Educational Opportunities and Benefits of a Maternal Fetal Medicine-Based Preconception Clinic

Purpose: Describe the content and continuum of inter-professional educational opportunities in a Maternal Fetal Medicine-based Preconception Clinic (MFM PRECON) clinic.Background: Ambulatory education is an underemphasized component of the ACGME milestones.ACOG has recommended Plan for Appropriate Tailored Healthcare in pregnancy (PATH) changes to content of prenatal care.Methods: Retrospective chart review of patient EMR records in Michigan Medicine MFM PRECON from 2018-2020.A Qualtrics satisfaction survey was sent to MFM PRECON referring providers.Results: Many diverse medical problems were evaluated in the MFM PRECON clinic.Lab and imaging orders were placed.Almost 40% of patients counseled were prescribed folic acid, approximately 12% were advised to begin taking a prenatal vitamin in anticipation of pregnancy, and numerous medications were evaluated, stopped, changed or started.Approximately 20% of patients were further referred to other subspecialty providers.Referring clinicians report strong satisfaction with MFM PRECON in the following domains: useful in subsequent care, useful in giving recommendations to follow, changed practice based on MFM PRECON recommendations, increased provider comfort in caring for common high-risk conditions, saved time in caring for high risk patients, and patients appreciated and benefited from the MFM PRECON consultation.Discussion: Subspecialty ambulatory clinics provide unique opportunities for medical education.MFM PRECON offered a unique educational curriculum for teaching the content of prenatal care, the ACOG PATH recommendations, and the content of MFM specific PRECON care.Milestones addressed for medical student, resident, and fellow education: complications of pregnancy, complex genetic counseling; coordination and transitions of care; physician role in health care systems, patient centered evidence-based and informed counseling; shared decision making and inter-professional, team and health system communication.