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Breastfeeding Residency Curriculum

- PATIENT CARE:   Goal A Goal A
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.

- Learner Objectives

  1. Identify normal nutritional parameters for the term infant
  2. Evaluate positioning and latch-on
  3. Demonstrate hand expression

- Activities and Evaluation Strategies

Essential
  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.

Additional

  1. Present the prepared lecture "Management of Common Breastfeeding Situations" PPT Slideshow 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.
  2. 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.
  3. 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 PDF Document and Objective Structured Clinical Examination Case Study: Standardized Patient Description and Script PDF Document 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 PDF Document. The evaluator can also use the Resident Care Evaluation: Communication Skills PDF Document and Resident Care Evaluation: Patient History and Education PDF Document forms to evaluate the resident's performance in any instance (actual mother, role-play, or standardized patient).

  4. 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.
  5. 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.
  6. 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.

- PATIENT CARE:   Goal B Goal B
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.

- Learner Objectives

  1. Perform a detailed mother/infant breastfeeding history.
  2. Identify absolute contraindications to breastfeeding and factors that are NOT contraindications.
  3. Educate families and health care professionals about contraindications to breastfeeding.

- Activities and Evaluation Strategies

Essential

  1. 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.

Additional 

  1. Present the prepared lectures (or a portion of the lectures specifically related to the above learner objectives), "Basic Breastfeeding Assessment," PowerPoint File "Management of Common Breastfeeding Situations," PowerPoint File and "Management of Common Breastfeeding Problems" PowerPoint File to the residents during noon conference.
    Evaluate the resident's knowledge of peripartum breastfeeding support by using the provided Pre- and Post-test or another simple exam.
  2. Participate in a 3-5 day newborn follow-up visit in a primary care office setting and observe the breastfeeding counseling that is provided during this visit.  Record the discussion between the physician and the mother pertaining to breastfeeding, comment on the positive and negative aspects of this interaction, and present to mentor as a case study.
    Evaluate the content of the case study presentation.
  3. Attend a newborn/lactation follow up clinic at least 5 times and report on experiences. Keep a journal to identify the positive and negative aspects of the clinic in relation to breastfeeding support and management.
    Evaluate the journal kept by the resident to see that she or he identified the positive and negative aspects of the clinic in regards to breastfeeding support and management.
     
  4. Develop a system for documenting telephone contact/visits with breastfeeding families in the first few weeks.
    Grade the telephone system that is developed and evaluate the possibility of implementation.

- PATIENT CARE:   Goal C Goal C
Residents will recognize and address common breastfeeding challenges and provide anticipatory guidance.

- Learner Objective

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

- Activities and Evaluation Strategies

Essential

  1. 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

  1. Present the prepared lecture (or a portion of the lecture specifically related to the above learner objectives) "Management of Common Breastfeeding Problems" PowerPoint File 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.
  2. 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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