print

R2 Objectives

HH Obstetrics

The HH rotation is six to seven weeks. The R2 takes night call on a rotating basis, which may include coverage of the oncology service. The R2 triages obstetrical patients, manages labor and delivery, takes responsibility for antepartum patients and first assists on cesarean sections.

Medical Knowledge

  • Develop a core knowledge of:
    • Disease processes that adversely affect pregnancy
    • Disease processes that pregnancy adversely affects
    • Management of multiple gestations
    • Intrapartum complications
  • Build on core knowledge of:
    • Normal and abnormal labor
    • Medical complications of pregnancy
    • Antenatal testing modalities for fetal well-being
    • Intraoperative techniques and core knowledge of pelvic anatomy
    • Types of anesthesia appropriate for pain control
    • Postpartum care

Patient Care

  • Take a targeted history and perform a relevant physical on the obstetrical patient who presents to triage
  • Appropriately triage patients who present for urgent evaluation and labor checks
  • Identify and manage these obstetrical complications:
    • First trimester bleeding
    • Intrauterine growth restriction
    • Third trimester bleeding
    • Postdates pregnancy
    • Oligohydramnios
    • Polyhydramnios
    • Incompetent cervix
    • Nonvertex presentation at term
    • Nonreactive nonstress test
    • Abnormal biophysical profile
    • Positive contraction stress test
    • Abnormal Doppler velocimetry
  • Perform:
    • External cephalic version
    • Delivery of multiple gestations by cesarean section or vaginal delivery
    • Vacuum delivery
    • Repeat low transverse cesarean delivery
    • Classical cesarean delivery
    • Neonatal resuscitation
    • Appropriate interventions for an abnormal fetal heart rate pattern
    • Appropriate labs and diagnostic tests for complicated patient

Interpersonal and Communication Skills

  • Communicate with attendings and the team regarding patient status and plan on patients evaluated in triage
  • Provide patients and their families management in the triage setting
  • Counsel patients in regards to:
    • Prolonged bed rest
    • Common antepartum conditions such as preeclampsia and PPROM
    • Normal physiological changes after a vaginal birth
    • Normal hospital course after a cesarean section
    • Use vacuum at the time of delivery
  • Learn to take a leadership role on labor and delivery; coordinate nursing, medical student and resident duties
  • Communicate effectively with the patient and family members regarding urgent obstetrical issues such as fetal bradycardia

Professionalism

  • Deliver the diagnosis of fetal demise or fetal distress in a sensitive manner
  • Assess the social situation and needs of a patient preparing for discharge
  • Provide consultative services for midlevel providers

Practice Based Learning

  • Increase awareness rules regarding transfer to a tertiary care facility
  • Become more aware of ACOG resources that outline acceptable medical practices
  • Use consultative services to improve patient care
  • Take responsibility for teaching obstetrical practice to medical students and other residents

System Based Practice

  • Increase awareness of the supportive services for patients who have experienced a perinatal loss
  • Understand the admission criteria for Level I, II, and III nursery
  • Understand the difference between a Level I, II and III hospital facility
  • Increase of awareness the cost of maternal care versus neonatal care
  • Understand the cost of a cesarean section versus a vaginal delivery to the patient and society

Learning Resources

  • The Resident Room has major obstetrics and gynecology textbooks and access to computers
  • Residents attend Thursday morning Grand Rounds followed by protected teaching time from 9-11am
  • 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.