensive health screening and history.
    1. Medical Conditions (e.g., diabetes, hypertension, PCOS, mental health disorders, cardiac conditions)
      1. Evaluate medical conditions.
        1. Optimize chronic medical conditions for pregnancy and discuss how these conditions will affect pregnancy.
        2. Treat infectious diseases.
        3. Evaluate for desire for pregnancy.
      2. Diagnose medical conditions.
        1. Order diagnostic testing considering relevant factors (e.g., cost appropriate, evidence-based).
        2. Interpret results of diagnostic tests.
      3. Provide management.
        1. Recommend treatment options to include medical interventions and lifestyle modifications.
        2. Determine risk stratification of future pregnancy.
        3. Identify conditions that may warrant consultation.
    2. Prior obstetric and gynecologic history (e.g., prior vaginal births, Cesarean birth history, postpartum hemorrhage, pre-term birth)
      1. Evaluate for prior obstetrical history including pregnancy loss and termination.
        1. Discuss how this will affect future pregnancy.
        2. Evaluate for desire for future pregnancy.
      2. Provide management.
        1. Counsel on further workup.
        2. Recommend treatment options.
        3. Determine risk stratification of future pregnancy.
        4. Identify conditions that may warrant consultation.
    3. Nutrition and Lifestyle Issues
      1. Advise on appropriate nutrition.
        1. Discuss diet safety issues.
        2. Encourage a healthful diet as appropriate for the patient.
        3. Diagnose and discuss nutritional deficiencies.
      2. Advise on ideal weight prior to and during pregnancy.
      3. Advise on exercise prior to and during pregnancy.
      4. Provide counseling to avoid harmful behaviors (e.g., smoking, alcohol, vaping, substance use) and refer if needed.
      5. Advise on travel recommendations.
      6. Discuss work or activity recommendations or restrictions.
      7. Discuss possible environmental exposures.
    4. Medications
      1. Advise on prenatal vitamin/folic acid intake in patients trying to conceive.
      2. Counsel on medication use during pregnancy (e.g., risks and benefits, contraindications).
      3. Discuss necessary dose adjustment of medications due to pregnancy impact on preexisting medical conditions (e.g., hypothyroidism, hypertension, seizures).
  2. Recommend vaccines based on patient vaccination status.
  3. Educate patients on infectious diseases (e.g., TORCH, influenza, chlamydia).
  4. Perform appropriate physical and laboratory examination of the patient (e.g., pap smear, sexually transmitted infections).
  5. Counsel on infertility and ovulation cycles/tracking and early pregnancy loss.
    1. Identify appropriate referral for infertility, recurrent pregnancy loss.
    2. Identify next steps in workup.
  6. Screen for behavioral health issues and other social determinants of health (e.g., depression, intimate partner violence, food insecurity).
  7. Review indications for preconception genetic counseling and screening.
  8. Family planning
    1. Discuss optimal timing of pregnancy.
    2. Identify special populations with specific counseling needs (e.g., teenagers, advanced maternal age, LGBTQI+, substance use disorders).
    3. Provide patient-centered counseling regarding current and future contraceptive plans.
  1. Care provided at initial prenatal visit and in first trimester
    1. Assess patient’s desire for pregnancy and counsel on pregnancy options.
    2. Obtain comprehensive medical and obstetric history.
      1. Identify prior or current medical conditions (e.g., diabetes, hypertension, substance use).
      2. Obtain obstetric history (e.g., mode of delivery, history of complications such as preterm births, preeclampsia or postpartum hemorrhage).
    3. Perform comprehensive physical exam (e.g., monitor weight change, vital signs).
    4. Select appropriate labs and imaging.
      1. Order or perform routine imaging and labs.
      2. Determine the need for additional labs and imaging (e.g., sickle cell screen, early diabetes screening).
      3. Counsel regarding genetic testing option and aneuploidy screening.
    5. Interpret lab and imaging results.
    6. Implement management plan based on evaluation.
      1. Order additional labs or imaging based on results.
      2. Identify conditions that may warrant consultation or transfer of care.
    7. Monitor patient for development of pregnancy complications and adjust management plan as indicated (e.g., severe hyperemesis gravidarum, first trimester bleeding).
    8. Provide appropriate anticipatory guidance.
  2. Care provided at subsequent prenatal visits
    1. Second trimester
      1. Assess the patient’s interval history (e.g., fetal movement, vaginal bleeding, leaking of fluid, contractions).
      2. Perform indicated maternal and fetal physical exam.
      3. Select appropriate labs and imaging.
        1. Order or perform routine imaging and labs (e.g., aneuploidy screening, diabetes screening, anatomy ultrasound).
        2. Determine the need for and counsel regarding additional labs and imaging.
      4. Interpret lab and imaging results.
      5. Implement management plan based on evaluation (e.g., GDM, placenta previa).
      6. Identify conditions that may warrant consultation or transfer of care.
      7. Monitor patient for development of pregnancy complications and adjust management plan as indicated.
      8. Provide appropriate anticipatory guidance.
    2. Third trimester
      1. Assess the patient’s interval history (e.g., fetal movement, vaginal bleeding, leaking of fluid, contractions).
      2. Perform indicated maternal and fetal physical exam (e.g., blood pressure, fundal height, cervical exam).
      3. Select appropriate labs and imaging.
        1. Order or perform routine imaging and labs (e.g., GBS, CBC).
        2. Determine the need for and counsel regarding additional labs and imaging (e.g., fetal growth ultrasound, urine protein:creatinine ratio).
      4. Interpret lab and imaging results, including results of antenatal fetal surveillance.
      5. Implement management plan based on evaluation (e.g., frequent blood pressure and lab monitoring in preeclampsia).
      6. Identify conditions that may warrant consultation or transfer of care.
      7. Monitor patient for development of pregnancy complications and adjust management plan as indicated.
      8. Provide appropriate anticipatory guidance.
  1. Identify complications of pregnancy.
    1. Maternal complications
      1. Systems
        1. Cardiovascular system (e.g., hypertension, cardiomyopathy, preeclampsia)
        2. Nervous system (e.g., migraines, seizures)
        3. Renal system (e.g., chronic kidney disease, nephrolithiasis, hydronephrosis)
        4. Endocrine system (e.g., thyroid abnormalities, pre-existing and gestational diabetes)
        5. Gastrointestinal system (e.g., fatty liver of pregnancy, cholestasis)
        6. Respiratory system (e.g., asthma, pneumonia)
        7. Integumentary system (e.g., Polymorphic eruption of pregnancy, melasma)
        8. Reproductive system (e.g., abnormal pap smear, uterine anomalies)
        9. Hematologic system (e.g., VTE, anemia)
        10. Other systems (e.g., musculoskeletal, genitourinary)
      2. Infectious (e.g., sexually transmitted infections, pyelonephritis)
      3. Behavioral health (e.g., depression, substance use disorder, intimate partner violence)
      4. Other complications (e.g., trauma, neoplasm)
    2. Obstetric complications
      1. First trimester (e.g., early pregnancy loss, hyperemesis gravidarum, ectopic)
      2. Second trimester (e.g., preterm labor, IUFD)
      3. Third trimester (e.g., PPROM, placental abruption, hypertensive disorders)
    3. Fetal complications (e.g., fetal anomalies, fetal growth abnormalities)
  2. Manage complications of pregnancy.
    1. Determine and interpret appropriate labs and imaging.
    2. Implement monitoring and surveillance.
    3. Counsel patient on risks and benefits of management.
    4. Counsel on risks to current and future pregnancies.
    5. Determine and implement appropriate interventions.
    6. Determine appropriate timing and mode of delivery based on maternal and fetal condition.
    7. Identify conditions that may warrant consultation.
    1. Perform appropriate history, physical exam, and order indicated labs and imaging.
    2. Identify risk factors that may affect labor and mode of delivery, and counsel patients accordingly (e.g., TOLAC, macrosomia, postpartum hemorrhage).
    3. Recognize the importance of shared decision making, patient autonomy, and documentation of these discussions.
    4. Determine timing of birth.
      1. Determine medical conditions that dictate timing of birth.
      2. Counsel on options for management of late term and post term pregnancy.
      3. Determine location of birth or need for consultation or higher level of care.
    5. Evaluate and manage methods of induction and labor augmentation.
      1. Assess need for cervical ripening (e.g., Bishop score).
      2. Evaluate use of cervical ripening agent (e.g., pharmacological, mechanical dilation, TOLAC).
      3. Demonstrate appropriate management of oxytocin.
    6. Interpret fetal monitoring.
      1. Determine when to use intermittent and continuous monitoring.
      2. Identify applications of external and internal monitoring.
      3. Identify and document category of fetal tracing based on National Institute of Child Health and Human Development (NICHD) criteria.
      4. Implement interventions based on NICHD criteria.
    7. Distinguish between latent and active labor.
    8. Determine the need for GBS prophylaxis and identify appropriate antibiotic selection and adequacy of treatment.
    9. Monitor and determine appropriate management for fetal presentation, descent, and position (e.g., physical exam, ultrasound).
    10. Recognize normal labor patterns.
    11. Recognize and manage labor dystocia, complicated labor patterns, and fetal distress.
    12. Identify and manage complications during labor (e.g., chorioamnionitis, preeclampsia, placental abruption).
    13. Monitor and manage rupture of membranes (e.g., indications, timing and complications of amniotomy, risk of infection, fetal distress).
    14. Assess and manage pain during labor.
      1. Discuss risks and benefits of pharmacologic options (e.g., epidural, IV medication, nitrous oxide).
      2. Discuss options for nonpharmacologic strategies for pain management during labor.
    15. Recognize medical and obstetric conditions that indicate need for Cesarean birth or operative vaginal birth.
  1. Determine and coordinate the appropriate environment for birth, including:
    1. Mode of delivery (e.g., need for Cesarean birth or operative vaginal birth).
    2. Necessary additional team members for maternal and newborn care (e.g., NICU team, anesthesia, surgical back-up).
    3. Birth setting (e.g., OR, regional perinatal health center).
  2. Normal vaginal birth
    1. Demonstrate understanding of the principles of normal second stage of labor.
    2. Demonstrate the principles and techniques of normal vaginal birth.
    3. Execute appropriate active management of the third stage of labor.
    4. Recognize the principles of appropriate perineal laceration prevention, evaluation, and repair.
  3. Complications during birth
    1. Anticipate, identify, and manage complications occurring during vaginal birth.
      1. Dystocia in the second stage
      2. Malpresentations and malpositions
      3. Umbilical cord prolapse
      4. Shoulder dystocia
      5. Uterine rupture
      6. Uterine inversion
      7. Retained placenta
      8. Other complications (e.g., nuchal cord, cord avulsion)
    2. Evaluate for necessary interventions.
      1. Operative vaginal birth
        1. List appropriate indications for operative vaginal birth.
        2. Describe the steps for safely placing and using a vacuum and/or forceps.
        3. Anticipate and counsel patients on possible complications when performing an operative vaginal birth.
      2. Recognize and respond to signs of fetal or maternal distress with resuscitative measures.
      3. Recognize indications for episiotomy and demonstrate technique.
  1. Identify and manage postpartum hemorrhage.
    1. Recognize signs of postpartum hemorrhage.
    2. Investigate and manage etiologies (e.g., uterine atony, cervical laceration).
    3. Interpret vital signs, lab values, and quantitative blood loss to guide appropriate interventions and treatment (e.g., PPH protocol, DIC).
    4. Administer medications and understand indications and contraindications.
    5. Determine and implement additional appropriate interventions (e.g., curettage, tamponade, advanced procedures).
  2. Diagnose and manage other complications (e.g., VTE, endometritis).
    1. Identify risk factors and anticipate postpartum complications.
    2. Monitor patient for signs and symptoms of postpartum complications.
    3. Collect and interpret clinical data to guide management decisions.
    4. Implement treatment and interventions and adjust as indicated.
    5. Identify conditions that may warrant consultation.
  3. Provide postpartum care to include post-operative care.
  4. Provide anticipatory guidance, counseling, and management for the postpartum period.
    1. Breast feeding and troubleshooting
    2. Family planning and contraception options
    3. Delayed postpartum complications
  5. Screen for behavioral health issues and other social determinants of health (e.g., mental health, intimate partner violence, return to work).
  6. Administer appropriate immunizations and immune globulin if indicated.
  7. Monitor and manage ongoing or developing complications and arrange for appropriate follow up (e.g., GDM, gestational hypertension, postpartum thyroiditis).
  1. Prenatal, antepartum, and intrapartum risk factors that might affect newborn care
    1. Identify management strategies for these conditions (e.g., intrapartum monitoring).
    2. Identify conditions that may warrant consultation.
  2. Neonatal resuscitation
    1. Differentiate between normal and abnormal signs and symptoms of newborn and identify newborn in need of resuscitation (e.g., Apgar).
    2. Perform tasks of newborn resuscitation.
    3. Understand indications to obtain cord gas and interpret results.
  3. Circumcision
    1. Discuss indications, risks, and benefits.
    2. Identify contraindications to circumcision (e.g., bleeding disorder history, anatomic abnormalities).
    3. Demonstrate knowledge of procedural methods for circumcision.
    4. Demonstrate ability to manage complications of circumcision.
    5. Counsel on appropriate after care and follow up.

 

References

A candidate should focus their examination preparation on the content provided in the examination blueprint. The reference list is not meant to be a list of comprehensive study materials but rather to aid candidates who may wish to prepare more in a specific area of the examination blueprint that they may not be as familiar with. You may wish to use the study materials to prepare for the written certification examination. All items appearing on examinations have been written based on the material presented in these study references.

Click here to Download Study References

Examination Administration

Click here for ABPS Examination Schedule Information

Examination Results

Candidates will receive score reports indicating their pass/fail status on the written examination. Candidates who fail are provided a breakdown of their performance by subject content domains. ABPS sends examination results to candidates within 60 days of the last day of the administration window. Each examination is scored against predetermined standards of acceptable performance, utilizing modified Angoff procedures for establishing the minimum acceptable scores. A candidate who is successful in passing the written examination is then approved to sit for the next administration of the oral certification examination.  A candidate who is successful in passing the written recertification examination is then recertified and retains Diplomate status within ABPS and AAPS.

Retaking Examinations

A candidate may take the written examination as many as three times to attain a passing score. Candidates who are not successful in passing the examination within the number of allowable attempts may reapply for certification by completing a new application and meeting all the eligibility requirements in effect at the time the new application is submitted.

Oral Examination

Click  here for further details regarding the Family Medicine Obstetrics Oral examination.

Accommodations for Religious Reasons and Disabilities

Click here to see the complete policy for accommodations.

 

 

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