OBSTETRICS: L&D and MIDWIVES

Rotation name: OB L&D

Year:R1

Rotation Contact Information:

•  OB L&D: Rachel Torano-Mark  RaToranoMark@salud.unm.edu 272-6525

Location: UNMH

Pre-requisites: none

Description: There are two components to this rotation experience: 1 week with the Midwife Service and 3 weeks with the OB Labor & Delivery Service.

OB Labor & Delivery Service:

BACKGROUND/EXPECTATIONS: The relationship between OB an FM is an important one for both of our departments.  In the past resident relationships have improved our departmental relationship. The key learning for you all on this rotation is getting precious exposure and experience on OB triage and in working with the midwives and OB providers to see how they practice, so that you can compare those styles to what you learn on MCH.  The OB team will be incorporating you in all aspects of the service, AND they are also under pressure to make sure that they get as many deliveries as possible as deliveries across New Mexico are down.  This has affected both FM and OB residents, and we will try to get you plenty of deliveries on MCH.  So the hope is that your month on OB will be a rich learning environment but it may not be a time for you to get many deliveries under your belt.  Please let the residency leadership team know if you have any issues during your OB rotation, and it's helpful to recognize the bigger context so that your expectations of what the rotation is intended to provide is accurate.

The intern will participate as an active member of the team working in the Labor & Delivery Unit. They are expected to pre-round on assigned patients, participate in 7AM morning rounds with the team, follow assigned laboring patients, evaluate patients in Testing & Triage and participate in check-out at the completion of their shift. The OB third year resident is responsible for “running the board” and will coordinate patient assignments among the various interns and students on the service.  See below for more information, links to note templates, instructions on powerchart usage on OB and an online orientation.

Schedule:  2 weeks of night shifts and 2 week of day shifts on L&D

OB L&D

Night shifts

Tuesday–Continuity Clinic 1:00 PM–6:00 PM; OB Shift 6:00 PM and end at 4:00 AM (15hrs)

Wednesday- Thursday: start at 6:00 PM and end at 7:00 AM (12hrs/shift)

Friday & Saturday: start at 7:00 PM and end at 7:30 AM after postpartum rounds (12.5 hrs/shift)

Day L& D shifts start at 6:00 AM and end at 6:00 PM (12hrs/shift)

Schedule will be provided by

One of the “Day Shift” weeks on the schedules below will be replaced by this schedule.

***We know that having Tues PM clinic prior to Night shift on this rotation schedule is not preferred, but given the other scheduling options, this has been the best option to meet week-in-clinic requirements while limiting the longer shifts for you.***

INTERN A

Sun	Mon	Tue	Wed	Thu	Fri	Sat
		DAY Clinic pm	DAY Didactics PM	DAY	DAY	DAY
OFF	DAY	DAY Clinic pm	DAY Didactics PM	DAY	DAY	DAY
OFF	DAY	Clinic pm NIGHT	NIGHT	NIGHT	NIGHT	NIGHT
OFF after rounds	OFF	Clinic pm NIGHT	NIGHT	NIGHT	NIGHT	NIGHT
OFF after rounds	OFF

INTERN B

Sun	Mon	Tue	Wed	Thu	Fri	Sat
		Clinic pm NIGHT	NIGHT	NIGHT	NIGHT	NIGHT
OFF after rounds	OFF	Clinic pm NIGHT	NIGHT	NIGHT	NIGHT	NIGHT
OFF after rounds	OFF	DAY Clinic pm	DAY	DAY	DAY	DAY
OFF	DAY	DAY Clinic pm	DAY	DAY	DAY	DAY
OFF	DAY

Duty hours: 4 X 12.5 (50 hrs) + 18 x 12 hrs (216 hrs) = 66.5 hrs/week (averaged); 5 days off; longest shift = 16 hrs; 10+ hrs between shifts

Call:none

Continuity Clinic: one half day per week (Tuesday PM)

Preceptor(s):Department of Obstetrics & Gynecology faculty; immediate supervision by OB R2 & R3; midwives

Additional Information

From OB (also emailed to all residents prior to OB rotation):

L&D is on the 4^th floor of the pavilion (the new part of the hospital, not the old one); if you have any questions feel free to Tiger Rachel Torano-Mark 

Here are a few highlights:

- AM shifts include pre-rounds around 05:30, rounds with the ward attending after morning board sign out on L&D, and conclude with evening board sign out at 18:00 except for Sundays that conclude at 19:00. Weekend rounding involves sign-out at 06:30 and rounds with the L&D attending at 09:00. 

- PM shifts on all days except Sun are 1800 through 07:00. On Sundays, PM shifts are 19:00-07:00. There may be days you are asked to post call round; the OB intern on during the day will be in touch with you about that​.

On your first day (7/20)

You will report to the L&D team room at 0700 for board sign out. After seeing that process, a 2nd year OB/GYN resident will run through what we hope will be an effective, dedicated, roughly 1-2 hour orientation​ to review the attached documents. Please read the attached information beforehand and bring any specific questions with you to your first day. Orientation tim​e will be used to help you set up the appropriate power chart lists, review the OB Triage order set, postpartum orders, the depart process, the delivery form and any questions you may have. 

Center for Reproductive Health (CRH):

·        If you have more questions on your CRH days, please contact Dr. Hofler or Dr. Krashin.

·        Dr. Hofler email: lhofler@salud.unm.edu

·        Dr. Krashin email: JKrashin@salud.unm.edu

 OB TRIAGE:

·        Coronavirus affected Medical Students greatly on their learning, so we are giving them priority to do Ob-Triage during this block. However, if there is a spot and the L&D chief agrees, you can be pulled to do OB-Triage while you are on your AM schedule.

·        Our department has recently changed the staffing of Ob-Triage.  Between 11:00 and 20:00, Ob-Triage will be staffed by our Certified Nurse Midwives.  They are able to accommodate up to two learners per day, and this has been incorporated into some of your schedules based on the value of this learning opportunity for your individual specialties.  THANK YOU FOR YOUR PATIENCE with our growing pains, this is new for all of us!

• If you have TRIAGE on your schedule, you will report to Ob-Triage at 11:00.  Your shift will end at 20:00.  You will NOT participate in board sign out of postpartum rounds on these days. 
• When scheduled for a night/float shift, there will not be Nurse Midwives in OB triage and thus the exposure to triage patients is preserved for residents.

·        If you have questions about OB-Triage please contact Thanh-Tam Ho THo@salud.unm.edu

Phone numbers of all the OB interns, although Tiger tends to be best: 

o   Raymundo Bustos: 706-512-7564

o   Fabiola Miranda: 818-282-3658

o   Diana Rascon: 512-626-2270

o   Jessica Rodriguez-Hernandez: 939-274-0888

o   Mingma Sherpa: 505-400-1354

o   Martin Jurado: 505-620-3522

Checklists:

-Things to do after each delivery: 1) Postpartum orders, 2) Delivery Form, 3) Cache Handoff, 4) Log it!

-Things to do with each triage patient: 1) OB Triage Provider Orders Powerplan; 2) Note; 3) Discharge patient + MSE

-Things to do with each postpartum patient before discharge: 1) Communication about postpartum appointments (1 wk for BP checks, 2 wks for incision checks and/or IUD string checks, and 3-6 weeks for a postpartum visit); 2) Meds: Tylenol, ibuprofen, Colace, prenatal vitamins, iron if anemic, Breast Pump Rx if breastfeeding (code Z39.1); Up to 20 Oxycodone 5mg on prescription paper if s/p c section; 3) Depart summary with appts; 4) Discharge summary within 48 hours of discharge

OB off-service orientation

OB orientation to powerchart

OB note templates

Goals & Objectives:

Available in New Innovation: Curriculum

The resident is expected to participate actively in a minimum of 10 deliveries during the block

Reading:

Family Practice Obstetrics, Ratcliffe et al, 2^ndedition

ALSO chapters

Evaluations of resident, faculty and rotation:

See New Innovations: Evaluations

Please contact the Residency Office for any questions regarding completion of evaluations