Department of Family & Community Medicine

Enhanced Skills Program: Low Risk Obstetrics Goals and Objectives

The Low Risk Obstetrical Program is a three month clinical residency aimed at providing additional experience to trainees committed to including family medicine obstetrics in their practice. It is of interest both to recent graduates of family medicine programs as well as practicing family physicians who wish to upgrade their skills. The program allows family doctors to enhance their obstetrical skills and knowledge so that they are both confident and competent in the management of family practice obstetrical patients. The program has defined goals and objectives, however it is flexible and self‐directed in order to provide the trainee with an opportunity to tailor the program to meet their self-identified learning needs. The majority of physicians spend their three months working on the labour and delivery ward of their chosen site. Most physicians include ambulatory experiences in antenatal care or hospital experiences in neonatal care.

MEDICAL EXPERT

The fellow will have the following knowledge base and technical skills:

Knowledge:

1. Antenatal & Postpartum Care:

  • Provision of standard prenatal care
  • Knowledge of genetic testing, routine prenatal testing
  • Knowledge of commonly used and avoided drugs in pregnancy & breastfeeding
  • Diagnosis and management of sexually transmitted infections as they pertain to pregnancy
  • Knowledge of signs and symptoms of abused women and appropriate referral resources
  • Management of pregnancy loss
  • Management of postpartum issues (e.g., depression, puerperal infection, breast feeding issues, birth control)

2. Management of complicated pregnancy:

  • Vaginal bleeding
  • GDM
  • IUGR
  • Pregnancy
  • Induced hypertension
  • VBAC
  • Substance abuse in pregnancy
  • Major medical illness in pregnancy
  • PROM
  • Antepartum hemorrhage
  • Premature labour
  • Post term pregnancy

3. Intrapartum Care:

  • Knowledge of normal and abnormal patterns of labour and delivery
  • Assessment and appropriate management of labour progress
  • Intrapartum fetal assessment including intermittent auscultation, electronic fetal monitoring, fetal scalp sampling interpretation
  • Knowledge and management of maternal and/or fetal distress
  • Indications for, methods and complications of induction of labour
  • Indications for, methods and complication of augmentation of labour
  • Anasthesia in labour (risks and benefits of medications available intrapartum)
  • Ability to recognize complicated labour and knowledge of indications for assisted vaginal birth and c-section

4. Treatment of obstetrical emergencies:*

  • Fetal distress
  • Shoulder dystocia
  • PPH
  • Malpresentation
  • Uterine
  • Cord prolapse
  • Eclampsia

(*) indicates knowledge of principles and as much experience as possible

5. Newborn Care:

  • Newborn resuscitation (including evidence completion of NRP course within the past year)
  • Newborn assessment

Technical Skills:

Assessment of patients in labour (cervical assessment, determining rupture of membranes, interpretation of fetal monitoring)

Performing ARM

  • Application of fetal scalp electrode
  • Fetal scalp sampling
  • Repair of 1st and 2nd degree tears and episiotomies
  • Repair of 3rd and 4th degree tears*
  • Manual removal of placenta
  • Vaginal delivery
  • Vacuum delivery
  • Forceps delivery*
  • C‐section assist

(*) indicates knowledge of principles and experience where possible.

COMMUNICATOR

As a communicator, the resident will demonstrate:

  • The ability to establish rapport and therapeutic relationships with pregnant and laboring patients and their families
  • An awareness of the unique issues surrounding pregnant patients (including psychosocial and cultural issues)
  • Effective communication within the interprofessional team of health care workers
  • Accurate and timely record keeping

COLLABORATOR

As a collaborator, the resident will:

  • Function effectively within the multidisciplinary team of the labour and delivery ward recognizing the roles and responsibilities of the different team members to ensure the provision of high quality care for the patient

MANAGER

As an effective manager, the resident will:

  • Demonstrate an understanding of the resources available to pregnant patients and their families and the appropriate use of these resources within the health care system
  • Coordinate the care of the patient both within the community and the hospital to ensure provision of the best possible care

HEALTH ADVOCATE

As a health advocate, the resident will:

  • Identify and respond appropriately to the needs of each individual patient
  • Identify opportunities to advocate for the health care needs for the antepartum intrapartum and postpartum patient and her family
  • Advise patients about local resources available to them and their families

SCHOLAR

As a scholar, the resident will:

  • Have an understanding of the seminal research in low risk obstetrical care and its application into daily practice
  • Demonstrate a commitment to maintaining and enhancing professional knowledge and activities through ongoing learning

PROFESSIONAL

As a professional, the resident continually strives to:

  • Commit to the provision of the best possible care for their pregnant patients
  • Demonstrate respect and compassion towards all patients and their families
  • Recognize and appropriately respond to ethical issues in practice
  • Demonstrate integrity and honesty

Logbooks: Each candidate will keep a logbook of procedures done. This should be intermittently reviewed with supervisor(s) to ensure that learning objectives are being met and it will be reviewed further as part of the exit interview for the residency. For each birth, the following information should be included:

  • Type of delivery
  • Procedures performed
  • Complications if any