University of Pennsylvania Family Medicine Residency Obstetrics Curriculum

All family medicine residents at the University of Pennsylvania must become capable of managing normal pregnancy and delivery, including the ability to manage common problems of prenatal and postnatal care. The resident must also demonstrate an under-standing of the biological and psychosocial impacts on a woman and her family of preg-nancy, delivery, and care of the newborn. The following block and longitudinal elements of the curriculum must be completed by all residents. Core competencies related to pro-fessionalism and interpersonal and communication skills are expected throughout the residency.

Advanced Life Support in Obstetrics.

All PGY1 residents will become ALSO certified prior to their initial obstetrics rotation. This course includes specific didactic and practical experience with: intrapartum fetal monitoring, shoulder dystocia, assisted delivery, first-trimester complications, medical complications of pregnancy, recognition and manage-ment of postpartum hemorrhage, and safety in maternity care (including systems of care, error reduction and collaborative practice.)

Labor floor blocks

Each resident will complete five labor floor blocks, including one on HUP’s OB service (SEE PGY1 HUP OB), one at Pennsylvania Hospital (see PGY1 Pennsy OB), one (PGY1) on the Family Medicine OB service at HUP including OB night float call for Family Medicine, and two (PGY2) Family Medicine OB/newborn nursery.

Inpatient block learning objectives include:

• Residents should pursue a minimum of 10 vaginal deliveries during each of their three primary PGY1 inpatient blocks.
• Diagnosis and management of labor
• Evaluation and management of P/PROM
• Diagnosis and management of preterm labor
• Recognition and management of labor pain
• Recognition and management of vaginal bleeding in pregnancy
• Diagnosis and management of pre-eclampsia
• Intrapartum fetal monitoring
• Performance of intrapartum ultrasound for determination of presentation and AFI
• Indications for and methods of induction including foley bulb insertion, misoprostol, prostaglandin and pitocin use.
• Facility with intrapartum procedures including fetal scalp electrode placement, intrau-terine pressure transducers, amniotomy, vacuum placement, laceration repair, and normal vaginal deliveries.
• Postpartum care
• Assistance at cesarean section
• Care of the newborn, including recognition and management of common newborn problems
• Circumcision
• Appropriate use of consultations

Continuity Patient Care Penn Family Care

Residents are required to manage a minimum of ten continuity patients over their three year residency. PGY1’s may accept assignment of prenatal patients only after completion of their initial HUP OB block and when the patient’s EDC is after July 1 of the resident’s PGY2 year. Residents are re-quired to maintain a list of their active prenatal patients and to precept these patients at each visit both with the office preceptor and a PFC OB faculty member.

OB Conference Series: Residents are required to attend and participate in monthly OB conferences. Topics addressed during these conferences include office based prenatal care, risk assessment, genetic assessment among others.

OB call/OB night float HUP

Residents on OB call for Penn Family Care are required to perform initial triage and management of Penn Family Care patients presenting to la-bor and delivery.

Procedure Block Penn Family Care: Ultrasound determination of fetal life.

Other (Board Review, Quality Improvement, Case Conference)

PGY2 and 3 residents are periodically required to present cases, perform quality improvement activities and or participate in structured intraining exam review on obstetrics.

Obstetrics Electives

Residents who choose may design electives in obstetrics to fit their individual learning requirements. Guidelines for Additional Training in OB are on this web.

Required Reading:

• Ratcliffe et.al. Family Practice Obstetrics, 2nd ed., 2003
• ALSO course syllabus, 2003
• AAFP Maternity and Gynecology suggested core curricular guidelines
• ACOG Technical Bulletin 54, VBAC
• Seeking and Giving Consultations, in Ethics in Obstetrics and Gynecology, 2nd edition, ACOG 2004
• Guidelines for staffing labor and delivery for Penn Family Care Obstetric Patients.

Evaluation

Residents are evaluated on all block rotations using residency evaluation forms by attending physicians and supervising residents as appropriate. Continuity care is evaluated longitudinally by office preceptors. Resident procedure logs, EPIC records, inpatient documentation, intraining scores and REACH performance review is used to evaluate progress in non-block elements.