700 - Variability in Attending Approaches to Antenatal Consultation: Implications for Curricular Design

Publication Number: 2683.700

Michelle J. Bartlett, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Mackenzie Frost, Childrens Hospital of Philadelphia, Ardmore, PA, United States

Background: One of the most common ways trainees learn to conduct antenatal consults is by observing attending neonatologists then progressing to being observed performing a consult and receiving feedback as their skills develop. However, literature shows that fellows are rarely directly observed performing consults, and little is known about how attending's model consults or how programs assess counseling skills. We suspect that attending's have a wide variability in how they envision the purpose of a prenatal consult and the goals of the information they plan to share, resulting in inconsistent and at times contradictory education and feedback for our fellows. This variability may have implications for tailored curricular design.

Objective: Explore attending neonatologists' perspectives on the priorities and goals of antenatal consults with the intent to inform curricular development.

Design/Methods: Using qualitative methods, we conducted 45-60 minute long focus groups of two to three neonatology attendings from level III and IV academic-affiliated neonatology intensive care units using an iteratively revised interview guide based on literature, expert input, and preliminary national survey data. Recruitment used purposeful, key informant, and snowball sampling. IRB exemption was obtained. Focus groups were moderated by MB with peer review by MF. Interviews were recorded with transcripts managed in Dedoose. Reflexive thematic analysis was performed based on a social constructionist framework using an iterative approach until thematic sufficiency.

Results: We conducted six focus groups of 17 attendings. Participants emphasized that consultations are not uniform, and a key distinction emerged in attending conceptualization between consults oriented toward "Information-Sharing" and those focused on "Decision-Making" (Figure 1). The structure of the consult was further delineated by the type of consult, the environment, and time constraints (Figure 1). All attendings emphasized the importance of communication and family-centered practices (Table 1). Attending's described divergent views on their role in offering recommendations and facilitating shared decision-making with families (Table 2). Senior attendings reported evolving over time from a formal rigid approach to a more flexible and responsive style.

Conclusion(s): Neonatologists conceptualize antenatal consults variably, influenced by consult type, time constraints, and career stage. Coupled with literature on parental preferences, these findings support tailored curricular interventions rather than a single, uniform curriculum.

Figure 1. Conceptual model of attending neonatologists' approach to antenatal consultations.
This model illustrates how attending's first consider the overall structure or "type" of consult, which subsequently guides whether the primary focus of the consult centers on "information sharing" or "decision-making." Additional factors influencing this process include time constraints, environmental context (such as level III versus level IV unit), and communication preferences of the family. Over time, attending's recognize that their approach to conducting and conceptualizing consultations evolves dynamically with experience.

Table 1. Representative quotes illustrating how attending neonatologists approach antenatal consultations through Relationship-Building and Understanding the Family Context.
The excerpts highlight two central themes: (1) Relationship Building, which encompasses efforts to establish trust, convey teamwork, and demonstrate commitment to the family through personalized and empathetic engagement; and (2) Family Context, which reflects how attending's seek to understand the family's social, emotional, and environmental circumstances in order to tailor communication and support.

Table 2. Representative quotes illustrating variability of how attending's use Shared Decision-Making and providing Recommendations during antenatal consultations.
This table highlights two interrelated themes reflecting how attending neonatologists conceptualize their roles in guiding families through complex antenatal decisions. The theme of Shared Decision-Making captures tensions between supporting parental autonomy and avoiding abandonment. The theme of Recommendations reflects clinicians' efforts to balance providing direction with maintaining family trust, as they navigate if, when, and how to offer professional opinions without undermining family agency.