MARCH Family Medicine Resident Rotation

Welcome to the MARCH  Family Medicine Resident Rotation for Advanced Family Planning and Abortion Care

We are excited to have you and please read the course orientation below.

Educational Purpose:

Provide exposure to

This elective is an opt-in interprofessional education opportunity designed to medical resident physicians on all aspects of family planning including contraception and pregnancy termination (medical and procedural).

The course utilizes the Innovating Education curriculum through UCSF.

Rotation Director:

Dr. Jessica Lee

Ryan Family Planning Residency Program Director

University of Maryland School of Medicine

jklee@som.umaryland.edu

Length of Rotation:  4 weeks

****I recommend you watch this video before the start of the rotation, it will help you understand D&C procedures:

https://vimeo.com/album/3395660/video/127882643
Passcode: outpatientEPL2015 

Below are some additional readings that will set you up for success on this rotation, please read prior to rotation start of in the first half of your first week:

1. Medical evaluation and management Ch 7
2. First trimester aspiration abortion Ch 10
3. Dilation and evacuation Ch 11
4. Values clarification –  I also encourage you to do this values clarification exercise (attached) as this is an abortion elective and I want you to have thought about some of these heavier questions before you begin.
5. An Overview of Maryland Abortion Law – Maryland Abortion and Reproductive Clinical Health Training Program

Extra Reading regarding later abortion that may help you process  later abortion care:

1. Thinking about and Processing Later Abortion: Second Trimester Abortion Provision: Breaking the Silence and Changing the Discourse

See below for expectations and objectives for your rotation:

Supervision: 

Resident physicians will work directly with nurse practictioners and attending physicians in the family planning clinic(s). You will be evaluated by these supervisors.

Educational Objectives:

Patient Care & Medical Knowledge – Abortion

1. Perform a thorough Ob/Gyn history, including menstrual, obstetric, gynecologic, contraceptive and sexual history. Elicit any medical history that may complicate pregnancy or abortion.
2. Gain competence in basic early pregnancy ultrasound (transvaginal and transabdominal).
3. Counsel patients regarding all options for an unplanned pregnancy or early pregnancy loss.
4. Understand indications for 1^st and 2^nd trimester termination of pregnancy.
5. Gain competence with medical abortion, including contraindications, medications used, and postoperative management.
6. Gain competence with use of conscious sedation in an outpatient setting.
7. Gain competence with 1st trimester procedural abortion and familiarity with 2nd trimester procedural abortion techniques.
8. Gain familiarity with post-abortion contraceptive options, including intrauterine contraception and subdermal implants.
9. Understand the historical and legal context of abortion in the United States, with focused study on Maryland to inform professional practice and advocacy efforts.

Patient Care & Medical Knowledge – Contraception

1. Describe the mechanisms of action of hormonal and non-hormonal contraception.
2. Understand the difference between efficacy and effectiveness.
3. Understand and describe the advantages, disadvantages, contraindications, failure rates, complications and appropriate follow-up associated with the following methods of contraception:
   1. Surgical sterilization
   2. Combined-oral contraception
   3. Progestin-only oral contraception
   4. Transdermal contraception
   5. Vaginal contraception
   6. Injectable contraception
   7. Intrauterine contraceptives
   8. Subdermal implants
   9. Barrier methods
   10. Natural family planning
4. Appropriately counsel low-risk patients in contraceptive choices.

Interpersonal and Communication skills

1. Demonstrate the ability to create and maintain a therapeutic relationship with patients and families.
2. Communicate effectively and respectfully with other members of the health care team.

Professionalism

1. Demonstrate respect, compassion, integrity, honesty.
2. Teach/role model responsible behavior.
3. Exhibit total commitment to self-assessment.
4. Acknowledge errors.

Practice-based learning improvement

1. Develop and maintain a willingness to learn from errors.
2. Locate, appraise and assimilate evidence from scientific studies related to their patients’ health problems.
3. Use technology to manage information for patient care and self-improvement.
4. Be evaluated by nurse practitioners and attendings

System-based practice

1. Anticipate problems patients/care givers may face in negotiating the health care system and advocate on the patient’s behalf.
2. Identify and work with other health care professionals and organizations that may assist in a patient’s care.

Learner Responsibilities:

1. Complete assigned Innovating Education online curriculum (first 3 weeks, ideally each week module should be done by Wednesday of that week).

Evaluation:

1. Based on direct observation of clinical care in combination of your completion of the Innovating Education online modules.
2. Global evaluation – Assessing six competencies: Patient Care; Medical Knowledge; Practice-based Learning and Improvement; Interpersonal and Communication Skills; Professionalism; Systems-based Practice. Completed by attendings based on personal contact. (this needs editing, we will likely be using TEACH competency based abortion skills evaluation)