Evaluation for FM Residents on Community Maternity Rotations
Date of Rotation:
Dates of Call:
Clinic Site:
Preceptors:
Name of Resident:
Procedure/Clinical
Scenario
Standard prenatal care
(blood work, u/s,
counseling)
Genetic screening
APH
STD’s
Viruses in pregnancy
(parvo, varicella,
HepB, ect.)
Abnormal u/s (CPC,
Echogenic foci, UPJ,
ect.)
Glucose intolerance of
pregnancy
PIH/gestational
hypertension
IUGR/SGA
Previa/low lying
placenta
Preterm labour
Observed
Discussed
Thorough
Knowledge
Base
Needs
Additional
Review
Needs
Remedial
Work
Comments
Initials
Name of Resident: _____________________________________
Procedure/Clinical
Scenario
Discussed
Observed
Thorough Needs
Knowledge Additional
Base
Review
Needs
Remedial
Work
Comments
GBS
Induction of Labour
Breech
PPROM
Latent Phase
Dystocia in 1st Stage
Dystocia in 2nd Stage
Shoulder dystocia
PPH
VBAC
Vaginal Delivery
(number performed _____)
st
Repair 1 Degree Tear
Repair 2nd Degree Tear
Repair 3rd Degree Tear
Fetal Monitoring
(NST, in labour, ect.)
Assisted Vaginal
deliveries
(Mneumonics)
(number performed _____)
Initials
Name of Resident: _____________________________________
Procedure/Clinical
Scenario
Pain Management in
Labour
Discharge teaching
Infant exam
Communication/patient
interaction
Professionalism
COMMENTS:
Discussed
Observed
Thorough Needs
Knowledge Additional
Base
Review
Needs
Remedial
Work
Comments
Initials