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:
20. Management of Maternal/Fetal Monitoring Devices (FSE, IUPC)
Objectives
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.
The resident will learn the physiologic mechanism of and be able
to facilitate/perform a normal vaginal delivery.
The resident will learn the principles of and be able to perform
an episiotomy repair.
Early during the PGYI year, the resident will be required to
successfully complete the Neonatal Resuscitation Program (NRP).
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.
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.
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.
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.
The resident will become familiar with resources to help
determine the safety of pharmacologic agents during pregnancy and lactation.
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.
Level of Supervision
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)
