1. Who Will Deliver My Baby
Who Will Deliver My Baby? Prenatal Care for Low-Risk Obstetric Patients An 18-month Interactive Learning Curriculum for Family Medicine Residents
Patricia L. Goodemote MD
Lt Col, US Air Force
Belleville/Scott AFB Family Medicine Residency

2. Imagine as pregnant. - yourself - your wife - your daughter
- your niece
as pregnant.

3. Who Will Deliver My Baby
Who Will Deliver My Baby? 23 Red Alert States (ACOG) in 7 OB/GYNs not providing obstetric care % OB/GYN PGY-1 slots - not filled Family medicine providing OB care declining; 43%(1986) - 22%(2000) Medicaid and uninsured have difficulty finding OB care

4. Location – Belleville, Illinois
Combined military/civilian Family Medicine
14 residents per year group
Purpose - train residents in full-spectrum care
Required to follow 15 OB continuity patients

5. Local Need Local Assessment Residency Assessment
Illinois and Missouri - Red Alert States
Our hospital lost 6 of 11 OBs in last 2 years
Residency Assessment
Focus Groups/Surveys/In-training-exams
Primary obstetric area needing improvement
Prenatal curriculum
Wednesday didactics – interactive learning

6. Interactive Learning Curriculum for Family Medicine Residents
Proposed Curriculum
Prenatal Care for Low-Risk Obstetric Patients
An 18-month
Interactive Learning Curriculum
for Family Medicine Residents

7. Curriculum Development
1. Received expedited IRB Approval
2. Derived course goal/structure
3. Specified unit goals and general content of each
4. Developed draft of sample unit to be tested:
Goals and Objectives
Content and Instructional Strategies
Learner Evaluation
5. Created materials for tested unit
6. Pilot test
7. Expert reviewers

8. Curricular Goals
As family medicine physicians working in the community, when seeing obstetric patients in each trimester will be able to :
1. Elicit and document history
2. Perform and document physical
3. Identify and document appropriate labs
4. Develop problem list and determine risk
5. Manage low risk obstetric patients
6. Counsel prevention and follow-up

9. Curriculum Overview Didactics - 6 sessions of 4 hours each
Unit I. First Trimester 2 sessions
Unit II. Second Trimester 1 session
Unit III. Third Trimester 3 sessions

10. Identify, counsel, and document labs
Curriculum Overview
Low-risk prenatal care
1st Trimester
2nd Trimester
3rd Trimester
Elicit and document history
Perform and document physical
Identify, counsel, and document labs
Develop problem list and determine if low risk
Manage low risk obstetric patients
Counsel on prevention/follow-up

11. Unit Pilot Test – 1st Trimester
Provides a solid foundation
March/April 2005
Intervention - 2 sessions (4 hours each)
Pre and post tests conducted
1 week prior and 2 weeks after
Selection criteria
Written test – all residents available during testing
Videotape – 1st years (advisors not involved in study)

12. Unit Objectives
When presented with a first trimester obstetric patient
a family medicine resident will be able to:
3. Identify/document appropriate laboratory tests
a) order routine labs and labs based on H&P
b) counsel patient on MSA* and CF** screen
c) document labs in obstetric chart correctly
*MSA – Maternal Serum Analyte
**Cystic Fibrosis

13. Unit Instructional Strategies
Explanation and Demonstration:
1. Order
a) Reviewed CPG* for appropriate lab tests to order
b) Ordered lab tests based on a simulated chart
2. Counsel
a) Reviewed samples of MSA and CF consent forms
b) Videotape shown of counseling a patient
3. Document
a) Reviewed where and how to document labs
b) Sample documentation of labs for simulated chart
*DOD/VA Clinical Practice Guideline for
Management of Uncomplicated Pregnancy

14. Unit Instructional Strategies
Practice:
1. Order
a) Residents given 3 sample charts and practiced ordering appropriate lab tests
b) Residents given 8 practice True/False questions on specific lab tests
2. Counsel
a) Residents broke into groups of 3 and practiced counseling each other on MSA and CF screen
3. Document – not specifically practiced

15. Practice Makes Perfect
Working on simulated charts
Practicing counseling skills

16. Unit Evaluation Strategies
1. Order – residents given written tests
a) 2 sample charts provided - ordered appropriate labs
b) 8 True/False questions on specific lab tests
2. Counsel – residents videotaped and scored
a) Simulated obstetric patient
b) Counseled patient on MSA and CF screen
3. Document – not tested as this is evaluated on every obstetric chart

17. Pilot Study Written test Videotape Counseling Evaluation
18 residents took both Pre and Post
16 residents had attended one or both sessions
Videotape Counseling Evaluation
3 first year residents pre and post video

18. Pilot Test – Written Results
Residents
pre and post tested
Number tested
Written
Pre-test
% Correct
Post-test
Total 18
63.7
72.8
Attended one or both sessions 16
63.2
73.7
Attended neither session 2
67.5
66.0
Paired differences in pre and posttest result percentages of the 16 residents who attended one or both sessions
Mean improvement of 10.5 % (CI ) P value <0.001

19. Pilot Test – Video Results
Counseling subject
Pretest Ave (%)
Post-test Ave (%)
CF and MSA
63.3
74.2
Prevention/Follow-up
58.3
80.0
Overall
60.8
77.1

20. Pilot Unit – Resident Rating
41 evaluations received
40 of 41 rated session good or excellent
Most useful
Practice with simulated charts
Least useful
Practice history taking with other residents

21. Reviewers Educational Design Expert (PhD) Content Experts (MDs)
Kent Sheets
“faculty development…to help with didactic sessions….assist in reinforcing new behaviors”
Content Experts (MDs)
Margaret Helton, Dave Harnisch, Deborah Bostock
“exceptionally organized and clear”
“more emphasis on prenatal counseling” (Harnisch)
Pre and post tests of equal difficulty

22. Future Endeavors Revise 1st Trimester Unit
Eliminate history taking exercise
Decrease didactic lecture style
Increase activities with practice simulated chart
Retest revised 1st Trimester Unit at Eglin AFB
Include faculty development prior to testing
Develop Other Units
2nd Trimester Unit - Spring 07
3rd Trimester Unit – Fall 07

23. Conclusion Family physicians can help
fill the gap in obstetric care even in this litigious environment
but they need a solid foundation.
This curriculum could start building
that foundation.

24. Who Will Deliver My Baby
Who Will Deliver My Baby? Prenatal Care for Low-Risk Obstetric Patients: An 18-month Interactive Learning Curriculum for Family Medicine Residents
Patricia L. Goodemote MD
Belleville/Scott AFB Family Medicine Residency