Faculty Chair:

Dolores Gomez, MD

Contacts:

Dolores Gomez MD
Jazmin Rodriguez, MD
Clark Alves MD
John Andazola MD
Amanda Provencio MD
Joanna Rachelson MD
Danielle Fitzsimmons-Pattison MD

ACGME Program Requirements:

ACGME Program Requirements 2023 (see IV.C.3.i)

Residents must have at least 200 hours (or two months) dedicated to participating in pregnancy-related care. (Core)

This experience must include a structured curriculum in prenatal, intrapartum, and postpartum care. (Core)
Residents must care for pregnant patients in the outpatient setting, including prenatal care and the care of medical issues that arise in pregnancy. (Core)
Each resident must have experience with a minimum of 40 vaginal deliveries. (Core)
Each resident should care for postpartum patients, including care for parental-baby pairs. (Detail)
Some of the maternity experience should include the prenatal, intrapartum, and postpartum care of the same patient in a continuity care relationship. (Detail)

Residents who seek the option to incorporate comprehensive pregnancy-related care, including intrapartum pregnancy-related care and vaginal deliveries into independent practice, must complete at least 400 hours (or four months) dedicated to training on labor and delivery and perform or directly supervise at least 80 deliveries. (Core)

Goal:

By the end of the OB rotation residents will develop the knowledge and skills to appropriately evaluate and treat the maternity patient. This will include the evaluation and treatment of the patients’ biomedical, behavioral, and social needs.

General Information:

Maternity care is a longitudinal experience that takes place during all three years of residency training. The level of resident independence and responsibility will gradually increase throughout their training. In general, residents will have 2-3 OB rotations each year. This includes OB Day Rotation and OB/Peds Night Float Rotation.

Admissions to the L&D come from:

1. Family Medicine Center (FMC)

Established patients of the FMC are admitted to the OB service when in labor or for scheduled procedures/deliveries or direct admits from the clinic. For direct admission from the clinic, the resident and attending in the clinic shall communicate with the OB team. The OB team is responsible for completing the H&P and writing orders unless other arrangements have been made. The resident who is the primary care physician of the patient shall aid in the management of his/her patient on L&D to get continuity credit. However, the primary management of the patient will be the responsibility of the residents assigned to the OB service unless communication with the continuity provider is made.

2. Women’s Medical Associates Clinic (WMA)

The OB team admits and manages patients from WMA. The team will be notified by WMA for any patients being sent directly from the office or scheduled procedures/deliveries will be done with communication with the L&D team leader.

3. Walk-in patients (city call)

Patients who present to L&D who have not had any prenatal care, prenatal care was done outside the community, or care was provided by another provider who does not admit to MMC, may be admitted to the OB service. This “city call” patient is managed by the OB team on call and attempts will be made to obtain any prenatal care records that may be available.

Resident and Faculty Expectations:

(Beyond those outlined in Resident Manual)

Patient Numbers:

To ensure adequate resident education, the minimum number of deliveries expected at the end of the residency is 40 deliveries, of which 10 should be continuity patients. This includes normal spontaneous vaginal deliveries and cesarean sections.

PGY 1,2,3 Resident:

The resident will evaluate and manage all patients on L&D and in triage under the direction of the CNM, FM Attending, FM Fellow or OB Attending.
The resident will do the initial evaluation of the patient and present the patient to the supervisory maternity care provider. This includes any triage patient prior to making the final disposition.
The resident will manage laboring patients and deliver all patients under their care with the direct supervision of the supervisory maternity care provider. This includes remaining on the deck when there is any patient in active labor (>6cm).
In general, residents should write labor notes every 4 hours for latent labor and every 2 hours for active labor. Inductions undergoing ripening can have notes every 8-12 hrs IF no maternal/fetal issues.
Residents will use the templated H&P and follow the Red Book or provided template examples for writing notes in order to have standardized way of documenting and presenting patients that are managed on Labor and Delivery.
The resident is expected to round daily on all postpartum, antepartum patients and neonates (PGY2 and 3 OB resident with the PGY1 Peds resident), write notes on all postpartum and antepartum patients, and report to the supervising provider.
The Resident is expected to 1st or 2nd assist on C-sections and to attend neonatal resuscitations as directed.
PGY 2 and 3 residents will supervise and teach the PGY1 Resident on the Peds service as well as supervise and teach the PGY 1 OB resident.
The resident will work collaboratively with the nursing team on L&D and notify the nurse(s) and the supervising provider when leaving the deck and his/her expected return.
The resident with update the L&D board in the provider work room each shift and provide handoff when his/her shift has ended or leaving for other duties.

Faculty:

All Faculty involved in the teaching and education of the OB resident will work in collaboration to help enhance the resident’s skill set in maternity care. The faculty’s expectations include:

The faculty will directly supervise all patients on the L&D service with the resident as the primary contact for patient care.
The faculty is expected to provide teaching and education while on the L&D unit to the resident on common maternal problems and complications seen on L&D.
The faculty will work collaboratively with the resident to provide conflict resolution between the OB nursing team, other OB attendings and/or CNMs when needed.
The faculty will provide a professional environment for the residents in order to provide a conducive learning environment. If there is conflict between the resident and the faculty, they will meet jointly in a private area to discuss any concerns and opportunities for improving learning and teaching. If there is an inability to reach resolution, then the faculty and/or the resident will reach out to the faculty chair of the OB rotation.

FM OB Attending

is an FM faculty member assigned to OB/Peds. His/her role is that of consultant/teacher, as well as attending with direct patient care responsibility. He/she will go over all OB admissions and laboring patients with the residents, and is expected to round daily on the patients and discuss management issues with the primary resident involved. The FM attending is expected to be present at daily work rounds. She/he should also be available to act as a liaison for conflict resolution between the ward team and private attendings and CNMs.

FM Fellow

is an FM faculty member who is gaining advanced training in OB during his/her 1 year fellowship. His/her role is that of consultant/teacher, as well as attending with direct patient care responsibility. He/she will go over all OB admissions and laboring patients with the residents, and is expected to round daily on the patients and discuss management issues with the primary resident involved. The FM attending is expected to be present at daily work rounds. She/he should also be available to act as a liaison for conflict resolution between the ward team and private attendings and CNMs.

CNM

is a major educator on the Maternity Care rotations. 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.

OB/Gyn Attending

is the supervising obstetrician. His/her role is that of consultant/teacher, as well as attending with direct patient care responsibility. She/he will go over all admissions and laboring patients, under his/her care, with the residents, and is expected to round daily on the patients and discuss management issues with the primary resident involved. She/he should also be available to act as a liaison for conflict resolution between the ward team and private attendings and CNMs. She/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 made the CNM, FM Fellow or FM OB Attending must be notified. The only exception is in an emergent situation where patient safety is an issue

Deliverables:

Anything a resident needs to produce during the rotation (journal entries, letter to editor, etc.)

Daily each resident and faculty will summarize within a minute 1 key point they learned in the past 24 hours related to their patients during morning brief.
Residents shall participate in weekly 5-minute OB teaching topics prior to rounds. The OB resident shall lead a teaching topic each week. The topic should be relevant to a current/recent patient case and should conclude with three take-away points.
Residents shall participate in the Monday didactics session (12pm) set for the FM-OB fellows if there is no conflict with direct patient care responsibilities.

Competency-Based Education

Objectives (Competencies)	Educational Strategies/Activities All of the following educational strategies will include some component of direction instruction, faculty role modeling, and bedside teaching.	Assessments
By the end of the OB rotation residents will be able to gather and interpret information relevant to maternity care on all L&D patients. (PC, IPC)	Perform inpatient admissions, triage of OB patients on L&D, and round on assigned patients daily.	Faculty observation, verbal feedback, and global assessment form.
By the end of subsequent OB rotations, residents will be able to formulate treatment and monitoring plans for common maternal conditions and/or complications associated with pregnancy. (PC, MK)	Perform inpatient admissions, triage of OB patients on L&D and round on assigned patients daily. Locate and utilize medical and drug information resources that are pertinent to the pregnant or breastfeeding patient.	Faculty observation, verbal feedback, and global assessment form.
By the end of the OB rotation, residents will be able to consistently critique and modify treatment plans of junior residents. (PC, IPC, PBLI)	Supervise junior residents during admissions and daily rounds. See and evaluate patients who are new admissions, triage patients, have a change in status, and others as appropriate.	Faculty observation, verbal feedback, and global assessment form.
By the end of the PGY3 year, residents will be able to describe the indications for and perform common procedures with guidance from preceptor that are specific to maternity and post-partum care. (PC). By the end of the OB rotation, PGY2/3 residents will be able to perform common procedures in maternity care with minimal guidance and correction from preceptor. (PC)	Perform common maternity care procedures under direct faculty supervision (e.g. SSE, SVE, NSVD, IUPC, FSE, amniotomy, 2nd-3rd degree vaginal repair, etc.).	Faculty observation, verbal feedback, procedure competency checklist, and global assessment form.
By the end of the OB rotation, residents will be able to identify personal strengths and areas for improvement. (PBLI) By the end of the FMS rotation, PGY2/3 residents will be able to set personal improvement goals and action steps. (PBLI)	Participate in weekly goal setting and debriefs with faculty on Maternity Care.Each resident and faculty will summarize within a minute 1 key point they learned in the past 24 hours related to their patients during morning brief. Residents shall participate in weekly 5-minute teaching topics prior to rounds. Residents will participate in didactic education with the FM fellow every Monday	Faculty observation, verbal feedback, and global assessment form.
By the end of the OB rotations, residents will consistently be able to deliver organized and effective patient case presentations to the inter-professional team (ICS, SBP).	Present patients utilizing the templated notes from the Red book or provided templates to the maternity provider, nursing staff, or others involved in the L&D patient’s care	Faculty observation, verbal feedback, and global assessment form.
By the end of the OB rotation, residents will be able to effectively communicate care plans with patients, family members, and caregivers using appropriate language and demonstrating compassion and respect. (ICS, PROF).	Residents shall lead the maternity team in communicating the care plan with the patient. S/he shall confirm understanding of information provided using teach-back methods. Resident will provide evidence-based information that is used for developing an appropriate labor plan or post-partum plan Residents will work collaboratively with the neonatal providers for shared decision making of care plans for the maternal-child unit	Faculty observation, verbal feedback, and global assessment form.
By the end of the OB rotation, PGY2/3 residents will be able to effectively communicate and coordinate care within inter-professional team, including proactively addressing discharge needs with case management and other team members, (ICS, SBP)	Residents will develop discharge plans and discuss with maternity provider.	Faculty observation, verbal feedback, and global assessment form.
By the end of the OB rotations, residents will be able to recognize how specific language may result in bias and patient harm. (SBP, IPC, SC)	Identify and discuss with team when specific language (e.g., “drug abuser”, “pt had care in Mexico” etc.) is utilized in oral presentations and chart documentation.	Faculty observation, verbal feedback, and global assessment form.
By the end of OB rotation, PGY2/3 residents will be able to identify and begin to address the social determinants of health that may have contributed or will contribute to the maternal-child unit. (SBP, SC)	Collect thorough social histories including home/work environments, social support systems, socioeconomic barriers to health, etc. Refer to appropriate resources and team members and arrange for inpatient referral and/or outpatient follow-up.	Faculty observation, verbal feedback, and global assessment for

Educational Resources

Texts

Comprehensive Handbook Obstetrics and Gynecology (The Red Book)- Thomas Zheng
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
ALSO

Web Resources

Useful Templates

OB Note Templates Download