Obstetrics
Obstetrics
Overview:
The maternity care curriculum of the Memorial Hospital Family Medicine Residency consists of inpatient labor and delivery experiences in all three years of training and longitudinal continuity experiences. Instruction, supervision, and evaluation are provided by Family Medicine Residency faculty, Obstetrics Proctors, Memorial Hospital perinatologists, and Family Medicine and Obstetrics Medical staff.
Goals:
The Maternity Care Curriculum experience shall:
• Meet the diverse training needs of our residents who may choose to practice a spectrum of maternity care and will enter a variety of practice settings
• Provide a structured educational experience in maternity care
• Provide a system to ensure that residents are adequately trained to perform obstetrical procedures
• Provide a positive training experience that encourages incorporation of obstetrical services in graduates’ future practices
Objectives:
While caring for maternity patients, the resident:
PGY-1
• Is able to obtain essential information and perform a physical exam on patients presenting to the triage area with routine complaints and low risk patients admitted to the childbirth. (PC)
• Is able to participate in developing and carrying out patient management plans on low risk patients. (PC)
• Demonstrates a structured approach to the interpretation of fetal monitoring tracings. (PC)
• Is able to present accurate patient information to patients, their families, nurses, and medical staff and obtain assistance when needed. (ICS)
• Is able to perform an initial OB intake on continuity OB patients and present to the faculty in clinic. (PC)
PGY-2
• Is able to obtain essential information and perform a physical exam on high risk patients presenting to the triage area and admitted to the childbirth unit. (PC)
• Is able to outline a management plan, present it to a supervising physician, and carry it out with minimal supervision. (PC)
• Will demonstrate proficiency in suturing as demonstrated in repair of simple perineal lacerations requiring minimal supervision. (PC)
• Demonstrates proficiency in fetal scalp electrode placement and amniotomy as per the Procedures curriculum. (PC)
• Is able to accurately document OB continuity patient care in the residency EMR. (PC)
PGY-3
• Is able to recognize and initially manage medical complications of pregnancy. (PC)
• Is able to demonstrate proficiency in vaginal deliveries at the level of an independent practitioner with consultation as is appropriate. (PC)
• Is able to demonstrate repair of more complex lacerations. (PC)
• Analyzes current medical literature related to patient care and is able to convey this information to peers, nursing staff, and medical staff members. (PBLI)
• Is able to present high risk patients at high risk OB conference and demonstrate a clear initial plan of care. (PC)
There are no procedural requirements that must be completed specifically during the Maternity Care rotation. However, there is a Procedures Curriculum and residents gain experience meeting these requirements during this rotation. Procedures typically performed on this rotation include: Vaginal Delivery, Cesarean Section Assist, Continuity care of the OB patient, Interpretation of Fetal Heart Rate Monitoring, Fetal Scalp Electrode Placement, Amniotomy/AROM, and ALSO (Advanced Life Support Obstetrics).
Implementation:
Educational Methods:
ALSO Course - Advanced Life Support in Obstetrics - all PGY I residents
• Didactic sessions, interactive sessions, and hands-on training sessions. Certification based on passing written examination and oral case mega delivery with demonstration of skills in fetal distress, operative delivery (vacuum and/or forceps), shoulder dystocia, and post-partum hemorrhage.
Interactive Didactic Sessions - Maternity Care rotation
• Facilitated by Family Medicine Residency faculty and Obstetrics proctors
• 8-9 lectures per block while on core obstetrics rotations (see list of topics)
Perinatal Multidisciplinary Rounds-Maternity Care rotation
• Weekly while on core obstetrics rotations - 8-9am in the Special Care Unit
Patient Care-Maternity Care Rotation
• Intrapartum management
• Delivery, both vaginal and c-section assist
• Minimum of 50 vaginal deliveries required for graduation
• Episiotomy and laceration repair
• Complications of above
Patient Care-Continuity Patients
• Minimum of 10 continuity patients followed through antenatal, natal and postnatal care required for graduation
OB Case Conferences
• Evidence based case presentations
• Each PGY-1 and PGY-2 prepares a case for conference presentation each year. Each PGY-3 has the option of presenting a case but it is not required.
High Risk OB Case Conference and other longitudinal OB conferences
• Each resident will prepare and present their high risk OB cases for discussion amongst colleagues, faculty, and proctors.
Self directed learning - longitudinal
• Utilizing resources listed in this document, Family Medicine faculty, Obstetrics proctors, perinatalogists, OB fellow, and OB rotation and continuity patient care experiences.
On-going Review of Patient Care Documentation by Family Medicine faculty and OB proctors
• Feedback and discussions as needed of above
• Formally reviewed at Periodic Evaluations
Other Experiential
• Participation in an OB intake with our OB nurse during the inital PGY1 OB rotation block
• Patient care on the mother baby unit with the lactation consultants at Memorial Hospital
Longitudinal OB experience
• Each resident will be assigned continuity OB patients at the commencement of their initial OB rotation
• Each resident will coordinate the care of their patients, document the care, consult faculty and proctors as needed, identify high risk patients, present appropriate patients at high risk conference, care for their patients in the hospital on the antepartum unit if necessary, be present for their labor and delivery, and provide post-partum care. Residents will assure continuity in their absence with one of their colleagues or the OB fellow. A minimum of 10 continuity patients will be cared for during the 3 years of residency.
Resources:
Memorial Family Medicine OB Handbook
Assigned articles for OB teaching sessions
ALSO Course Manual
C-section Challenger Module
Pfenninger and Fowler's Procedures for Primary Care Textbook
Up to Date as available through the Memorial Hospital Library website
Memorial Library
Methods of Evaluation:
Performance-based evaluation methods include:
• Rotation evaluations will be filled out by an OB proctor that compiles feedback from multiple proctors following each rotational block
• Procedure log and evaluations
• Case presentation evaluations
• Team Leader and OB proctor on-going chart review
• Performance on Family Medicine In-training examination
PGY1 Evaluation Questions:
1) Is the resident able to obtain essential information and perform a physical exam on patients presenting to the triage area with routine complaints and low risk patients admitted to the childbirth unit?
YES NO
2) Is the resident able to participate in developing and carrying out patient management plans on low risk patients?
YES NO
3) Does the resident demonstrate a structured approach to the interpretation of fetal monitoring tracings?
YES NO
4) Is the resident able to present accurate patient information to patients, their families, nurses, and medical staff?
YES NO
PGY 2 Evaluation Questions:
1)Is resident is able to obtain essential information and perform a physical exam on high risk patients presenting to the triage area and admitted to the childbirth unit?
YES NO
2)Is the resident able to outline a management plan, present it to a supervising physician, and carry it out with minimal supervision?
YES NO
3) Does the resident demonstrate proficiency in suturing as demonstrated in repair of simple perineal lacerations requiring minimal supervision?
YES NO
PGY 3 Evaluation Questions:
1) Is the resident able to recognize and initially manage medical complications of pregnancy?
YES NO
2) Is the resident able to demonstrate proficiency in vaginal deliveries at the level of an independent practitioner with consultation as appropriate?
YES NO
3) Is the resident able to demonstrate repair of more complex lacerations?
YES NO
4) Does the resident demonstrate analysis of current medical literature related to patient care and conveys this information to peers, nursing staff, and medical staff members?
YES NO
Obstetrics (Residents attend 8-9 lectures during each OB rotation; schedule is designed so that each resident has the opportunity to hear each lecture topic at least once during a 3 year span.)
• Vaginal Delivery Techniques and Suturing*
• Induction of Labor
• Circumcision*
• OB Ultrasound
• Interpretation of Fetal Heart Rate Monitoring*
• Preterm Labor and PPROM
• Fetal Scalp Electrode/IUPC Placement*
• Amniotomy/AROM*
• Postpartum Care
• Common Complaints of Pregnancy
• Prenatal Genetic testing
• Multiple Gestation
• Diabetes Complicating Pregnancy
• ALSO Review (shoulder dystocia, assisted vaginal delivery, postpartum hemorrhage)
• Spectrum of Hypertensive Disorders
• Group B Strep in Pregnancy
• Exercise in Pregnancy
• Urinary Tract Infections in Pregnancy
• Perineal Lacerations
• Bleeding in Pregnancy
• Nutrition in Pregnancy
• Decreased Fetal Movement
• Antepartum Fetal Monitoring
• Fetal Growth Restriction
* Indicates lecture covers a required procedure.