OB Eval

Faculty Chair:

Leandrita Ortega, MD

Contacts:

John McAndrew, MD

Ruthven Sampath, MD

Gurdial Dhillon, MD

 

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Required Experiences:

Residents will spend 4 weeks on a traditional OB rotation during their PGY-1 year at MMC in Las Cruces. During their PGY-2 and 3, they will spend one month attending the OB clinic followed by one month of OB call (coinciding with their GYN rotation in PGY-2 and self-study in PGY-3) in order to participate in the deliveries of patients they saw in clinic the previous month. They will also have the option to participate in deliveries during the OB Clinic month. Residents will have 4 continuity clinics during the Clinic rotations and 2 during the months of call.

Weekly Schedule PGY1:

Sunday	Monday	Tuesday	Wed	Thursday	Friday	Saturday
	OB	OB	Clinic	OB	OB
	OB	OB	Didactics	OB	OB

Weekly Schedule PGY2 or 3: (OB Clinic)

Sunday	Monday	Tuesday	Wed	Thursday	Friday	Saturday
	Clinic	OB	Clinic	Clinic	OB
	OB	Clinic	Didactics	OB

Weekly Schedule PGY2: (OB Call/GYN)

Sunday	Monday	Tuesday	Wed	Thursday	Friday	Saturday
	GYN	GYN	GYN (Surgery)	GYN	OB Call	OB Call
	OB Call	Clinic	Didactics	Clinic	OB Call	OB Call

Weekly Schedule PGY3: (OB Call/Self-Study)

Sunday	Monday	Tuesday	Wed	Thursday	Friday	Saturday
	Self-study	Self-study	OB Call	Self-study	Self-study	OB Call
	OB Call	Clinic	Didactics	Clinic	OB Call	OB Call

Optional Experience:

Additional call/electives with OB attendings to gain proficiency in C-section and other procedures if desired for future practice.

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RRC Requirements:

AOA

Women’s Health

The program must provide at least twelve weeks of training in women’s health, including at least four weeks of training during the OGME-1 year.

At a minimum training in women’s health must include:

• Didactic and clinical training experiences.
• Gender specific health care needs of women.
• Domestic violence identification and prevention.
• Gynecology.
• Obstetrics.
• Breast Disease.

The obstetrical portion of this training experience shall include both ambulatory and in-hospital patient care. At a minimum this shall include:

• Prenatal care.
• Labor and delivery.
• Postnatal care.
• Medical complications of pregnancy.

ACGME

Residents must document 200 hours (or two months) dedicated to participating in deliveries and providing prenatal and post-partum care. (Core)

This experience must include a structured curriculum in prenatal, intra-partum, and post-partum care. (Core)

Programs should provide an experience in prenatal care, labor management, and delivery management. (Detail)

Some of the maternity experience should include the prenatal, intra-partum, and post-partum care of the same patient in a continuity care relationship. (Detail)

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Description of Rotation or Educational Experience

The OB curriculum requires two months of OB in the PGY1 year and one month in each of the next two years. Residents obtain substantial additional obstetric experience throughout the three years of training.

Care provided in family medicine clinic is consistent, high-quality, and evidence-based. Social and psychological aspects of care, as well as an appropriate history and physical examination, are integral parts of training. The knowledge, skills and judgment required in residency training are a recognized necessary base.

The curriculum in obstetrics for family practice residents incorporates knowledge of diagnosis and management, core skills and advanced skills.

Expectations:

Residents:

PGY1 Residents are expected to evaluate and manage all patients on L&D and in triage under the direction of the 1st step Midwife, FM Attending or OB Attending. The PGY1 Resident will do the initial evaluation of the patient and present the patient to the supervision maternity care provider. The PGY1 resident will manage laboring patients and deliver all patients under their care with the direct supervision of the supervision maternity care provider. The PGY1 resident is expected to round daily on all postpartum, antepartum patients and neonates, write notes and report to the supervising provider. The Resident is expected to assist on c-section and to attend neonatal resuscitation as directed.

Senior Residents will supervise and teach the PGY1 Resident on the OB service. They are also expected to evaluate and manage patients on L&D and in triage under the direction of the 1st step Midwife, FM Attending and/ or OB Attending. The Senior Resident will also manage laboring patients and deliver all patients under their care with the direct supervision of the supervision maternity care provider. They resident is expected to round daily on all postpartum, antepartum patients and neonates, write notes and report to the supervising provider. The Resident is expected to assist on c-section and to attend neonatal resuscitation as directed.

Faculty:

 

OB Attending

Is the OB faculty member. His role is that of consultant/teacher, as well as attending with direct patient care responsibility. He will go over all admissions and laboring patients, under his care, with the residents, and is expected to round daily on the patients and discuss management issues with the primary Resident involved. He should also be available to act as a liaison for conflict resolution between the ward team and private attendings and Midwives. He is available for consultation on high risk OB patients and for those who may need surgical intervention. Before any formal consults are made or if management of care changes are planned, the FMS attending should be notified. Although the FMS Team is trained to address a variety of normal and complicated obstetric conditions, the team should recognize that additional expertise may be required in certain patients and should refer to specialty and subspecialty-trained physicians as appropriate. The goal of the entire team is patient safety.

Midwife

Is the major educator on the Maternity Care rotations at Memorial Medical Center. Her role is that of consultant/teacher, as well as direct patient care responsibility. She will go over all admissions and laboring patients, under her care, with the residents, and is expected to round daily on the patients and discuss management issues with the primary Resident involved.

 

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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

• Be able to perform a comprehensive women’s health assessment and develop acute and long-term treatment plans based on the unique aspects of the physiology of women. Special care must be given to where a woman is in her reproductive years and whether or not pregnancy is a consideration. (Patient Care, Medical Knowledge)

Objectives

• Obtain, document and report an accurate cervical exam (10 supervised prior to promotion) R1
• Perform, document and report a routine vaginal delivery (10 supervised prior to promotion) R1
• Assess for suspected labor
• Perform, document and report a newborn examination (5 supervised prior to promotion) R1
• Perform, document and report routine postpartum care R1
• Perform, document , and counsel women about breastfeeding R1
• Manage mild preeclampsia in labor (5 supervised prior to promotion) R2/R3
• Manage gestational diabetes in labor (5 supervised prior to promotion) R2/R3
• Evaluate and initiate treatment for preterm labor (5 supervised prior to promotion) R2/R3
• Interpret fetal strip reading using the DR C BRAVADO mnemonic of the ALSO course R1/R2
• Perform appropriate procedures, with attention to consent, technique, patient comfort and follow-up
  • NST
  • Antepartum Fetal Monitoring
  • AFI measurement
  • Induction and augmentation of labor
  • Accurate cervical exam
  • AROM
  • Insertion of IUPC, FSE
  • Routine vaginal delivery
  • Vacuum-assisted delivery
  • Knot tying and suturing
  • Perineal laceration repair
  • Limited L&D/triage US
  • First assisting at a cesarean delivery
  • Amnioinfusion
• Must be familiar with the priniciples of obstetric anesthesia, including conduction anethesia, general anesthesia, and local anesthesia techniques. Although the performance of these procedures are usually the responsibility of the attendants trained in anesthesia, the resident must be aware of the indications and contraindications for different anesthetic techniques and must be capable of managing anesthetic related complications such as hypotension, seizures, and respiratory arrest.

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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

• Counsel a patient regarding the impact of pregnancy on maternal medical conditions.
• Counsel a patient regarding the impact of maternal medical conditions on pregnancy.
• Counsel a patient regarding appropriate lifestyle modifications conducive to favorable pregnancy outcome.
• Counsel patients about appropriate immunizations during pregnancy.
• Counsel patients about warning signs of adverse pregnancy events.

Objectives

• Describe the indications, contraindications, advantages, and disadvantages of antepartum diagnostic tests, such as: (MK, PC)
  • Nonstress test
  • Contraction stress test
  • Biophysical profile
  • Vibroacoustic stimulation test
• Describe the management of the stages of labor
• Knows and applies basic and clinical knowledge in specified areas/diagnoses
  • preterm labor
  • SROM
  • pre-eclampsia and other hypertensive disorders
  • bleeding in pregnancy
  • management of labor dystocia
  • management of a non-reasurring fetal strip
  • operative delivery, vaginal and caesarian
  • management of post-partum hemorrhage
  • routine postpartum care
• Demonstrate knowledge of specific medical conditions:
  • Diabetes mellitus
    • Classify diabetes mellitus in pregnancy. (MK)
    • Interpret screening tests for gestational diabetes. (MK, PC, SBP)
    • Monitor and control blood sugar in the pregnant patient with diabetes mellitus. (PC)
    • Assess, recognize, and manage fetal and maternal complications such as: (MK, PC)
    • Fetal malformations
    • Disturbances in fetal growth
    • Diabetic ketoacidosis
    • Counsel patients with diabetes regarding future reproduction and the long-term health implications of their medical condition. (ICS, P, SBP)
  • Diseases of the urinary system
    • Evaluate signs and symptoms of urinary tract pathology in pregnant patients. (PC)
    • Describe the indications for the common diagnostic tests for renal disease in pregnancy. (PC)
    • Interpret the results of common diagnostic tests for renal disease in pregnancy. (MK, PC, SBP)
  • Infectious diseases
    • Perform a focused history and physical examination in pregnant patients who have known or suspected infectious diseases. (PC)
    • Choose and perform laboratory tests to confi rm the diagnosis of infection. (MK, PC, SBP)
    • Assess the severity of a specifi c infection and its potential maternal, fetal, and neonatal impact. (PC)
    • Describe the possible adverse maternal and fetal effects of antibiotics administered during pregnancy. (MK, PC, ICS)
    • Manage specifi c infections in consultation with other specialists, as indicated. (ICS, P, SBP)
  • Hematologic disorders
    • Evaluate possible causes of anemia, thrombocytopenia, deep vein thrombosis, and coagulopathy in pregnancy. (MK)
    • Institute appropriate acute and chronic management plans for these conditions, including prophylaxis to minimize recurrence risk. (PC, SBP)
    • Counsel patients about the fetal and maternal impact of hematologic disorders in pregnancy. (ICS, P)
  • Cardiopulmonary disease
    • Describe symptoms and physical fi ndings suggestive of cardiopulmonary disease in pregnancy. (MK)
    • Describe the indications for and interpret the results of common diagnostic tests for cardiopulmonary disease in pregnancy. (MK, PC) 3. Counsel patients about the impact of pregnancy on cardiopulmonary disease and the impact of these diseases on pregnancy. (ISC, P)
    • Develop, in consultation with other specialists, a comprehensive plan for the perinatal management of patients with cardiopulmonary disease. (P, SBP)
  • Gastrointestinal Disease
    • Diagnose and provide initial management of common gastrointestinal diseases in pregnancy. (MK, PC)
    • Develop, in consultation with other specialists, a comprehensive plan for the perinatal management of patients with gastrointestinal disease. (P, SBP)
  • Neurologic Disease
    • Counsel pregnant patients regarding the impact of pregnancy on neurologic disease and the impact of the disease on pregnancy. (ICS, P)
  • Endocrine Disorders (excluding diabetes mellitus)
    • Describe the indications for and interpret the results of common diagnostic tests for endocrine disease, such as: (MK, PC)
      • Thyroid function tests
      • Adrenal function tests
      • Pituitary function tests
      • Imaging studies
    • Counsel patients about the impact of an endocrine disease and its treatment on pregnancy and the impact of pregnancy on the endocrine disorder. (ICS, P)
  • Collagen vascular disorders
    • Describe the indications for and interpret the results of common diagnostic tests for collagen vascular disease in pregnancy, such as: (MK, PC)
      • Serologic tests for rheumatoid factor
      • Anti-DNA antibodies
      • Antinuclear antibodies
      • Lupus anticoagulant
      • Anticardiolipin (antiphospholipid) antibodies
      • Anti-Ro, Anti-La
    • Counsel patients regarding the impact of collagen vascular disease and its treatment on pregnancy and the impact of pregnancy on collagen vascular disease. (ICS, P)
    • Develop, in consultation with other specialists, a comprehensive plan for the perinatal management of patients with collagen vascular disease. (P, SBP)
  • Substance abuse in pregnancy
    • Describe behavior patterns suggestive of substance abuse. (MK)
    • Perform a thorough history and physical examination in patients suspected of substance abuse in pregnancy. (PC)
    • Counsel patients about the impact of substance abuse on the fetus/neonate. (ICS, P)
    • Assess the fetus for adverse effects of substance abuse, such as congenital anomalies or growth restriction. (MK)
    • Refer patients with known or suspected substance abuse for counseling and follow-up. (P, SBP)
  • Psychiatric disorders
    • Perform a mental status examination. (PC)
    • Describe the symptoms of common psychiatric disorders in pregnancy. (MK)
    • Assess the risk of psychiatric disorders such as bipolar disorder, schizophrenia, depression, and the safety of psychiatric medications in the patient and her fetus. (PC, ICS)
    • Identify patients who require referral for psychiatric consultation. (P, SBP)

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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

• Locate, appraise and assimilate evidence from scientific studies related to their patients’ health problems
• Use information technology to optimize learning

Objectives

• Recognize his/her own strengths and limitations
• Ask questions as an engaged, critical learner
• Locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems
• Use information technology to manage information, access on-line medical information, and support their own education

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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:

• Incorporate considerations of cost awareness and risk-benefit analysis in patient care
• Work in interprofessional teams to enhance patient safety and improve patient care quality
• Create an optimal treatment plan based on local women’s health care resources that includes local, state and governmental agencies. (Systems-based Practice, Practice-based Learning)
• Schedule and perform appropriate antepartum follow-up visits for routine and high-risk obstetric care. (PC, PBLI, SBP)

Objectives

• Practice cost-effective health care and resource allocation that does not compromise quality of care
• Advocate for quality patient care and assist patients in dealing with system complexities to minimize discomfort or confusion

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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

• Accept responsibility for patient care
• Never misrepresents patient care information
• Consistently performs in a punctual, reliable and collegial manner
• Demonstrate dress, hygiene and manner of speech that consistently reflect appropriate standards
• Demonstrate sensitivity and responsiveness towards patients’, colleagues’ and team members’ gender, age, culture, disabilities, ethnicity and sexual orientation.

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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

Objectives

• Knowledge of antenatal, natal, and postnatal care based on written documentation and oral communication R1
• Make organized and effective oral presentations
• Elicit and provide information using effective listening, nonverbal, explanatory, questioning, and writing skills
• Communicate with the patient, family and members of the healthcare team in a timely, developmentally and culturally appropriate manner
• Counsel patients about the benefits of breast feeding. (ICS, SBP)

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Teaching Methods

Residents will provide maternity care to patients under the direct supervision of the attending physician or Midwife. They will be supervised on all procedures performed. OB topics will be presented in the weekly conferences.

Residents will be assigned specific reading topics to be completed by the end of their last month on the Maternity Care service.

Assessment Method (Residents)

A 360 global assessment tool and the REDI assessment tool will be used in assessment of the resident during their experience. All procedures will be recorded on New Innovations.Residents will recieve on-site timely formative feedback from the senior resident, and attending staff (certified nurse midwife, Family Medicine Attending, First Step OB Attending, SNMFRP OB Attending)

Assessment Method (Program Evaluation)

Residents will be provided with an evaluation of their experiences and given the opportunity to provide feedback of the longitudinal rotation during their quarterly IEP assessments.

Level of Supervision

The resident is directly supervised by the Attending physician or Midwife during all procedures performed in the hospital. The PGY1 Resident will have supervision provided by a Senior Resident and Attending and Midwife. The Senior Resident will be supervised by the Attending and Midwife. The attending or Midwife will see all patients on the service each day and will document their involvement in the patient’s care. An Attending and Midwife will be available 24 hours a day.

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Educational Resources

Presentation

Readings:

PGY1

Week 1

Week 2

Week 3

Week 4

PGY2

Week 1

Week 2

Week 3

Week 4

Diagnosis and Management of Gestational Diabetes Mellitus

Texts

• Williams’ Obstetrics or Gabbe’ Obstetrics, Normal and Problem Pregnancies
• Creasey and Resnik’s Maternal -Fetal Medicine,Principles and Practice
• ACOG Compendium
• Drugs in Pregnancy and Lactation

Videos

Web Resources

• Labor, Delivery and Post Partum Issues AFP
• NIH Drugs and Lactation Database (LactMed)
  • LactMed for iPhone
  • LactMed for Android

Tele-health Resources

ECHO Project, bi-weekly teleconferance with University of New Mexico Department of Obstetrics and Gynecology, Maternal- Fetal Medicine