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R1 Objectives

SMH Obstetrics

The SMH Obstetrics rotation is six to seven weeks with half as Night Float (Sunday 24 hours, Monday-Thursday 5pm to 7am) and half on Days (Monday-Thursday 7am-5pm and Friday 24 hours). During the Night Float rotation the R1 is also responsible for covering the gynecology floors and taking consults from the Emergency Department. For rotation goals related to gynecology, refer to the Gynecology educational objectives.

Medical Knowledge

  • Develop a core knowledge of:
    • The components of prenatal care
    • Prenatal labs
    • Normal and abnormal labor
    • Antepartum and intrapartum fetal monitoring
    • Normal physiological changes of pregnancy
    • Obstetrical lacerations
    • Routine postpartum care
    • Circumcision
    • Indications for operative vaginal deliveries
    • Indications for cesarean delivery

Patient Care

  • Recognize common abnormalities in the obstetrical exam such as abnormal fundal height, abnormal blood pressure
  • Perform:
    • Appropriate prenatal labs for uncomplicated patients
    • Obstetrical dating
    • Fundal height
    • Fetal heart tones
    • Leopold’s maneuver for presentation and estimated fetal weight
    • Cervical dilation, effacement, station and position
    • Spontaneous vaginal delivery
    • Outlet vacuum delivery
    • Midline episiotomy and repair
    • Repair first and second degree lacerations
    • Primary low transverse cesarean delivery
    • Fetal scalp electrode placement
    • Artificial rupture of membranes
    • Intrauterine pressure catheter placement
    • Amnioinfusion
    • Sterile speculum exam to diagnose ruptured membranes
    • Neonatal circumcisio
  • Prescribe:
    • RhoGAM
    • Antibiotics
    • Pitocin
    • Cervical ripening agents
    • Postpartum contraception
    • Postpartum analgesia
  • Interpret a reactive nonstress test
  • Recognize factors in the history or physical that indicate possible medical, genetic or obstetrical complications
  • Recognize postpartum complications such as:
  • Endometritis
  • Postpartum hemorrhage
  • Deep venous thrombosis

Interpersonal and Communication Skills

  • Provide patients with an explanation of pain control options in labor
  • Provide patients with an explanation of routine procedures such as intrauterine pressure catheter placement, artificial rupture of membranes and fetal scalp electrode placement
  • Communicate a thorough sign-out on patients to improve continuity of care

Professionalism

  • Understand the components of informed consent
  • Demonstrate a commitment to patient confidentiality
  • Incorporate the team concept in taking care of patients which includes the attending, students and nurses
  • Increase awareness of the patient’s expectation of her birthing experience

Practice Based Learning

  • Dictate intraoperative notes and discharge summaries in a timely fashion
  • Concentrate on using only hospital approved abbreviations
  • Write orders based on the pharmacy protocol to prevent medical errors
  • Understand and comply with teaching physician regulations

System Based Practice

  • Offer patients who are breast feeding the option of a lactation consultant if necessary
  • Understand the criteria that necessitates neonatal physician presence at a delivery
  • Understand patient, family and neonatal issues that require social work intervention

Learning Resources

  • The Resident Resource Room has major obstetrics textbooks, instructional videos and access to computers.
  • Residents will review a fetal monitoring tracing with the chairman on Tuesday mornings as part of sign-outs.
  • Residents attend Thursday morning Grand Rounds followed by protected teaching time from 9-11am. (Night Float residents may not attend per work hour rules.)
  • The team attends weekly Perinatal Conference on Friday 12pm. The R1 will present cases at Perinatal Conference at the discretion of the chief resident
  • Daily sign-outs at 7AM and 5PM. Team members will give short educational lectures at the morning sign-out.

Evaluations

  • Faculty and resident colleagues are encouraged to provide direct verbal feedback so that resident performance can be commended or improved during the rotation.
  • Residents are evaluated via a Web-based evaluation system at MyEvaluations.com at the end of each rotation using a standardized evaluation form given to supervising OB/GYN attendings and upper-level residents. Attending evaluations are available for immediate review by the resident once completed.
  • Problems, which appear to be of a more urgent nature, will be brought immediately to the attention of the resident and residency program director for discussion.
  • Residents will receive a form at the end of each rotation via MyEvaluations.com soliciting feedback regarding the rotation, upper-level residents, and faculty. This information is shared anonymously and used for course/faculty improvement activities.