2020-2021 M3/M4 Course Syllabi
Obstetrics & Gynecology
COURSE NUMBER:
11 01 47
TITLE:
Breastfeeding Management -ICE
4th year students will spend 2 weeks working in both inpatient and outpatient settings to learn strategies to promote breastfeeding and support the breastfeeding mother-baby dyad. Students will observe novel methods to support patient education, including breastfeeding support groups group prenatal care.
PREREQUISITES:
26920371 (FAMILY MEDICINE CORE CLKSP), 26946374 (OBSTETRICS/GYN CORE CLKSP), 26961373 (PEDIATRICS CORE CLKSP)

Successful completion of OB/Gyn and Pediatric Core Clerkships

Badging and Epic training requirements

Student membership in ACOG (should be valid from 3rdyear OB/Gyn Clerkship)

Optional student membership in the Academy of Breastfeeding Medicine ($25/student).   For information see:   https://abm.memberclicks.net/membership

Cell phone
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GENERAL INFORMATION

COURSE YEAR:
M4
CREDIT HOURS:
4
CREDIT WEEKS:
2
DOMESTIC VISITING:
NO
INTERNATIONAL VISITING:
NO
GRADED:
Honors/High Pass/Pass/Fail
COURSE QUALIFICATIONS:
ICE
COURSE TYPE:
Clinical
STATUS:
Full-Time   
OFFERED AS FULL-TIME AND PART-TIME: NO
ALLOWS OVERLAP: NO
COURSE LENGTH:
2 weeks
DIRECTOR:
Andrea Hamel
hamelam@ucmail.uc.edu
513-558-6919
MSB, 4460
ADMINISTRATIVE SUPPORT PERSON:
Natalie Cassady
cassadnc@ucmail.uc.edu
558-7653
MSB, 4461
SITE(S):
UC Health West Chester Hospital
University of Cincinnati Medical Center
MAX ENROLL:
1 
ROTATIONS:
Rotation Dates Max
1 07/20/2020 - 07/31/2020 0
2 08/17/2020 - 08/28/2020 1
3 09/14/2020 - 09/25/2020 1
4 10/12/2020 - 10/23/2020 1
5 11/09/2020 - 11/20/2020 1
6 12/07/2020 - 12/18/2020 1
7 01/18/2021 - 01/29/2021 1
8 02/15/2021 - 02/26/2021 1
9 03/01/2021 - 03/12/2021 1
9 03/15/2021 - 03/26/2021 1
10 04/12/2021 - 04/23/2021 1
11 05/10/2021 - 05/21/2021 1

NOTE: If a rotation is offered in both 2 and 4 week slots, the max capacity is limited to the actual spots offered for the 4 weeks. (ie: the 2 week rotations listed share the max of the 4 week rotation)
WORKING HOURS:
8:00 am – 5 pm, Monday-Friday, may include weekend hours
REPORT 1ST DAY:
UC Health 3rd floor, LC office, Room 3300. 8:30am- This may vary

INSTRUCTION

LEARNING ACTIVITIES:
  • Clinical Experience - Inpatient
  • Demonstration (description, performance, or explanation of a process, illustrated by examples, observable action, specimens, etc)
  • Completion of pre- and post-test knowledge assessment and complete data collection activity for ongoing Quality Improvement project related to Breastfeeding
  • Patient Presentation--Learner
  • Research
LEARNING ENVIRONMENT POLICIES:
UCCOM strives to provide medical students with a learning environment that is conducive to their professional growth. All UCCOM and visiting medical students are encouraged to review the Student Handbook.

The Office of Student Affairs and Admissions is available to all UCCOM and visiting medical students to discuss any concerns/questions related to the learning environment. Please call 558-6796 to access faculty/staff that can assist you.
TEACHING:
10% Attending Physician
10% Other Faculty
80% Other Allied Health Professional(s)
FEEDBACK:
IBCLC Certified Nurses and Registered Dieticians
ASSESSMENT:
FINAL GRADE:
GRADE ASSIGNED BY: Course director

OBJECTIVES

Curricular Resources :
Well Start Self-Study Level I (2014) (REQUIRED)

    http://www.wellstart.org/Self-Study-Module.pdf

    Complete pre-test on first Monday of rotation.  Complete post-test on Friday of second week.  

    Submit both for grade.

 


Books (available from Natalie Cassady's office for loan during the rotation). Lawrence, R. A.& Lawrence, R. M. (2016). Breastfeeding:A guide for the health profession (8th ed.).   Philadelphia, PA:Elsevier. ($65 replacement fee)

Hale, T. W.& Rowe, H. W. (2017). Medications and mothers' milk (17th ed.). New York, NY: Springer Publishing. ($65replacement fee)




Academy of Breastfeeding Medicine Protocols (REQUIRED Reading)

Protocols1-20 are in Appendix J from     Lawrence, R.A. & Lawrence, R. M. (2016). Breastfeeding:A guide for the health profession

    (8thed.). Philadelphia, PA: Elsevier.  

   


Some of the protocols

     T. Colaizy(2016). Donor human milk in VLBW infants: Experience, research, and future

    direction.  Presented at ABM Physian workshop, Alexandria, VA, October 2016. (PDF handout

   of slides available from Dr. Hamel, with additional references.)

 

  ACOG readings (available for download at ACOG website with student membership)

     Committee on Breastfeeding (2016).   ACOG Breastfeeding toolkit for providers.

    http://www.acog.org/About-ACOG/ACOG-Departments/Toolkits-for-Health-Care-

    Providers/Breastfeeding-Toolkit   (Accessed November 1, 2016)



    Committee for Healthcare of the Underserved. (2009) Committee Opinion 423: Motivational

    interviewing: A tool for behavior change.


AAP curriculum
     Several videos, power point lectures, and a pre- and post-test are available

    https://www2.aap.org/breastfeeding/curriculum/
Knowledge/Skills:
Know breast anatomy and physiology of lactation

Know the 10 Hospital Steps to Successful Breastfeeding

List the various healthcare organizations and their recommendations for breastfeeding practices and duration (i.e. WHO, AAP, ACOG) (NUTRITION)

Know the maternal/infant benefits of breastfeeding andrisks of formula feeding (PREVENTION & RISKS/BENEFITS)

Know the unique benefits of breast milk, including donor milk, for the high risk neonate (NICU) (PREVENTION, NUTRITION, & MEDICAL DECISION MAKING)

Know the nutritional variations in donor milk, mom's own milk, and formula.

Know the medical indications for formula supplementation (MEDICAL DECISION MAKING)

Know the benefits of early skin to skin

Recognize common breastfeeding problems and manage these (MEDICAL DECISION MAKING)

     Engorgement

     Mastitis/Breast Abscess

     Sore nipples

     Low supply(actual and perceived)

Know the indications for interventions: pumping (with proper phalange fitting), supplemental nursing system, nipple shields, breast shells)

Understand indications for referral to IBCLC (MEDICAL DECISION MAKING)

Recognize cultural variations in breastfeeding practices

Understand pharmacologic parameters used to evaluate drug safety in lactation (CLINICAL PHARMACOLOGY CONSIDERATIONS)
Main Course Topics :
Cost efficient and effective medical decision making

Risk/benefit issues

Prevention

Nutrition

Clinical Pharmacology considerations/common drugs appropriate for the field
Procedures:
Counsel a mom about the benefits of breastfeeding and the risks of formula feeding (PREVENTION & RISKS/BENEFITS)


Assist a mom/baby with latch

Identify mothers at risk for breastfeeding challenges(based on PMH, PSH, social factors, anatomical findings) (MEDICAL DECISION MAKING)

Perform a breastfeeding-focused breast exam

Assess infant oral anatomy (i.e. palate and for evidence of ankyloglossia) (MEDICAL DECISION MAKING)

Demonstrate and teach hand expression

Demonstrate and assist a mom with correct use of electric breast pump

Demonstrate reverse pressure softening for breast engorgement/areolar edema

Develop a feeding plan for infant/breastfeeding management strategy for mom (MEDICAL DECISION MAKING)

Provide breastfeeding discharge education to the breastfeeding dyad  

Assess medications for safety in lactation using published pharmacologic parameters and online references. (CLINICAL PHARMACOLOGY CONSIDERATIONS)

SAMPLE WEEK

Monday:
8:00AM 2:00PM UC Lactation rounds
2:00PM 6:00PM Take pre-test (week 1) SDL (week2)
Tuesday:
8:00AM 3:00PM Hoxworth Outpatient Lactation
3:00PM 6:00PM D/C phone calls or QI data
Wednesday:
9:30AM 12:00PM Baby Café at Westchester hospital
1:30PM 6:00PM Hoxworth Centering Pregnancy
Thursday:
8:00AM 3:00PM Hoxworth Outpatient Lactation
3:00PM 6:00PM D/C phone calls or QI data
Friday:
8:00AM 2:00PM UC Lactation rounds
2:00PM 6:00PM Take post-test (week 2) SDL (week1)
SCHEDULE NOTE:

ATTENDANCE AND ABSENCE POLICY

 

Session Attendance for M4 Students

  • Students may miss no more than two days of planned excused absences on a four week rotation without being required to make-up the work, at the discretion of the clerkship/elective/course director or his/her designee.
  • Non-AI Rotations - Per the Student Duty Hours Policy, an average of one day (24 hours) in every seven must be free of clinical responsibilities (including seminars, clinic, rounds, lectures) averaged over a four week period. These days off are assigned by the clerkship director to best align with the site schedule. Students may request to schedule 1 or more of these 4 days for planned absences that fall under 1 of the categories listed below for excused absences during non-AI rotations, in consultation with the course/elective director, who may or may not approve such planned absences.
  • AI Rotations - Per the Student Duty Hours Policy, an average of one day (24 hours) in every seven must be free of clinical responsibilities (including seminars, clinic, rounds, lectures) averaged over a four week period. These days off are assigned by the course director to best align with the site schedule. Students may request to schedule 1 or 2 of these days for planned absences that fall under 1 of the categories listed below for excused absences during AI rotations, in consultation with the course director, who may or may not approve such planned absences. Students must avoid scheduling Step 2 examinations during an Acting Internship.
  • Excused Absences - The following will be considered excused absences:
    • Diagnostic, preventative, and therapeutic health services (e.g. doctor appointments, physical therapy, counselling, etc).
    • Personal illness, accident or a major catastrophic event
    • Death or serious illness of immediate family members. Immediate family members, as defined by UC, are Grandparents, Brother, Sister, Brother-in law, Sister-in-law, Daughter-in-law, Son-in-law, Father, Mother, Mother-in-law, Father-in-law, Step-sister, Step-brother, Step-mother, Step-father, Spouse or domestic partner, Child, Grandchild, legal Guardian or other person who stands in place of parent (in Loco Parentis)
  • Whenever possible, planned absences should be requested a minimum of six weeks in advance of the start of the clerkship/elective/course in which the absence will occur; this enables the clerkship/course/elective to help plan for educational event scheduling (e.g. a known appointment could be scheduled around with enough notice and the student might not have any required coursework to make up). Absences requested less than 1 week prior to the planned absence may not be considered for a possible excused absence unless extenuating circumstances prevented the student from providing timely notification per the policy. Students should first submit their request for a planned absence to the clerkship/elective/course director using the online MSSF. All planned/excused absences for any reason should be documented on the MSSF.
  • The COM abides by the UC Religious Observance Policy that respects the religious diversity of its students by providing opportunities, where possible, for accommodation in cases where conflicts exist between students’ religious beliefs/practices and educational activities. In clinical settings, such accommodations must honor the primacy of a commitment to patient care and avoid unduly burdening faculty, staff and the general student population involved in the affected educational and/or patient care activity.
  • The following items are explained in detail in the Medical Student Handbook:
    • Excused/unexcused/unplanned absence, religious holidays, jury duty, and make-up work

See Attendance and Absences Policy, Religious Observance Policy, Medical Student Handbook.




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