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R2 Objectives

SMH OB Rotation

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). The R2 performs the majority of cesarean sections, evaluates patients in triage and covers the antepartum floor.

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:
    • Hypertension and preeclampsia
    • 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 patients
  • Prescribe
    • Tocolytics
    • Postpartum analgesia

Interpersonal and Communication Skills

  • Communicate with attendings and the team regarding patient status and plan for patients evaluated in triage
  • Provide patients and their families regarding 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 of vacuum at the time of delivery

Professionalism

  • Deliver the diagnosis of fetal demise or fetal distress in an understandable manner
  • Demonstrate sensitivity to the patient’s needs during a prolonged hospitalization
  • Assess the social situation and needs of a patient preparing for discharge

Practice Based Learning

  • Increase awareness of preauthorization for medical services provided
  • Understand appropriate use of new technology in the treatment and management of preterm labor
  • Enhance student involvement in patient care
  • Become more aware of ACOG resources that outline acceptable medical practices
  • Use consultative services to improve patient care

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 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 Resource Room has major obstetrics textbooks, instructional videos and access to computers.
  • Fetal heart rate monitoring strips are reviewed with the department chair on Tuesday mornings during daily signout
  • 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 R2 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.