Objectives

Introduction

The educational objectives for Family Medicine Obstetrics, outlined below, focus on the educational experience in Obstetrics obtained throughout the residency training program. However, the Department of Family Medicine recognizes that it is not reasonable or possible to cover all presentations and topics in the field of Obstetrics. Therefore, the goal here is to teach the recognition of emergency situations; the concepts of patient evaluation, investigation and management, and the methods whereby further investigation and management strategies can be acquired. Each resident will have individual goals and objectives based on individual needs and interests, as well as on areas of need from past training. Trainees in the Department of Family Medicine, while on their in-hospital Obstetrics rotations, are encouraged to discuss their goals and objectives with any of the consultants with whom they work, or any of the Obstetrics residents.

Structure and Learning Environment

Family Medicine residents develop knowledge, skills and attitudes in diagnosing and managing common Obstetrical presentations in a variety of settings: the antenatal and post-partum wards, the Labour and Delivery Suite, consultant physicans' offices, out-patient clinics and in the Family Medicine setting.

There is a one-month rotation in Obstetrics during first year and one or two months during rthe second year of the Family Medicine Residency Progam. There are options to do do additional Obstetrics rotations as selectives/electives. Obstetrical rotations may be in London, St. Thomas or Kitchener. Obstetricians, Family Physicians, Obstetrical residents, and labour and delievery nursing staff are educational resources for achieving the Department's educational objetives in Obstetrics.

Objectives for Obstetrics

1. The Family Physician is a skilled clinician

A. The Family Medicine Resident will become knowledgeable in the following:

  1. Diagnosis of pregnancy, physical examination of the pregnant female and the risk factors which determine the Obstetrical risk of the patient on initial presentation
  2. The major parameters which must be assessed at each antepartum visit
  3. Optimal weight gain and appropriate uterine growth curve
  4. The judicious prescription of medication during pregnancy and awareness of potential drug effects on the mother and fetus
  5. Preconceptual counselling requirements
  6. Antenatal testing including options, indications, and interpretation
  7. The signs and symptoms of pre-eclampsia and eclampsia of pregnancy
  8. Causes and managment of bleeding in all trimesters
  9. Causes and management of abdominal pain during pregnancy
  10. Proper triaging of Obstetrical patients in labour or with antenatal issues
  11. The Obstetrical indications for induction of labour
  12. The normal progress of labour
  13. The signs and symptoms of maternal psychological and physical distress
  14. The signs of fetal distress
  15. Indications for operative delivery (including C-section, forceps delivery and vacuum extraction)
  16. Post-partum orders that provide for the needs of the patient in the hospital
  17. Recognition of the need for neonatal screening for metabolic abnormalities (eg. PKU, thryroid assessment)

B. The Family Medicine Resident will become competent at performing each of the following:

  1. Assessment for possible rupture of membranes
  2. Amniotomy
  3. Vaginal exam for assessment of presentation, position and degree of dilatation of the cervix
  4. Prenatal assessment using non-stress tests and intrapartum assessment of fetal heart-rate tracings.
  5. Management of spontaneous delivery
  6. Exploration of the uterus and systematic inspection for lacerations of the cervix, vagina and perineum
  7. Performance of episiotomy, when indicated
  8. Assessment of degree of perineal tearing
  9. Repair of first degree perineal tears
  10. Management of post-partum hemorrhage
  11. Assistance at caesarean section deliveries

C. The Family Medicine Resident may become competent at performing each of the following:

  1. Vacuum extraction in the OA position
  2. Delivery using low forceps extraction
  3. Insertion of intra-uterine pressure catheters
  4. Fetal monitoring, including fetal scalp clip application
  5. Fetal scalp blood sampling to assess blood gases
  6. Repair of third-degree perineal tears
  7. Repair of midline and medio-lateral episiotomies and repair of second-degree tears

2. The patient-doctor relationship is central to the role of the Family Physician

The Family Medicine Resident will demonstrate qualities and attitudes basic to understanding the relationship between the patient and Family Physician by:

  1. Providing emotional support to the pregnant woman and her family in the antenatal, intrapartum and post-partum periods
  2. Listening to and incorporating, wherever possible, the patient's desires and requests for management during the in-hospital period.

3. The Family Physician is community-based

Family practice is based in the community and is significantly influenced by community factors. As a member of the community, the family physician is able to respond to people’s changing needs, to adapt quickly to changing circumstances, and to mobilize appropriate resources to address patients’ needs.