OB/Maternity Care

Description of Rotation or Educational Experience

The Maternity Care experience occurs in all three years of post-graduate training. During the PGYI experience, the resident is required to complete three one-month blocks of inpatient obstetrical care.  Each week of the rotation consists of three twenty-four hour shifts. There will be two PGYI residents on this rotation per month and each resident will have ½ day of clinic at the FMC per week.  The rotation has been designed to be completely in compliance with resident work duty hours.  Supervision is provided by the OB/GYNs of the Parkhill Clinic for Women.   This educational experience at Willow Creek Women’s Hospital is designed to educate and train resident physicians in the management of the obstetrical patient during the antepartum, intrapartum and postpartum periods and to develop the necessary skills to provide this care.

Residents in all training years gain experience in providing antepartum and postpartum care of their continuity patients in the Family Medicine Center.

All residents are required to perform at least forty deliveries (ten of which must be continuity from their panel of continuity patients in the Family Medicine Center) within their three years of training, and are responsible for documenting such deliveries in New Innovations in a timely manner.

Residents receive didactic lectures pertaining to OB and maternity care throughout their three years of training, which are presented by the Family Medicine Faculty and Obstetrician preceptors.

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

·         Foster a positive, nurturing environment for the obstetrical patient and her family during the delivery and immediate postpartum period.

·         Facilitate appropriate bonding of the newborn with the mother and family members, and to observe maternal and newborn interactions to identify potential impediments to a healthy transition from inpatient care to home care.

·         Update medical records in a timely manner.

·         Round on all patients.

Objectives

·         The resident will be identified by the patient and family through their interactions as her “primary provider” during the hospitalization.

·         The resident will provide care that is timely, appropriate, and results in effective liaison with OB attendings.

·         The resident will pay close attention to medical records and due dates on their continuity patients in the FMC and complete medical records at Willow Creek Women’s Hospital in a timely manner. 

·         Rounds to be completed on all patients daily by 7:00 a.m. except on Thursday a.m. when rounds should be completed as soon as possible after 7:00 a.m. 

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 gain knowledge regarding the following:

Competencies

1.       Normal Labor and Delivery

2.       Interpretation of Fetal Heart Rate Monitoring

3.       Preterm Labor/ Premature ROM

4.       Labor Dystocia

5.       Episiotomy Management

6.       Placenta Previa/ Placental Abruption

7.       Multiple Gestation

8.       Hyperemesis Gravidarum

9.       Routine Prenatal Care

10.   Gestational Diabetes Mellitus

11.   Gestational Hypertension/ Pre-Eclampsia/ Eclampsia/ HELLP Syndrome

12.   Intrauterine Growth Restriction

13.   Obstetrical Ultrasonography

14.   Pharmacology in Pregnancy

15.   Bleeding in Pregnancy

16.   Intrauterine Fetal Demise

17.   Abnormal Fetal Presentation (Breech)

18.   Shoulder Dystocia

19.   Indications for Cesarean Delivery

20.   Management of Maternal/Fetal Monitoring Devices (FSE, IUPC)

   Objectives

1. The resident will learn the physiologic mechanism of normal labor and be able to identify and address deviations from this process including recognition of abnormalities in the Fetal Heart Rate tracing, identifying premature labor, and recognizing labor dystocias.
2.  The resident will learn the physiologic mechanism of and be able to facilitate/perform a normal vaginal delivery.
3. The resident will learn the principles of and be able to perform an episiotomy repair.
4. Early during the PGYI year, the resident will be required to successfully complete the Neonatal Resuscitation Program (NRP).
5. The resident will become knowledgeable of the accepted standard of care in providing routine prenatal and postpartum care, and will be able to deliver such care to their continuity patients in the Family Medicine Center.
6. The resident will appropriately recognize and direct care for the complicated obstetrical patient (including multiple gestations, Hyperemesis gravidarum, gestational diabetes, gestational hypertension, placenta previa, etc.). The resident should be proficient in obtaining consultative services in obstetrical care when deemed appropriate.
7. The resident will become familiar with the available methods of providing anesthesia/analgesia to laboring patients and be able to request such services from Anesthesia in a time appropriate fashion.
8. The resident will become proficient at performing the application of monitoring equipment on the laboring patient to include the proper insertion/removal of fetal scalp electrodes and intrauterine pressure catheters.
9. The resident will become familiar with resources to help determine the safety of pharmacologic agents during pregnancy and lactation.
10. The resident will learn the appropriate indications for Cesarean delivery and will participate with Cesarean deliveries with their supervising faculty physician and or Obstetrician.

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 and perform appropriate learning activities
• Use information technology to optimize learning

Objectives

• Access through E-Resources current guidelines and the latest treatment recommendations.
• Recognize a high risk OB situation and seek appropriate consultation.

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

• Work in interprofessional teams to enhance patient safety and improve patient care quality

Objectives

• Residents will be oriented to the inpatient obstetrical milieu and will be instructed about hospital protocols and procedures that will help facilitate a safe and nurturing delivery environment.
• The resident will learn to interact with obstetrical nurses, NICU nurse, and obstetrical attending physicians, and will serve as an integral part of the care team.  

Professionalism

Goal

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

Competencies

• Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation

Objectives

• The residents are exposed to a diverse patient population in the FMC’s and the hospital setting and are expected to be sensitive to care needs and preferences of various diverse ethnic groups. This is measured by direct observation by their attending physicians and by review of responses on patient surveys at Willow Creek Women’s Hospital.

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 physicians, other health professionals, and health related agencies.

Objectives

• The resident is expected to learn how to effectively communicate and convey patient care issues with their Obstetrical attending in order to facilitate appropriate and timely care for their patients.

Assessment Method

At the conclusion of each resident rotation, the residency coordinator sends a formative-type, rotation-specific performance evaluation form to the rotations’ supervising physician.  When the completed evaluation is returned, the resident physician and the resident’s faculty advisor review the evaluation and attest to reviewing it by signing/initialing the form.  Next, the program director reviews and attests to the document.  Once all three have reviewed and attested the evaluation, it is included in the resident’s permanent file. 

Each resident is asked to evaluate the rotation and supervising physician(s) at the end of the rotation.  The resident’s faculty advisor and program director review the evaluation and attest to reviewing it by signing/initialing the form. These evaluations are filed together by resident year.

Supervision of all deliveries is provided by the OB/GYNs of the Parkhill Clinc for Women.

Educational Resources

Available at the AHEC Library:

Williams Obstetrics by Cunningham, Gilstrap, and Leveno

Obstetrics: Normal and Problem Pregnancies by Gabbe

Danforth’s Obstetrics and Gynecology edited by Scott

Ultrasonography in Obstetrics and Gynecology by Callan

Drugs in Pregnancy and Lactation by Briggs

Distributed to the Resident at Orientation:

Willow Creek Women’s Hospital OB Rotation Manual

On Line Resources:

UpToDate, DynaMed, The American College of Obstetricians and Gynecology website (Practice Guidelines)