General Implementation Strategies

The Breastfeeding Residency Curriculum has been designed to be flexible and to fit in to your existing residency program, but if you don't know where to start, here is a general implementation strategy.

Before you begin - Conduct a needs assessment. Determine the following about your residency program/hospital system:

1. What is currently taught about breastfeeding?
2. Who teaches the breastfeeding content?
3. What do faculty know about breastfeeding, and are they able to teach about it?
4. If faculty are capable of teaching about breastfeeding, who are they comfortable teaching?
5. How well do the faculty and residents promote, manage, and support breastfeeding? (You can find this out by surveying mothers, nurses, residents, and faculty, about their experiences.)
6. Are staff at the hospital (especially the residents) able to breastfeed or express breast milk at work?
7. Determine the breastfeeding rates at your institution (at discharge and 6 months).

 

Once you have performed a needs assessment, prioritize components of the curriculum according to major needs. 

Step 1 - Gain buy-in from other key faculty and residency and hospital administration (Department Chairman, Residency Program Director, GME director, etc.).

Tools and Resources - Pediatrics article: "Residency Curriculum Improves Breastfeeding Care"

Step 2 - Train faculty to be able to teach about breastfeeding and consider assessing the quality of care in your hospital for breastfeeding mothers and babies (including staff policies). What systems-based changes need to happen for this curriculum to be successful in teaching residents about breastfeeding?

Tools and Resources - Sample Breastfeeding Hospital Policy , Baby Friendly Hospital Initiative Web site, Baby Friendly Hospital Initiative Self Appraisal Tool

Step 3 - Determine length of time that you will expect residents to participate in the curriculum (decide upon doing the curriculum in 1 rotation, 1 year, or over the whole course of residency).

Tools and Resources - Various Implementation Strategies

Step 4 - Develop an implementation plan that includes the length of time you have decided upon for residents to complete the curriculum and how you will keep track of their progress. Think about times for certain activities and lectures, grand rounds on breastfeeding, noon conferences, hands-on-experience, and field trips.

Tools and Resources - Curriculum Tools

Step 5 - Review the resources that have been shown to be most helpful in teaching the residents about breastfeeding care. Work the cost of these materials in to your budget for the residency program or seek outside funding to purchase them.

Tools and Resources - Curriculum Resource Guide

Step 6 - Consider formal evaluation of the curriculum by testing the residents before they receive breastfeeding education and after they have completed the program. Measuring breastfeeding rates at your institution may also show improvement in breastfeeding care and the value of teaching your residents about this subject. Remember, more breastfed babies = lower health care costs. Remember to evaluate the residents following each activity as well, particularly according to the ACGME Core Competencies.

Tools and Resources - Curriculum Tools: Pre-test, Post-test, Resident Care Evaluation: ACGME Core Competencies, tools for the Objective Structured Clinical Examination, and the Data Collection Guide.

Step 7 - Consider having a kick-off event to introduce and celebrate breastfeeding support and education. Plan a day for hospital-wide breastfeeding education and invite outside breastfeeding experts to present.

Tools and Resources - Breastfeeding Day Example , Grand Rounds and Faculty Training Day Agenda

Step 8 - Implement the curriculum. Work through each activity with the residents and be sure to evaluate and document their progress (this can be done according to the ACGME Core Competencies)

Tools and Resources - Residency Curriculum Web site

Step 9 - Continually train and update faculty on breastfeeding.

Tools and Resources - Section on Breastfeeding, Academy of Breastfeeding Medicine, Wellstart Lactation Management Self-Study Modules Level 1

Step 10 - Periodically re-assess the progress of the hospital in reaching optimal breastfeeding rates. Consider performing a cost-analysis to determine the benefit to the hospital of implementing the curriculum.

Tools and Resources - Data Collection Guide