Rebecca Newman, MD,FAAP Attending, Normal Newborn Nursery, Prentice Women’s Hospital, Northwestern Memorial Hospital

Rebecca Newman, MD, FAAP Prentice Women’s Hospital, Northwestern Memorial Hospital

 Why develop a curriculum  Who should develop a curriculum  How develop a curriculum  What should be in the curriculum  How to implement a curriculum  How to standardize the curriculum

 CDC ◦ Healthy People  American Academy of Pediatrics ◦ Section on Breastfeeding. Breastfeeding and the use of human milk(policy statement). Pediatrics. 2005;115(2):  U.S. Department of Health and Human Services. ◦ The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011  The Joint Commission ◦ exclusive breastfeeding as a (optional) performance measure

“The establishment and maintenance of breastfeeding should be one of the major goals of good post partum care.” “Inaccurate and inconsistent guidance from health staff has been recognized as a major obstacle to breastfeeding”

 Orientation and expectations  Breastfeeding is a core competency ◦ the best method of feeding ◦ Breastfeeding is a learned process that may take a mother-baby couplet days to weeks to perfect ◦ Newborns need very little nutrition in the first 3 days of life ◦ Treat babies by their behavior, gestational age, and alertness not by their birth weights and latch scores

Affect teaching styles Considered in development Provide for a better success

1. Visual learners are those who learn through seeing things 2. Auditory learners are those who learn best through hearing things 3. Kinesthetic learners are those who learn through experiencing/doing things

 Visual aid when studying ◦ colorful outline of test materials ◦ visual tools improve recall  Make outlines of everything!  Copy what's on the board  Ask the teacher to diagram  Take notes  Make lists  Watch videos

 Using word association to remember facts and lines.  Recording lectures.  Watching videos.  Repeating facts with eyes closed.  Participating in group discussions.  Follows spoken directions well.  Is not afraid to speak in class.

 Is fidgety during lectures  Can't sit still for long  Role playing  Studying with others

 In the best of all possible worlds, you would incorporate all three learning styles into each of your lessons.  Rule of Three’s ◦ 50% once ◦ 75% twice ◦ 90% thrice ◦ But if see, hear, and do 100%

 Visual Learner ◦ Written articles ◦ Online courses, PowerPoint presentations ◦ Bedside teaching  Auditory Learner ◦ Live lecture, PowerPoint presentations ◦ Bedside teaching ◦ Rule of three  Kinesthetic learner ◦ Case studies ◦ Family centered care ◦ Observing role modeling ◦ Lead care rounds

ACGMEAAP core competencies 1. Medical knowledge 2. Patient care 3. Interpersonal skills and communication 4. Practice-based learning and improvement 5. Systems-based practices  Residents must be able to ◦ Demonstrate knowledge about established science and apply to patient care ◦ Provide family centered patient care ◦ Use interpersonal communication skills with parents families and professional associates ◦ Use scientific evidence to improve patient care ◦ Exhibit a commitment to ethical principles and sensitivity to cultural diversity ◦ Practice quality care and advocate for patients

 Teach the basics ◦A◦Assume they know nothing ◦L◦Learn differently: oral/auditory/written ◦3◦3 times a charm rule of learning  R Role modeling ◦Y◦Your technique ◦Y◦Your nurses ◦Y◦Your breastfeeding counselor ◦Y◦Your lactation counselor ◦M◦Make them watch/ provide the opportunity/ protect the time

 One power point presentation  Daily sit down rounds  Daily bedside rounds  Patient consult with a lactation consultant  online course  The AAP pretest exam

 www2.aap.org/breastfeeding/curriculum/ www2.aap.org/breastfeeding/curriculum  The curriculum is flexible and can be implemented over 1 rotation, or entire length of residency  Planning tools: data collection  Evaluation tools: pre and post test  Teaching tools: case study, presentations

  Online  Free of charge  Printed certificate of completion  quite thorough  Likely mode of tracking for Baby Friendly ◦ after residency

Newborn care is always family centered? Family Centered Care Cincinnati Children’s Hospital

The challenges of breastfeeding Family Centered rounds

 Part of daily rounds and care plan  Examine mother’s breast development  Examine baby oral patterns and explain  stages of post partum recovery  Weight and output  Observe feeding daily

 The stages of postpartum recovery in the newborn and mother and its effect on breastfeeding ◦ Initial period of vigilance for 4 hour ◦ Second stage of recovery for 1-3 days ◦ Third stage of emergence on day 3 and the chemical markers  The effects of iatrogenic interference:  Type of delivery, induction, IVF  Maternal illness and meds  Gestational age  Painful procedures

 Scripts at sit down rounds ◦ “How is feeding?” ◦ “Are you feeling any pain?”-”May I examine your breast as well?” ◦ “How do you know when your baby is ready to feed?” ◦ “How many poop and pee diapers have you changed?” ◦ “What is your feeding plan for the day?” ◦ “Why did your baby stay in the nursery overnight last night?”  Bedside teaching  Role modeling ◦ Attending ◦ Nursing ◦ Breast feeding counselor ◦ Lactation consultant

Role modeling Protected time Practice and reinforcement

 Expectations  Protected session with LC, BFC ◦ Arrange, insist, follow up  Different patients-different problems-different solutions ◦ Gestational age ◦ Cultural differences  Caucasian  African -American,  Hispanic  indigenous Africans,  Indian,  Middle eastern, Muslim  Feed back session after LC and at the end of rotation ◦ Written ◦ Verbal

Multiple sites Multiple opportunity Multiple teachers

 Medical school rotations ◦ Obstetrics 1 month ◦ Pediatrics 1 month  N.I.C.U. ◦ 4-6 month rotation  Normal newborn ◦ 1 month rotation  Continuity clinic ◦ weekly for 3 years  Inpatient ◦ General pediatric medicine : 6 months

Wellstart International’s Lactation Management Self- Study Modules, Level 1, Third Edition 2009

◦ For official designation as a Baby Friendly®* Hospital by Baby- Friendly USA, Inc. (BFUSA) ◦ physicians involved in care of either mothers or babies in candidate hospitals, they must have at least 3 hours of acceptable breastfeeding management training.” ◦ by using current evidence-based self-study modules. ◦ Meets JACHO certification

 To facilitate record keeping, ◦ has developed a Certificate of Completion process. ◦ A “final exam” is available  without charge.  May be taken multiple times ◦ A Certificate is available  for a passing score of 80% or greater  free downloading and print  Includes the name of the candidate and the date of achievement ◦ This Certificate can be printed and given to the staff or faculty member who is maintaining the records

 Does not currently give CME for completion  If certificate is lost, must retake the test  Does not require the study module to complete the test  Must have computer and printer access  Governing body who will enforce certification

Ann and Robert H. Lurie Children’s Hospital

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