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Breastfeeding Residency Curriculum
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PATIENT CARE:
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Goal A |
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Residents will understand the importance of and be able to teach the new mother
of a healthy, term infant, the 3 key breastfeeding educational components described
below.
- Identify normal nutritional parameters for the term infant
- Evaluate positioning and latch-on
- Demonstrate hand expression
Essential
- 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  and Resident Care Evaluation:
Patient History
and Education forms to evaluate the resident or develop your own point scale
and give the appropriate amount of points dependent on the parents' feedback.
- 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 and Resident Care Evaluation: Patient History and Education forms to evaluate the resident
or develop your own point scale and give the appropriate amount of points dependent
on the parents' feedback.
Additional
- Present the prepared lecture "Management of Common Breastfeeding Situations"
 to
the residents during noon conference.
Evaluate the resident's knowledge of managing common breastfeeding situations by
using the provided Pre- and Post-test or another simple
exam.
- Observe "Breastfeeding, A Guide to Getting Started" video and review companion booklet,
"The ABCs of Breastfeeding."
Evaluate if the resident identified the 2-3 most common reasons given by mothers
for discontinuing breastfeeding (insufficient milk production, problems with attachment
[milk transfer and latch] and lack of maternal confidence) within the first month
and that the resident sufficiently described how to minimize these issues.
- Discuss, role-play, or demonstrate teaching a new mother:
- The 4 normal nutritional parameters: weight loss, feeding volumes in first 5 days,
a reliable clinical sign of adequate intake on day 5, and timeline to regain birth
weigh
- How to position a baby in the cross-chest hold (cradle or cross-cradle), using a
sandwich hold, and an asymmetrical latch
- How to hand express colostrum and early milk
This activity can either be done as part of an Objective Structured Clinical Examination
(OSCE) or with an actual mother. If you choose to include it during an OSCE, use
the Objective Structured Clinical Examination Case Study: Set Up
and
Objective Structured Clinical Examination Case Study: Standardized Patient Description and Script
for
information on how to set-up, conduct, and evaluate the exam using a standardized
patient.
If you choose to complete this activity with an actual mother, you can adapt the
Objective Structured Clinical Examination Case Study: Performance Assessment
.
The evaluator can also use the Resident Care Evaluation: Communication
Skills and
Resident Care Evaluation: Patient History and Education
forms to evaluate
the resident's performance in any instance (actual mother, role-play, or standardized
patient).
- Call 3 new mothers 24-48 hours after discharge to discuss outcome and assist with
follow-up.
Evaluate the resident by reviewing the patient logs at least 3 times for
completion of follow-up and accuracy of information provided.
- Present 3 hypothetical or real cases that illustrate pre-glandular, glandular
and post-glandular causes for insufficient milk production (1 case for
each category)
Evaluate the resident by grading the quality of the cases and the description of
the problems and solutions.
- Observe physicians providing breastfeeding management in the office setting (prenatal
and postnatal). Generate a report on what was observed that was done correctly,
and where improvements could be made. This could be done in many different settings
including community-based pediatric offices, newborn nursery, continuity clinic,
etc.
Evaluate the resident's report on the physician they observed and determine if the
areas of improvement were valid and if the residents' suggestions on how to improve
the situation were accurate.
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PATIENT CARE: |
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Goal B |
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Residents will understand how to provide peripartum breastfeeding support related
to lactogenesis, labor and delivery management, position and attachment, evaluation
of breastfeeding, problem solving, infants with special needs, medications and breastfeeding,
and management.
- Perform a detailed mother/infant breastfeeding history.
- Identify absolute contraindications to breastfeeding and factors that are NOT contraindications.
- Educate families and health care professionals about contraindications to breastfeeding.
Essential
- 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.
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PATIENT CARE:
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Goal C |
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Residents will recognize and address common breastfeeding challenges and provide
anticipatory guidance.
Identify at least 5 common challenges experienced by the breastfeeding infant and
mother, and suggest initial management strategies for these challenges, including:
- Insufficient milk production
- Attachment problems (latch-on, milk supply)
- Sore nipples
- Engorgement/mastitis
- Hyperbilirubinemia/dehydration
Essential
- 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."
Additional
- Present the prepared lecture (or a portion of the lecture specifically related to
the above learner objectives) "Management of Common Breastfeeding Problems"
 to the residents during
noon conference.
Evaluate the resident's knowledge of management of common problems by using the
provided Pre- and Post-test
or another simple exam.
- Make rounds with a physician who has a breastfeeding-friendly practice and present
1 breastfeeding challenge that was observed while making rounds to mentor. Present
to mentor 1 breastfeeding challenge that was observed while making rounds.
Evaluate the quality of the resident's presentation. The resident must provide the
etiology, remedy, and any possible anticipatory guidance that may have prevented
the concern from arising
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Learner Objective
