Download Obstetrics (3rd month) Description

Obstetrics (3rd month)
Description
The goal of the a 3rd month Obstetrics rotation is to provide learning opportunities that will enable
residents to develop skills required for the practice of advanced low risk obstetrics.
Objectives
By the completion of these rotations, residents will be able to:
Family Medicine Expert
Pre-conception and pre-natal care
MAT1 Provide pre- and early-pregnancy counseling
1.1
Pre- and early pregnancy counseling: Provide care for pre-pregnancy planning
including addressing issues such as lifestyle, exercise, dietary options/suggestions (eg
folate, Vitamin D, multivitamin use) environmental factors (smoking, pets, infectious
diseases, alcohol, radiation or chemical exposures), teratogenic medications (including
isotretinoin/Accutane, angiotensin converting enzyme (ACE) inhibitors,
misoprostol/diclofenac) and anti-epileptic medications.
1.2
Pre- and early pregnancy vaccination: Offer pre-pregnancy immunizations (eg
Measles-Mumps-Rubella for non-immune women, influenza vaccination to protect
women when pregnant).
1.3
Work issues relevant to pregnancy: List exposures (work, home - toxins, mutagens,
infections eg Parvovirus) needing to be managed and employment and maternity leave
issues pertinent to patients who intend to become pregnant or who are pregnant.
1.4
Infertility and repeat pregnancy loss: Provide support and perform initial investigation
regarding infertility and repeat pregnancy losses.
MAT2 Confirm and date pregnancies
2.1
Confirmation and dating: Confirm and date pregnancies accurately, and if dates are
uncertain consider ordering an early dating ultrasound.
MAT3 Perform early pregnancy counselling
3.1
Family Structure and dynamics: Assess family structure, family dynamics (including
between partners) and stresses and supports facing the pregnant patient.
3.2
Pregnancy desirability: Establish the desirability of the pregnancy in a patient with
suspected or confirmed pregnancy. Ascertain whether the pregnancy is planned or unplanned.
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3.3
Pregnancy options: Demonstrate an open-minded and non-judgmental attitude when
discussing all pregnancy options including pregnancy termination, and adoption.
3.4
Infertility and repeat pregnancy loss: Provide support and perform initial investigation
regarding infertility and repeat pregnancy losses.
MAT4 Plan and comprehensive pre-natal care to low risk female patients
4.1
Prenatal Visits (Schedule, Purpose): Plan an appropriate prenatal visit schedule for a
pregnant patient, and outline the purpose of each visit.
4.2
Common prenatal office-based maneuvers: Perform and interpret key pregnancyrelated office based screening questions, examination techniques and investigations to
screen for conditions relevant to maternal and fetal well- being (including fetal movement
counts, symphysis fundal height, maternal weight, use of Doppler to assess fetal heart
rate).
4.3
Pregnancy risk stratification: Describe maternal and fetal criteria for a pregnancy to be
considered "low risk" and criteria for pregnancy to be considered "high risk" and requiring
obstetrical specialty consultation.
4.4
Prenatal screening: Counsel patients on common tests ordered in pregnancy including
Integrated Prenatal Screening (IPS) tests, genetic screening, ultrasounds, and other
screening tests including laboratory investigations.
MAT5 Manage concurrent medical conditions in pregnant patients
5.1
Manage chronic concurrent medical conditions in pregnancy: Appropriately manage
ongoing medical issues (eg diabetes, HTN, hypothyroidism, asthma, inflammatory bowel
disease, epilepsy, cardiac conditions, and depression) whose management may affect or
be affected by pregnancy. Refer to specialist colleagues as appropriate.
MAT6 Identify, evaluate and manage early pregnancy problems
6.1
Nausea and vomiting of pregnancy: Assess and manage nausea and vomiting of
pregnancy.
6.2
Ectopic pregnancy: Identify ectopic pregnancy and appropriately refer for management
6.3
First trimester bleeding: Diagnose and manage first trimester bleeding appropriately
(including threatened and missed abortions). For patients who experience miscarriage
offer empathic, supportive counseling and advice and management plan.
6.4
Rh status: Diagnose Rh status and counsel women on role of Rh status. Manage Rhnegative status including discuss benefits and risks of Rhogam or Winrho.
MAT7 Identify, evaluate and manage late pregnancy problems
7.1
Abnormal lie: Describe and diagnose an abnormal lie (including transverse lie). Propose
appropriate management plan for abnormal lie.
7.2
Breech presentation: Describe management plan for breech presentation.
7.3
IUGR: Describe characteristics of Intrauterine Growth Retardation (IUGR), its diagnosis,
prevention and management.
7.4
Gestational hypertension: Describe approach to diagnosis and management of
gestational hypertension / pregnancy induced hypertension, including pre-eclampsia.
Updated: February 2016
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7.5
Placenta Position: Recognize significance including risks of placenta and placenta
previa, and describe approaches to counseling and managing these patients.
7.6
GDM: List risk factors for Gestational Diabetes Mellitus (GDM). Order screening tests for
GDM, and list implications (for mother and baby) of GDM in the long term care of the
patient and post-partum follow-up of affected individuals.
7.7
Manage Acute Maternal Infections during pregnancy: Describe key infections that
might affect the pregnancy (eg TORCH infections, Parvovirus B19 – Fifth`s disease,
Listeria, Influenza, varicella, urinary tract infections, bacterial vaginosis, Group B strep
infections) and how to prevent these infections, and appropriately manage the infections
when they are acquired.
7.8
STIs in pregnancy: Screen, diagnose, and manage sexually transmitted infections
(STIs) in pregnancy.
7.9
Antepartum hemorrhage (APH): Recognize, diagnose and manage antepartum
hemorrhage appropriately in a timely fashion.
7.10
Premature rupture of the membrane (PROM): Describe approach to diagnosis and
management of premature rupture of membranes.
7.11
Preterm labor: Counsel patients on preterm labor, and how to recognize and manage
this appropriately.
7.12
Post-dates: Describe and approach to managing post-dates pregnancies, including
indications for fetal assessment and induction.
Intrapartum
MAT8 Confirm, monitor and manage labour
8.1
Stages of labour: List and describe different stages of labour.
8.2
Fetal membranes: Assess for spontaneous rupture of membranes.
8.3
Cervical assessment: Perform vaginal examination for cervical status (position,
effacement, cervical dilation), fetal station and position.
8.4
Analgesia during labour: Describe different forms of pharmacologic (including epidural)
and non-pharmacologic means to control pain and discomfort during labour and delivery.
8.5
Fetal surveillance: Perform basic fetal surveillance including intermittent auscultation
and electronic fetal monitoring, including scalp electrode placement. Recognize
concerning patterns and respond appropriately to these.
8.6
Failure to progress: Describe risk factors for an abnormal or difficult childbirth or labour.
Recognize failure to progress and when appropriate treat by non-pharmacologic means
and pharmacologic means, including oxytocin.
8.7
Induction: Manage induction for postdates or ruptured membranes at term, including the
use of cervical ripening, amniotomy and oxytocin.
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MAT9 Manage spontaneous vaginal delivery
9.1
Manage spontaneous term singleton vertex delivery (including delivery of the placenta)
and immediate care and after care of mother and baby.
9.2
With consultation, manage VBAC (vaginal birth after C-section) delivery
9.3
With consultation, manage spontaneous vaginal delivery of twins.
MAT10 Manage obstetrical emergencies
10.1
Shoulder dystocia: Recognizes and manages shoulder dystocia (including request for
assistance)
10.2
Nuchal cord: Recognizes and manages a nuchal cord at delivery
10.3
Prolapsed umbilical cord: Describe an approach to recognizing and providing
emergency management for a prolapsed umbilical cord.
10.4
Intra-partum fever and infection: Choose appropriate cultures to perform, and manage
acutely and empirically if necessary. Manage prolonged rupture of membranes
appropriately.
10.5
Retained placenta: Recognize retained placenta and perform manual removal a retained
placenta.
10.6
Post-Partum Hemorrhage (PPH): Describe risk factors and approach to diagnosis,
prevention and management of immediate and later postpartum hemorrhage.
10.7
Breech management: Recognize and manage pre-partum breech presentation with
appropriate referral. Explain the management of an emergency vaginal breech
presentation.
10.8
Support of newborn: Anticipate and prepare for the at-risk or depressed newborn.
MAT11 Perform episiotomy and perineal repair
11.1
Episiotomy: Describe the indications for an episiotomy, and perform one as required.
11.2
Perineal injury: Assess the degree of perineal injury
11.3
Repair: Repair 1st, 2nd or 3rd degree lacerations or episiotomy.
MAT12 Participate in operative delivery
12.1
Assisted Vaginal Delivery: Describe indications and contraindications for use of outlet
vacuum or forceps assistance for a low assisted vaginal delivery. Perform vacuum
assisted delivery and outlet forceps delivery as indicated.
12.2
Cesarean section: Describe indications for caesarian section. Provide assistance at
cesarean section.
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Postpartum
MAT13 Provide basic postpartum care in both the hospital and office environments
13.1
Anticipatory guidance: Provide anticipatory guidance regarding common maternal
concerns.
13.2
Breastfeeding: Encourage breastfeeding, develop strategies to promote this, and
prevent breast feeding difficulties, and help women with breastfeeding difficulties.
13.3
Post-partum medical complications: Diagnose and manage key maternal post-partum
complications including pain, fever, urine retention, bleeding, delayed hemorrhage,
infections, and uterine rupture.
13.4
Post-partum visits: At postpartum visits demonstrate an organized approach to
following up maternal complications during the pregnancy and providing preventative
care.
13.5
Mood post-partum: List risk factors for postpartum depression. Screen for, assess and
manage post-partum support and depression (using common tools such as depression
screening scales).
Communicator
FAM10. Establish effective professional relationships with patients and their families
10.1
Patient centered approach: Communicate using a patient-centered approach that
encourages patient trust and autonomy and is characterized by empathy, respect, and
compassion
10.2
Environment: Optimize the physical environment for patient comfort, dignity, privacy,
engagement, and safety
10.3
Patient perspectives: Recognize when the values, biases, or perspectives of patients,
physicians, or other health care professionals may have an impact on the quality of care,
and modify the approach to the patient accordingly
10.4
Non-verbal communication: Respond to a patient’s non-verbal behaviors to enhance
communication
10.5
Disagreements: Manage disagreements and emotionally charged conversations
10.6
Adapt communication: Adapt to the unique needs and preferences of each patient and
to his or her clinical condition and circumstances
FAM11. Elicit and synthesize accurate and relevant information, incorporating the
perspectives of patients and their families
11.1
Patient-centered interviewing: Use patient-centered interviewing skills to effectively
gather relevant biomedical and psychosocial information
11.2
Structure of interview: Provide a clear structure for and manage the flow of an entire
patient encounter
11.3
Corroborating information: Seek and synthesize relevant information from other
sources, including the patient’s family or caregivers, with the patient’s consent
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FAM12. Share health care information and plans with patients and their families
12.1
Sharing information: Share information and explanations that are clear, accurate, and
timely, while checking for patient and family understanding
12.2
Disclosure: Disclose harmful patient safety incidents to patients and their families
accurately and appropriately
MAT14. Engage patients and their families in developing birth plans that reflect the
patient’s health care needs and goals
14.1
Birth plans: Understand the role of “birth plans” and review this with patients, and
communicate it to the other health care team members.
14.2
Cultural safety: Facilitate discussions with patients and their families in a way that is
respectful, non-judgmental, and culturally safe
14.3
Information technology and decision making: Assist patients and their families to
identify, access, and make use of information and communication technologies to support
their care and manage their health
14.4
Consumer health information: Analyze consumer health information that is evidencebased and able to review such information with patients
14.5
Common ground: Use communication skills and strategies that help patients and their
families make informed decisions leading to a shared plan of care.
Collaborator
FAM13. Work effectively with physicians and other colleagues in the health care
professions
13.1
Relationship: Establish and maintain positive relationships with physicians and other
colleagues in the health care professions to support relationship-centered collaborative
care
13.2
Shared decision-making: Negotiate overlapping and shared responsibilities with
physicians and other colleagues in the health care professions
13.3
Respect: Engage in respectful shared decision-making with physicians and other
colleagues in the health care profession
13.4
Positive working environment: Implement strategies to promote understanding,
manage differences, and resolve conflicts in a manner that supports a collaborative
culture
FAM14. Hand over the care of a patient to another health care professional to facilitate
continuity of safe patient care
14.1
Timing of transfers: Determine when care should be transferred to another physician or
health care professional
14.2
Safe transfers: Demonstrate safe handover of care, using both verbal and written
communication, during a patient transition to a different health care professional, setting,
or stage of care
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Leader/Manager
FAM17. Engage in the stewardship of health care resources
17.1
Resource Allocation: Allocate health care resources for optimal patient care, including referral
to other health care professionals and community resources
17.2
Cost appropriate care: Apply evidence and management processes to achieve cost-appropriate
care
Health Advocate
FAM21. Respond to an individual patient’s health needs by advocating with the patient within
and beyond the clinical environment
21.1
Determinants of health of individuals: Work with patients to address determinants of health
that affect them and their access to needed health services or resources


Community resources: Demonstrate awareness of community resources to help support
patients. Recognize the indications for these services and advocate effectively
Barriers to care: Identify barriers that prevent patients from accessing healthcare, including
financial, cultural or geographic
Scholar
FAM24. Integrate best available evidence, contextualized to specific situations, into real-time
decision-making
24.1
Identifying learning gaps: Recognize practice uncertainty and knowledge gaps in clinical and
other professional encounters and generate focused questions that can address them
24.2
Pre-appraised information: Demonstrate proficiency in identifying, selecting, and navigating
pre-appraised resources
24.4
Integrating evidence: Integrate evidence into decision-making in their practice by review and
appropriately applying guidelines from organizations such as Health Canada, the College of
Family Physicians of Canada, and the Society of Obstetricians and Gynecologists of Canada
(SOGC).
Professional
FAM27. Demonstrate a commitment to patients
27.1
Professional behaviors: Exhibit appropriate professional behaviors and relationship in all
aspects of professional practice, reflecting honesty, integrity, commitment, compassion, respect,
altruism, respect for diversity, and for maintenance of confidentiality.
27.2
Excellence: Demonstrate a commitment to excellence in all aspects of practice.
27.3
Ethical issues: Recognize and respond to ethical issues encountered in practice.
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Entrustable Professional Activities

Provide pre-conception and pre-natal care

Provide intra-partum care and perform low-risk deliveries

Recognize and manage common intra-partum emergencies

Provide postpartum care
Evaluation

Field Notes/End of Shift report

In-training Evaluation Report
Updated: February 2016
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