Teaching Considerations for the Labor and Delivery Suite

JayDoc Lunch & Learn Series

2/4/08

SKILLS REQUIRED FOR TEACHING ON THE JOB IN MEDICAL EDUCATION ENVIRONMENTS:

THE Outpatient CLINIC, O.R., & HOSPITAL

HANDOUT Prepared by: John Calkins, MD

Teaching Considerations for the Labor and Delivery Suite: I. Factors influencing teaching styles A. Similarities in all settings: 1. Time 2. Numbers of patients 3. Complexity of patient problems 4. Extent of actual patient care B. Unique issues in L&D 1. Obstetrical assessment (lie, presentation, position, station, effacement, dilatation and estimated fetal weight) - nurses are a great resource. Focused assessment keeps the patient’s dignity in line. 2. Involvement of the family unit: a.) students and residents need to incorporate the family in information dissemination, both in and out b.) discharge instructions best done in the presence of the S.O. – new mothers can be overwhelmed with “baby issues”. 3. Physiologic changes in pregnancy – inquire of the student and or resident about relevant issues at the bedside – the patient makes a great corroborator. 4. Contraception – students/residents need to inquire about plans going forward and understand risks, benefits, and contraindications of various methods. This provides an excellent opportunity to assess the learner’s comfort with discussing sexuality and their respective counseling skills. II. Format A. Presentation of patient history – best initially done prior to going to the bedside in case there are privacy issues 1. Gravity, parity and current gestational age are of paramount importance 2. Prior obstetrical outcomes and other risk factors – faculty should inquire on impact of these on current gestation and how they influence management 3. After meeting with the patient – provide learners with the opportunity to ask questions B. Delivery – You never know when you will be called into action 1. Use of manikins can be very helpful 2. “Shared experience” maintains control and yet gives the learner the sense of participating FEEDBACK: Formative verses Substantitive ( Immediate verses Cumulative) Immediate – Usually lends itself to “at the bedside” 1. Differential diagnoses 2. Management plans 3. Surgical technique 4. Bedside procedures – lines, catheters, monitors Exceptions: 1. Errors in technique that the patient may misconstrue 2. Patient input 3. Professionalism Cumulative - 1. Best done one-on-one (unless disciplinary action anticipated) 2. Interval dictated by level of learner (weekly, monthly, semi- annually, annually) – all faculty should participate 3. “360 degree” evaluations can be revealing 4. “Exit interview” helps shape the learning for years to come

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