Core
Required
Rotation:
Block Rotation
OBSTETRICS (MATERNITY CARE)
1) Location: North Colorado Medical Center
2) Duration:
a) R1 year: two 4-week blocks, and night OB call when on Gyn rotation
b) R2 year: OB call and labor deck coverage on ICN
c) R3 year: two 4-week blocks
3) Goals and Objectives. By graduation, each resident is expected to demonstrate the following level of
general and specific competence (categories based on the ACGME Competencies).
a) Medical Knowledge.
i) Demonstrates good knowledge of basic and clinical sciences, uses textbooks and evidencebased resources to supplement knowledge; demonstrates good understanding of complex
relationships and disease processes.
ii) Medical Knowledge Competencies specific to this rotation include demonstrated knowledge
(and application of knowledge to patient care) in the following areas:
(1) Complications of pregnancy:
(a) Gestational hypertension including preeclampsia and eclampsia
(b) gestational diabetes
(c) spontaneous abortion
(d) placenta previa
(e) abruptio placenta
(f) IUGR
(g) multiple gestation
(h) abnormal presentation
(i) blood group incompatibilities
(j) inadequate psychosocial support systems
(k) fetal demise
(2) Complications of labor and delivery:
(a) premature labor
(b) post dates pregnancy
(c) fetal distress
(d) abnormal progress of labor
(e) abnormal presentation
(f) premature rupture of membranes
(g) gestational hypertension including preeclampsia and eclampsia
(h) appropriate fetal monitoring
(i) techniques of augmentation/induction of labor
(j) dystocia
(k) cord problems
(l) retained placenta
(3) Postpartum complications:
(a) Hemorrhage
(b) Fever
(c) Depression
(d) Lactation
(e) contraception/family planning
(4) demonstrate knowledge of management of medical problems in the pregnant patient such
as thyroid disease, preexisting hypertension or diabetes, asthma, and the surgical
abdomen; to include appropriate consultation
(5) demonstrate knowledge of drugs which may or may not be used in pregnancy.
b) Patient Care.
i) Consistently develops an effective therapeutic relationship with patients and families that
includes sensitivity to culture, age, gender and disability; gathers essential and accurate
information from the patient and other sources (labs, xray, old records, family); develops a
detailed differential and is able to prioritize that differential based on urgency and likelihood;
develop a comprehensive treatment plan that incorporates patient preferences and health care
maintenance/disease prevention (when appropriate); appropriately involves consultations in
the care of patients.
ii) Performs accurate and complete physical exams; demonstrated competence to perform simple
procedures and more complex procedures that the resident plans to include in his/her future
practice (including knowledge of indications, contra-indications, appropriate consent,
complications (and how to address them), and follow up).
iii) Patient Care competencies specific to this rotation are predominantly focused on care of the
maternity patient and are accomplished through:
(1) The management of at least fifteen women from the resident’s own panel beginning with
the diagnosis of pregnancy and continuing through the prenatal, intrapartum, and
postpartum period.
(2) The management of at least one hundred labors and deliveries over the course of three
years, including appropriate utilization of fetal monitoring techniques.
(3) Demonstrate competence in common procedures in maternity care, including:
(a) Normal spontaneous vaginal delivery
(b) Vacuum-assisted vaginal delivery
(c) Surgical assisting for cesarean delivery
(d) Episiotomy and repair
(e) Repair of perineal, vaginal and cervical lacerations
(f) Manual extraction of retained placenta
(g) Local anesthesia and pudendal anesthesia
(4) Demonstrate proper utilization of narcotics, pudendal, epidural and local anesthesia
during labor and delivery
(5) Demonstrate initial skills (competence depending on interest, experience, and desire to
include in future practice) in:
(a) Forceps assisted vaginal delivery
(b) Postpartum tubal ligation
(c) Cesarean delivery
c) Practice-Based Learning and Improvement. Investigates and evaluates his/her own patient care,
appraises and assimilates scientific evidence, and uses this information to work toward
improvements in patient care.
d) Interpersonal and Communication Skills.
i) Written documentation/communication is legible, timed and dated, complete (but with
appropriate conciseness), accurate and using appropriate language and abbreviations. Verbal
communication with patients, families, and members of the healthcare team are respectful and
effective (including effective presentation skills). Keeps supervising physicians up to date on
patients.
ii) Interpersonal/Communication skill competencies specific to this rotation include,
demonstrated ability
(1) To prepare patients and their families to deal with the stress of pregnancy on the family
system.
(2) The ability to include and support other family members.
(3) To support patients through the prenatal, labor and delivery and postpartum process.
(4) Demonstrated ability to identify and address inadequate social resources and normal and
abnormal family-infant bonding.
e) Professionalism. Consistently on-time, works hard, able to identify required tasks and complete
them in a timely and efficient manner; team-oriented and willing to assist with work load as needed
to optimize team function; able to identify need for help and request it; demonstrates a positive
attitude and interactions with team members; adheres to ethical principles in the course of his/her
f)
practice; identifies and progresses toward personal educational goals; is receptive to, seeks, and
incorporates feedback.
Systems-Based Practice.
i) Demonstrates an awareness of the larger healthcare system, assists patients in dealing with
system complexities through the effective use of hospital and community resources;
participates in some system improvement through identification of errors and system problems
and initial discussion of potential system improvements; acts as an effective teacher of junior
residents and other members of the healthcare team.
ii) Systems-Based Practice competencies specific to this rotation include:
(1) Demonstrated ability to utilize hospital and community resources such as social work,
First Steps, WIC, and Child Protective Services.
(2) Incorporate consultation (with OB, perinatology, other specialists, and allied health
specialties) when appropriate, to manage the complications of pregnancy, labor, delivery
and postpartum care.
(3) Using the evidence base to prepare and present topics for daily didactic rounds and
demonstrating effective teaching skills in this setting and in the supervision of junior
residents and medical students on the labor deck.
4) Methods:
a) The resident spends two 4-week blocks on obstetrics during the R1 year. During the R2 year, the
resident spends two 4-week blocks on intensive care nursery (ICN), which due to the nursery’s
proximity to the labor deck, allows the resident to participate in obstetrics call and coverage of the
labor deck while maintaining an active presence in the nursery and at all high risk deliveries.
During the R3 year, each resident spends two 4-week blocks as the “OB Chief”. The OB Chief
and family medicine attending are available to assist junior residents in patient management and
attend all of their deliveries on NCFM, Weld County Health Department, and Sunrise patients.
The OB Chief also participates in all C-sections and postpartum tubal ligations performed at North
Colorado Medical Center.
b) Daily pediatrics and obstetric lectures are held in conjunction with combined morning rounds.
Once per week, the topic includes review of fetal monitor strips.
c) While on service, the residents are responsible for antenatal outpatient visits to the labor deck,
labor and delivery, and postpartum care of all patients of the Weld County Health Department,
Sunrise Community Health Center, and Salud clinic, under the supervision of the OB Chief and
family practice attending.
d) While on service the resident on call is responsible for the care of all patients in labor, unless
specifically requested by the patient’s attending. The attending of record will be the supervisor
with whom the resident will work on any given patient. Care of patients from North Colorado
Family Medicine, Sunrise Community Health Center, and Weld County Health Department is
supervised by the family medicine faculty member on service with consultation from the
obstetrical staff at North Colorado Medical Center as indicated.
e) Other experience in obstetrics includes:
i) Residents are responsible for the prenatal care, labor and delivery, and postpartum care of
their own patients from the Family Practice Center.
ii) Urgent and emergent obstetrical topics are part of the core didactic curriculum and occur
within the first two to three months of every academic year, so that residents have early
exposure to the subject matter.
5) Evaluation: This curricular area is evaluated as outlined in the policy “Evaluation of Residents”.
SG
Reviewed and Approved:
H. Daniel Fahrenholtz, MD, MBA, Program Director