PACE Subcommittee: Maternal/Newborn Curriculum Committee Retreat 12/16/04

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PACE SubcommitteeMaternal/NewbornCurriculum
Committee Retreat 12/16/04

• Maria Afanador, MS
• Karen L. Bruder, MD
• Robert Nelson, MD
• Michael Parsons, MD
• Judith Ranells, MD
• Laura Weathers, MD

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Clerkship Summary

• The Obstetrics/Newborn Clerkship is a four-week
  clinical rotation which encompasses outpatient
  and inpatient obstetrics and the newborn nursery.
  Ambulatory obstetrical care is taught at
  Genesis, the primary teaching site for residents
  in obstetrics. This clinic includes low risk and
  high risk obstetric care and is attending
  supervised. Throughout the clerkship, students
  are expected to participate in the care of
  patients with low risk and high risk pregnancies,
  fetal surveillance, deliveries, and surgeries.
  Students will also be exposed to the principles
  of genetics, preconception counseling, lactation,
  and maternal physiology.
• The newborn experience is incorporated into the
  labor and delivery segments of this rotation,
  emphasizing health care delivery to infants.
  Medical management of the healthy newborn, common
  newborn problems, general growth and development,
  disease prevention, and parental teaching are
  stressed.
• Knowledge attained on rotations in the newborn
  nursery, labor and delivery, and ambulatory
  clinic settings is solidified with individual and
  web based tutorials, and weekly case discussions.
  This broad based clinical clerkship provides a
  well-rounded clinical experience with the overall
  health care of the pregnant patient and her
  newborn.

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Previous MS3 Experience

• OBSTETRICS
• 4 weeks of an 8 week OB/GYN clerkship
• Inpatient (TGH)
• Outpatient (Genesis)
• Didactics- Wed am and pm qweek
• Total 16 hours
• Evaluations OSCE/NBME/faculty and resident input
  based on direct observation

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Previous MS3 Experience

• NEWBORN
• 1 week of an 8 week Pediatric clerkship
• Inpatient (TGH)
• Didactic Mon Fri am of newborn week (2 hours)
  Thurs q week (2 hours) Total 4 hours
• Evaluations OSCE/ NBME/ Input from Faculty and
  residents based on direct observation

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Our Challenge

• Combine Maternal/Newborn Experience
• 4 total weeks
• Inpatient and Outpatient Experience
• Include longitudinal issues

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WEEK ONE

• AM Rounds, Newborn PE in Newborn Nursery at TGH
• Brief NICU visit/introduction
• Grand Rounds OB Wed 9-10am, PEDS Thurs
  8-9am
• PM LD, PE of Newborns following deliveries
• Student Conferences Wed 1-5pm
• SAT 24 hours following LD days

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WEEK TWO

• AM HIGH RISK OB (INPT ROUNDS)/GENESIS HR CLINIC
• Grand Rounds OB Wed 9-10am, PEDS Thurs
  8-9am
• PM LD, PE of Newborns following deliveries
• Student Conferences Wed 1-5pm

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WEEK THREE

• AM No responsibilities
• PM LD nights (5pm-7am) beginning Sunday night
• through Friday night

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WEEK FOUR

• AM Outpatient Low Risk OB- Genesis with Midwives
• Grand Rounds OB Wed 9-10am, PEDS Thurs
  8-9am
• PM Mon-Outpt. Low Risk OB, Lee Davis Clinic
• Tues-OB Ultrasound Genesis
• Wed- Student Conference 1-5pm
• Thurs- Genetic counselling Genesis
• Fri- Preconception Counselling Genesis

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Objectives/Competencies

• Association of Professors in Gynecology and
  Obstetrics (APGO), Educational Objectives, 8th
  Ed.
• Council on Medical StudentEducation in
  Pediatrics (COMSEP), 2002
• Sections Issues Unique to the Newborn" and
  "Medical Genetics and Dysmorphology".

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Objectives Chart

• To include
• Objective/competency
• Method of Achieving Competency
• Method of Evaluation
• Integrated Longitudinal Issues
• Level Of Competency
• (BOLDmust know, fineshould know)

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The student will be able to
   
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Methods of Competency(methods by which students
will learn each objective)

• Clinical Observation (CO)
• Direct Patient Care (DPC)
• Case Discussion (CD)
• Didactic Time (DT)
• Self Study (SS)

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The student will be able to
   
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Methods of Evaluation

• Direct Observation (DO)
• Key Features Exam (KF)
• Multiple Choice Examination (MCQ)
• Oral Exam (OE)
• Objective Structured Clinical Exam (OSCE)
• Standardized Patient (SP)
• (From Methods of Evaluation and ACGME Toolbox of
  Assessment Methods Checklist, 2000 ACGME and
  ABMS. A product of the joint initiative of the
  ACGME Outcome Project of the Accreditation
  Council for Graduate Medical Education and the
  American Board of Medical Specialties (ABMS).
  Version 1.1.)
•  

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The student will be able to
   
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Integrated Longitudinal Curriculum

• 1. Disease Prevention and Health Promotion
• 2. Evidence Based Medicine
• 3. End of Life Care
• 4. Ethics
• 5. Nutrition
• 6. Pain Management
• 7. Pathology and Laboratory Medicine
• 8. Patient Safety and Medical Error
• 9. Professional Communication
• 10. Radiology
• 11. System Based Practice

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The student will be able to
   
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Common DiagnosesObstetrics

• Pregnancy
• Labor
• Ectopic pregnancy
• Spontaneous abortion
• Medical/Surgical conditions of pregnancy
• Diabetes mellitus
• Urinary tract disorders
• Herpes
• Rubella
• Group B Streptococcus
• Hepatitis

• HIV
• Cytomegalovirus
• Toxoplasmosis
• Varicella
• Parvovirus
• Cardiac Disease
• Asthma
• Alcohol, tobacco, substance abuse
• Surgical abdomen
• Preeclampsia-eclampsia
• Isoimmunization
• Multifetal gestation

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Common DiagnosesObstetrics (cont)

• Fetal death
• Non reassuring fetal heart rate pattern
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
• Abnormal labor
• Shoulder dystocia
• Umbilical cord prolapse
• Third trimester bleeding
• Abruptio placentae
• Placenta previa
• Preterm labor
• Incompetence cervix

• Premature rupture of membranes
• Postpartum hemorrhage
• Postpartum infection
• Postpartum depression
• Postterm pregnancy
• Fetal macrosomia
• Fetal growth restriction
• Mastitis

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Common Diagnoses Newborn

• Newborn History and Physical Exam
• Normal newborn care
• Fetal growth retardation
• Birth Trauma
• Respiratory Conditions
• Infections specific to the Newborn
• Hemolytic Disease of the Newborn
• Perinatal Jaundice
• Feeding Problems

• Endocrine and Metabolic Disturbances specific to
  the Newborn
• Hematological Disorders of the Newborn
• Perinatal Disorders of the Digestive System
• Conditions involving the Integument and
  Temperature regulation
• Drug Exposure of the Newborn
• Chromosomal Anomalies
• Congenital Anomalies

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Lecture Topics

• Obstetrics
• Normal and Abnormal Labor
• Premature Ruypture of Membranes/Premature labor
• Abruption/Placenta Previa/PPH
• HTN, Preeclampsia Complicating Pregnancy
• Diabetes Complicating Pregnancy
• Postdate Pregnancy
• Fetal Growth Problems IUGR/Macrosomia
• Multiple gestation
• Operative Delivery Cesarean Section/Forceps/Vacuu
  m
• Fetal EvaluationUltrasound/Monitoring
• Patient Safety/Medical Error

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LECTURE TOPICS

• NEWBORN
• Newborn History and Physical ExamAssessment of
  Gestational Age/ Transition of Newborn from
  Intrauterine to Extrauterine Environment
• Care of the NewbornFeeding/elimination/sleep
  patterns/skin care
• Newborn screening tests/Newborn safety/
  AnticipatoryGuidance/immunizations/circumcision
• Common Newborn ProblemsJaundice/Respiratory
  Distress/Feeding Problems/Sepsis and Newborn
  Infection/LGA/SGA babiesPreterm
  infant/congenital heart defects
• Common Malformation Syndromes and Chromosomal
  Abnormalities