The UF Experience: Breastfeeding Curriculum Is Not Optional
1
DO ,
1
IBCLC ,
1
MD ,
1
MD ,
2
PhD
Elizabeth Davis,
Mary Ryngaert, ARNP,
Karen Bodnar,
Meredith Mowitz,
Randy Graff,
and
1
Sandra Sullivan, MD, IBCLC , (1)Pediatrics (2)Academic Information Systems Support, University of Florida, Gainesville, FL
ABSTRACT
Case Report: We present our experience with a 2-phase implementation of a breastfeeding curriculum for pediatric residents.
Discussion: Inclusion of breastfeeding material into the current residency curriculum was enthusiastically support by the program. As is the case with many
teaching institutions, our newborns are seen in the "acute clinic" until an opening is available with their continuity clinic resident. For many reasons, including
time constraints, infectious environment, lack of continuity, and absence of breastfeeding knowledge, we moved newborn visits into our new Breastfeeding and
Newborn Clinic (BNC), staffed by a Pediatric Nurse Practitioner who is also an International Board Certified Lactation Consultant. Patients are often recently
discharged from the nursery by the same resident, improving the continuity of care. We incorporated many components of the AAP Breastfeeding Residency
Curriculum into our current Newborn Nursery (NBN) Rotation in 2 phases. Phase 1 began July 2009 and included: written pre- and post-tests for all
residents. Residents were required to attend 2 BNCs, complete Wellstart modules 1, 2 , and 3, choose 4 of 6 chapters from the Washington Breastfeeding
Coalition discs, watch 2 videos and shadow the hospital lactation consultant for a half day. This was to be completed over 2 years of residency. BNC was
overwhelmingly well-received by resident reports. However, CDs and DVDs were difficult to keep secure yet allow easy access. We did not have a useful way to
track progress through the individual components of the curriculum and tests. Therefore, for phase 2, beginning July 2010, we enlisted the help of e-learning
experts to develop an online course that would allow residents to work through the curriculum at their convenience and incorporate clinical experiences into the
course requirements. An online forum would allow for better utilization of videos, better tracking of pre- and post-tests, and potential chat/discussion rooms for
residents. Changes in specific components are anticipated as follows: pre- and post-tests will be formatted as online surveys, with feedback, consisting of
randomly selected questions from a bank of questions from the AAP curriculum, journal writing assignment of experiences in the clinic, addition of 3-5 question
formative assessments from the Wellstart curriculum, and reflective writing assignments associated with other components will be required. Future Directions:
One resident is monitoring progress of her colleagues as part of her advocacy project. She will be analyzing pre- and post-test scores and attitudes after approval
from IRB. Another resident is developing an advanced elective and a medical student introduction to breastfeeding medicine.
INTRODUCTION
We present our experience with the first of a 2-phase
implementation of breastfeeding curriculum for pediatric
residents. We incorporated many components of the AAP
Breastfeeding Residency Curriculum into our current Newborn
Nursery (NBN) Rotation, while adding material from other
sources and instituting a “Breastfeeding Clinic”.
Phase 1, July 2009: Institute curriculum in paper/CD format
Phase 2, July 2010; Development of an online course
RESULTS
CURRICULUM
KNOWLEDGE: MEAN TEST SCORES
Pre-test in July each year
Post-test following NBN rotation each year
PRETEST
90
PGY-1:
Attend 2 breastfeeding clinics, Shadow hospital IBCLC ½ day
Complete Wellstart module 1
Complete 2 of the following from WBC discs: Immunology of
human milk, Glucose, or Feeding the late preterm
Watch video: “Baby-led Breastfeeding: The Mother-Baby Dance”
Assemble and operate the manual/electric breast pumps provided
by our hospital
83
75
75
PGY-1
PGY-2:
Attend 2 breastfeeding clinics
Complete Wellstart module 2
Complete 2 of the following from WBC discs: Medications and
contraceptives, Breast pain, or Insufficient weight gain
Watch video: “Breastfeeding Management, Educational Tools for
Physicians and Other Professionals”
PGY-3:
Review case scenarios in Wellstart module 3
MATERIALS
1. AAP Breastfeeding Residency Curriculum www.aap.org
2. The Revised 3rd Edition of Wellstart’s Lactation Management SelfStudy Modules, Level 1, Wellstart International, www.wellstart.org
3. Lactation Education for Physicians 2 CD set, Washington
Breastfeeding Coalition
4. “Baby-Led Breastfeeding: The Mother-Baby Dance”,
Christina Smillie, MD
5. “Breastfeeding Management, Educational Tools for Physicians and
Other Professionals”, Jane Morton, MD
POST-TEST
PRETEST
POST-TEST
(MEAN % + SD) (MEAN % + SD)
2009 PGY-1
2009 PGY-2
2009 PGY-3
(N=3)
2010 PGY-1
P VALUE
75 + 12.3
75 + 12.05
87
83 + 8.79
90 + 6.65
---
0.1775
0.0049
---
74 + 9.92
---
---
This project was funded by grants from W. K. Kellogg Foundation, Thomas H. Maren Foundation, and Children’s Miracle Network.
PGY-2
MODIFICATIONS
•Clinic was overwhelmingly well-received by resident reports
•Expanded opportunities, 5 days per week
•Development of online course:
•remedy access issues to CDs & DVDs, tracking of individual
progress, tracking of test completion & scores
•relieve labor intensive monitoring of each resident’s progress by
Dr. Davis (her advocacy project)
• enhance learning by:
• providing feedback for online pre- and post-tests
• personalize clinic (and other) experiences with reflective writing
assignments
• incorporate 3-5 question formative assessments throughout the
Wellstart modules
• fostering more independent study of material at residents’
convenience
• Advanced elective in breastfeeding medicine
• Medical student introduction to breastfeeding medicine lecture