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Breastfeeding Residency Curriculum

Essential Activities

This is a summary of the Essential Activities that will help your residents develop the confidence and skills in needed for breastfeeding care. They are the most important activities from the Breastfeeding Residency Curriculum. These activities will also help your residents become proficient in the ACGME Core Competencies and for you to document their progress towards achieving this goal. For goals, objectives, and evaluation tools related to these activities see the full Breastfeeding Residency Curriculum.

- Medical Knowledge

  1. Complete Wellstart International's Lactation Management Self-Study Modules Level 1.
    Have the residents take the accompanying self-study exam immediately following the completion of the modules, and again 4-6 months later.
  2. Learn how to assemble and operate the manual and electric breast pumps provided by your hospital/clinic setting or used in your community. Describe how to use these tools to the mentor.
    Observe the resident describing how to assemble and operate manual and electric breast pumps. Assess clarity and accuracy in describing how to use the machines.
  3. Observe Jane Morton's video about manual expression for the preterm infant and mother, "Making Enough Milk, The Key to Successful Breastfeeding...Planning for Day One."
    Observe the resident providing guidance on manual expression with and without the infant latched and while using an electric or manual breast pump.
  4. List and become familiar with all the methods of contraception that can be used by a breastfeeding mother including the Lactational Amenorrhea Method, and understand what methods may interfere with breastfeeding and why.
    Evaluate the number of methods of contraception that the resident identified for the breastfeeding mother and particularly their description of the Lactational Amenorrhea Method, including the 3 criteria that must be met for this method and the rate of efficacy.

- Patient Care

  1. Discuss with an expectant mother and father how to establish milk production and normal attachment (latch-on and milk transfer) (use "Breastfeeding, A Guide to Getting Started" video and companion booklet, "The ABC's of Breastfeeding"). Present this interaction to mentor.
    After the resident leaves the room, obtain feedback from the parents on the success of the resident's counseling – use all or portions of the Resident Care Evaluation: Communication Skills PDF document and Resident Care Evaluation: Patient History and Education PDF document forms to evaluate the resident or develop your own point scale and give the appropriate amount of points dependent on the parents' feedback.
  2. Teach at least 3 new mothers the 3 key educational components of breastfeeding education. To prepare for this activity, residents should watch video, "Breastfeeding Management, Educational Tools for Physicians and Other Professionals" and discuss personal strategies and barriers to teaching new mothers with their mentor.
    After the resident leaves the room, obtain feedback from the parents on the success of the resident's counseling – use all or portions of the Resident Care Evaluation: Communication Skills PDF document and Resident Care Evaluation: Patient History and Education PDF document forms to evaluate the resident or develop your own point scale and give the appropriate amount of points dependent on the parents' feedback.
  3. Identify true contraindications to breastfeeding and the use of human milk and those that are sometimes identified as contraindications, but are not (both medicines and medical conditions). Present a case in which a mother was inappropriately counseled not to breastfeed and the consequences that this led to in the health of the mother and the infant.
    Evaluate the content of the case study presentation.
  4. Participate in a case-based didactic series to describe a step-by-step approach in the management of:
    • A mother who, on her baby's fourth day of life, is engorged and her hungry baby will not latch on
    • A baby that is latching, but causing nipple damage and trauma
    • A baby who has ankyloglossia
    Evaluate the discussion of the cases by the resident.
    Hint: To prepare for this activity residents and mentors should watch "Breastfeeding, a Guide to Getting Started" video.

- Systems Based Practice

  1. Assess the hospital policy with respect to the Baby Friendly Hospital Initiative, The Ten Steps to Successful Breastfeeding, and identify at least 1 barrier and 1 solution that could be suggested to improve the hospital's policy. The Ten Steps are clearly described in the AAP/ACOG Breastfeeding Handbook for Physicians.
    Use the Baby Friendly Hospital Initiative Self-Appraisal Tool PDF document and have the resident present this information to the mentor.
  2. Attend community educational sessions at 1 of the following groups or bring together these groups at a fair for the residents (2 sessions per rotation):
    • Postpartum Support Groups for New Mothers and Families (such as La Leche League Support Groups, Grandmother's Tea, Father's Supporting Breastfeeding, Mother's Milk Club, etc. For the Grandmother's Tea or the Father's Supporting Breastfeeding Groups contact your local WIC office to see if they support these programs. Contact local hospitals to see if they have Mother's Milk Clubs.)
    • WIC clinic lactation consultant sessions
    • Maternal and Child Health outreach groups or individual sessions
    • Other peer support groups or charitable or religious organizations that offer support and education
    Following the visit, residents can survey parents about the community services and report on this feedback as well as their own experiences.
    Evaluate residents by the number of parents they surveyed and the quality of their suggestions to the various community education services.

- Practiced Based Learning and Improvement

  1. Deliver a presentation of the 2-3 most common reasons given by mothers for discontinuing breastfeeding within the first month, and strategies for minimizing these outcomes:
    • Insufficient milk production
    • Problems with attachment (milk transfer and latch)
    • Lack of maternal confidence.
    Teaching evaluation of lecture given.

- Interpersonal Communication Skills

  1. Conduct a role play of a case study involving a physician providing peripartum support to a mother. Continue the role play of the same case study by adding the scenario where the pediatrician or family physician discusses the case with the mother's obstetrician and/or vice versa. The purpose is to exemplify the importance of communication among different types of physicians when providing breastfeeding support.
    Evaluate the role-playing performance.
  2. Use the Cultural Case Studies PDF Document, or develop case studies based on faculty/resident experience to have residents practice different scenarios that require consideration with regard to cultural competency. Use a teaching conference or teaching rounds to illustrate problem solving skills that require cultural knowledge and sensitivity.
    Grade the answers/responses of residents to the case studies against the answers that have been provided in this curriculum or use the Cultural Competence Health Practitioner Assessment to evaluate residents' knowledge of providing culturally competent care.
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