“Centering Pregnancy” as a Longitudinal Rotation A Recipe for Success Building a curriculum and milestone based evaluations Susan Hasti, MD Michelle Karsten, MD Anne DeNucci-Lushine, MA, IBCLC, ICCE

Our Centering Pregnancy Journey so far… A brief history Adding residents to the mix Making it an “official rotation”

Our CP Recipe Start a Centering Pregnancy program 2008 One FM faculty, one FM Nurse Practitioner Suboptimal space Typical successes and “opportunities” MK-CP prenatal assignments competed for resident assignments

Now add residents to the mix… 2013 residents assigned to CP groups 6 groups per year 2 residents per group SH- Problems: Who attends deliveries and gets “credit” for a primary delivery Confusion of check ins No clear ownership by the resident. Scheduling issues

Simmer residents with CP Attempt to achieve “ownership” In 2014 increased to 12 groups per year Every resident got his/her “own” group Recruited 2 additional faculty problems: Some residents “coasted” Scheduling conflicts with “official rotations” Persistent lack of ownership in some residents. No formal way to give feedback, positive or negative to resident.

Promote resident to head chef Development of written expectations Formal evaluation of the residents Building the rotation Identification of milestones that fit CP Goals and Objectives Evaluation tools Raised the profile of Centering within the curriculum

Which ingredients (milestones) to use??? Patient Care – we chose PC3 MK2 PBLI 2? 3? SBP 1? 2? 3? 4? PROF 2? 3? 4? C 1? 2? 3? 4? SH

Has not achieved level 1 Level 1 ( Novice) Beginning resident PC 3. Partners with the patient, family, and community to improve health through disease prevention and health promotion Has not achieved level 1 Level 1 ( Novice) Beginning resident Level 2 ( Competent) Junior resident Level 3 (Proficient ) Senior resident Level 4 ( Expert) Graduating resident Level 5 (Master) Personal Physician   Resident takes a comprehensive prenatal intake history and identifies health risk factors and social determinants of health Resident follows prenatal guidelines for appropriate testing throughout pregnancy and post-partum care Resident actively participates in group, using facilitative techniques to promote healthy behaviors for pregnancy Resident mobilizes the health care team for optimal prenatal care Physician partners with the community to offer improvements to the Centering program at Whittier Resident performs initial exam and subsequent prenatal exams Resident manages health conditions and prenatal complications in a group visit Resident actively participates in group to help patients identify barriers, manage conflicting needs and set goals for healthy pregnancies Resident attends to patient privacy during the exam in group setting Level selection

Our progress so far… 2 residents completed the formal rotation Evaluations sent to faculty through RMS Identified lack of MA and co-facilitator input (360 review) New tool to be launched for MA/RN feedback

Dr. Yamanaka: our first head chef “we had a very very intense event in this group… he was a very compassionate and competent provider to this patient throughout her pregnancy and she trusted him very much”

Contacts Michelle Karsten michelle.karsten@hcmed.org Susan Hasti susan.hasti@hcmed.org Anne DeNucci-Lushine Anne.deNucci-Lushine@hcmed.org