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R3 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 24 hours on Friday). The R3 oversees the obstetrical service in consultation with the R4 and attendings. The R3 performs complex cesarean sections and appropriate operative vaginal deliveries. During the Night Float portion of the rotation, the R3 works with the R1 to complete ED consults and management the gynecology floors.

Medical Knowledge

  • Build on core knowledge of:
    • Normal obstetrics
    • Disease processes that adversely affect pregnancy
    • Disease processes that pregnancy adversely affects
    • Methods of antenatal testing of fetal well-being
    • Obstetrical complications of pregnancy

Patient Care

  • Provide risk appropriate care for patients with medical conditions including:
    • Cardiovascular disease
    • Collagen vascular disease
    • Neurological conditions
    • Diabetes
    • Antiphospholipid syndrome
    • Thrombotic events
  • Provide appropriate antepartum care for pregnancies complicated by fetal anomalies such as:
    • Fetal arrhythmias
    • Intrauterine growth restriction
    • Twin-twin transfusion syndrome
    • Isoimmunization
    • Hydrops—immune and non-immune
    • Poly- and oligohydramnios
  • Identify and manage these obstetrical complications:
    • Umbilical cord prolapse
    • Vasa previa
    • Placenta previa
    • Placenta accreta
    • Fetal death in utero
    • Wound dehiscence
  • Perform
    • Outlet forceps delivery
    • Complicated cesarean delivery
  • Prescribe:
    • Tocolytics
    • Insulin

Interpersonal and Communication Skills

  • Counsel patients in regard to:
    • Management options for parents with a periviable fetus
    • Initial grief counseling for a fetal loss
    • Management plans for their pregnancy
    • Diabetic diet education
    • Insulin injection
    • Hypoglycemic reaction
    • Management of hyperemesis
    • How a specific disease state impacts pregnancy
  • Continue to improve communications with anesthesia, neonatology, and the charge nurse

Professionalism

  • Increase awareness of racial disparities in obstetrical outcomes
  • Coordinate transfers from other hospitals to SMH

Practice Based Learning

  • Continue to use online services to research clinical questions
  • Critique a research article
  • Access the CDC’s website regarding women’s health care policies, such as guidelines for treating GBS, hepatitis B prophylaxis, etc
  • Increase awareness of patient’s rights as a research subject

System Based Practice

  • Understand the role of the quality assurance committee
  • Identify discharge coordinator and work with the individual to assure patient has appropriate needs at home
  • Become aware of the hospital utilization review process and how it impacts patient care.

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 R3 will resent case at Perinatal Conference at the discretion of 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.