Low Risk OB Educational Program

Structure and Topics

The educational structure will focus on the topic of the week format over a 4 wk L&D rotation, as the unpredictable nature of L&D does not readily lend itself to scheduled formal teaching sessions. The lists are short, (e.g. ACOG compendium and possibly one other guideline or ABOG "key article"). Each resident is expected to have read this at the beginning of each week. These topics will be covered, emphasizing national standards of care. Obviously this may not always match what we do on our labor and delivery, as many of our patients are unique and high risk- these unique issues will be discussed as they come up. Since all residents will have one 4 wk L&D block in the fall/winter and then again in the spring, topics are arranged in the following manner, per 4 wk rotation:

Drs. Mendiratta, Lewis, and Debiec (back up) staff L&D on Tuesdays, Wednesdays (AM only- starting in August 2010), and Thursdays to provide consistent education regarding low risk obstetrical care- triage assessment, management of labor and associated complications, deliveries, and postpartum care. A typical daily clinical and educational schedule includes:

6:30 AM

  • L&D Board rounds + TeamStepps
  • All resident postpartum and antepartum work rounds must be complete
  • Antepartum, OB night float, and OB day residents and faculty are present

7:30 AM

  • APS team rounds with MFM faculty and Generalist faculty rounds on postpartum with R1s –see POD 1 C/S patients, C/S discharges and any other pts with postpartum complications, anemia, 3/4th degree epis/lacs, and/or any others identified for teaching points
  • R2/R4s cover triage and evaluate all potential C/S.

8:30 AM

  • "Huddle" rounds with entire team including anesthesiology if available
  • As a team, see all pts in active labor, introduce team and assign primary resident, discuss management of their labor and assess their expectations (ie. Epidural, pitocin, ours and their threshold for C/S)
  • Begin scheduled C/S – generalist faculty to cover if there is not a faculty provider actively managing the patient
  • All triage patients should be checked out with the OB R4 for pt safety and educational reasons and together determine a management plan before staffing with the Generalist Faculty
  • Procedure and ultrasound competency cards should be signed off by faculty when resident has achieved sufficient level of competency

Noon

  • Generalist faculty depart (Wedn and Thurs) and MFM faculty take over

5:30 PM

  • L&D Board rounds + TeamStepps

Educational Program

There is a 4 week rotation of educational topics to be covered. Each topic has an associated reading (generally ACOG practice bulletin and/or book chapter). We will introduce these topics in an informal way throughout the day, including on rounds and during "downtime". You will be expected to have read the article ahead of time and there will be some gentle "pimping" during the week. We will also staff U/S evaluations and be able to sign off on U/S skills cards during the 4 week rotation.

For the Gabbe Obstetrics text , I am referencing the 5th Ed, available on L&D, in resident office or online at UW Health Science libraries, eBooks module.

Week 1:

  • Review of rotation expectations, educational goals and objectives with day/night team
  • Maternal physiology basics – Gabbe's Obstetrics, Ch 3 Maternal Physiology

Week 2:

  • Normal and Abnormal Labor - Practice bulletin 49
  • Chapter 12 Normal Labor and Delivery pages 303-316, and Chapter 13 pages 322-326

Week 3:

Week 4:

  • Exit interview and verbal and written feedback- completion of resident and student evals
  • Review of procedure cards and sign as needed
  • C-Section techniques, indications, rates, "on demand"- Committee Opinion 394
  • Gabbe Obstetrics Chapter 19: 486-499

Winter/Spring

Week 5:

Week 6:

Week 7:

Week 8:

  • Exit interview and verbal and written feedback- completion of resident and student evals
  • Review of procedure cards and sign as needed
  • Tocolysis - Practice Bulletin 43
  • PDF on magnesium for Labor and PTL