OB (L&D) (PGY-1)

Description of Rotation or Educational Experience

This rotation is a continuation of the two-month combined prenatal and labor & delivery (see OB Prenatal) experience is designed to allow the resident to gain a working knowledge of basic obstetrical skills for both prenatal and labor & delivery.

Patient Care

Goal

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents are expected to:

Competencies

• Receive training to perform those clinical procedures required for their future practices in the ambulatory and hospital environments.
• Receive training that focuses on the core principles of Family Medicine: including Continuity of Care, Family-Oriented Comprehensive Care Experience, Family Medicine Center Experience, Patient Care Experience, FMC Continuity and Accessibility, Medical/Surgical Experiences, and Inpatient Experiences.

Objectives

By the end of the rotation the resident is expected to be able to:

• Demonstrate ability to evaluate pts in triage and make decisions regarding admission.
• Continue learning and acquiring a deeper knowledge base of the following:

1. perform a thorough new obstetrical patient history and physical exam

2. perform a complete but focused exam for a routine prenatal visit

3. perform a thorough postpartum exam accurately perform cervical exams of laboring women

The resident is encouraged to familiarize themselves with the following procedures:

• Normal spontaneous vaginal delivery
• Amniotomy
• Episiotomy and repair
• Repair of first-and second-degree lacerations
• Fetal scalp electrode placement
• Intrauterine pressure catheter placement
• Sterile speculum exams (evaluation of membrane rupture)
• Scalp pH sampling
• Non-stress test interpretation
• Performance of ultrasound for determination of presentation
• Assisted cesarean section

Medical Knowledge

Goal

Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. Residents are expected to:

Competencies

• This rotation fulfills family medicine-specific training and educational requirements for Maternity Care, including the principles and techniques of prenatal care, management of labor and delivery, and postpartum care.

Objectives

By the end of the rotation the resident is to continue learning and acquiring a deeper knowledge base of the following:

• Describe the management of normal and abnormal management
• Describe the technique and adequately perform normal spontaneous vaginal delivery
• Correctly interpret fetal monitoring for laceration
• Perform an exploration of the vagina, cervix, and uterus for laceration

The resident must understand and be able to discuss the evaluation and management of :

• Postpartum hemorrhage
• Beta strep infections in pregnancy
• Shoulder dystocia
• Hypertension in pregnancy
• Fetal distress
• Management of post-dates pregnancy
• Retained placenta
• Rh isoimmunization
• Third trimester bleeding
• Intrauterine fetal growth retardation
• Pre-term labor
• Hyperemesis gravidarum
• Premature rupture of membranes
• Gestational diabetes

Practice- Based Learning and Improvement

Goal

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning. Residents are expected to develop skills and habits to be able to :

Competencies

• Identify strengths, deficiencies and limits in one’s knowledge and expertise;
• Identify and perform appropriate learning activities

Objectives

By the end of the rotation the resident is expected to be able to:

• Acquire knowledge regarding the various computer systems utilized in tracking women in various stages of delivery.

Systems Based Practice

Goal

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected to:

Competencies

• Coordinate patient care within the health care system relevant to their clinical specialty
• Advocate for quality patient care and optimal patient care systems

Objectives

By the end of the rotation the resident is expected to be able to:

• Consult neonatal personnel and initiate resuscitative procedures when appropriate.

Professionalism

Goal

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate:

Competencies

• Compassion, integrity, and respect for others
• Responsiveness to patient needs that supersedes self-interest

Objectives

By the end of the rotation the resident is expected to be able to:

• Develop and maintain functional interprofessional teams.

Interpersonal and Communication Skills

Goal

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates. Residents are expected to:

Competencies

• Communicate effectively with patients and families across a broad range of socioeconomic and cultural backgrounds
• Act in a consultative role to other physicians and health professionals

Objectives

By the end of the rotation the resident is expected to be able to:

• Participate in the delivery of bad news as appropriate.

Teaching Methods

What teaching methods are you using on this rotation or educational experience?

• Didactic lecture
• Direct role-modeling and observation

Assessment Method (residents)

How do you measure the resident’s performance on this rotation or educational experience?

• Faculty evaluations of the rotator’s performance
• Real-time feedback during direct observation
• Resident is to generate self-observed behavior reports in each competency at least weekly over the course of this rotation.

Assessment Method (Program Evaluation)

How do you evaluate whether this educational experience is effective?

• Resident evaluation of rotation

Level of Supervision

How is the resident supervised on this rotation?

· Directly by attending physicians

Educational Resources

List the educational resources

• Relevant orientation materials are indicated and/or given at the beginning of the rotation and used throughout.

Resources and people residents have identified as useful, and encourage new rotators to become familiar with:

• Make good use of orientation
• Up-to-date
• Gyn/OB Morning report
• Gyn/OB M&M
• Maternal fetal medicine
• Midwives & OB residents & staff
• Ob/Gyn reference book