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