Rebecca Newman, MD,FAAPAttending, Normal Newborn Nursery,

Prentice Women’s Hospital, Northwestern Memorial Hospital

Rebecca Newman, MD, FAAP

Why develop a curriculum Who should develop a curriculum How develop a curriculum What should be in the curriculum How to implement a curriculum How to standardize the curriculum

CDC ◦ Healthy People 2000-2010-2020

American Academy of Pediatrics◦ Section on Breastfeeding. Breastfeeding and the use of

human milk(policy statement). Pediatrics. 2005;115(2):496-506.

U.S. Department of Health and Human Services. ◦ The Surgeon General’s Call to Action to Support

Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011

The Joint Commission ◦ exclusive breastfeeding as a (optional) performance measure

“The establishment and maintenance of breastfeeding should be one of the major goals of good post partum care.”

“Inaccurate and inconsistent guidance from health staff has been recognized as a major obstacle to breastfeeding”

Orientation and expectations

Breastfeeding is a core competency

◦ the best method of feeding

◦ Breastfeeding is a learned process that may take a mother-baby couplet days to weeks to perfect

◦ Newborns need very little nutrition in the first 3 days of life

◦ Treat babies by their behavior, gestational age, and alertness not by their birth weights and latch scores

Affect teaching stylesConsidered in developmentProvide for a better success

1. Visual learners are those who learn through seeing things

2. Auditory learners are those who learn best through hearing things

3. Kinesthetic learners are those who learn through experiencing/doing things

Visual aid when studying ◦ colorful outline of test materials◦ visual tools improve recall

Make outlines of everything!

Copy what's on the board

Ask the teacher to diagram

Take notes

Make lists

Watch videos

Using word association to remember facts and lines.

Recording lectures.

Watching videos.

Repeating facts with eyes closed.

Participating in group discussions.

Follows spoken directions well.

Is not afraid to speak in class.

Is fidgety during lectures

Can't sit still for long

Role playing

Studying with others

In the best of all possible worlds, you would incorporate all three learning styles into each of your lessons.

Rule of Three’s◦ 50% once◦ 75% twice◦ 90% thrice◦ But if see, hear, and do 100%

Visual Learner ◦ Written articles◦ Online courses, PowerPoint presentations◦ Bedside teaching

Auditory Learner◦ Live lecture , PowerPoint presentations◦ Bedside teaching◦ Rule of three

Kinesthetic learner◦ Case studies◦ Family centered care◦ Observing role modeling◦ Lead care rounds

ACGME AAP core competencies

1. Medical knowledge2. Patient care3. Interpersonal skills

and communication4. Practice-based

learning and improvement

5. Systems-based practices

Residents must be able to◦ Demonstrate knowledge

about established science and apply to patient care

◦ Provide family centered patient care

◦ Use interpersonal communication skills with parents families and professional associates

◦ Use scientific evidence to improve patient care

◦ Exhibit a commitment to ethical principles and sensitivity to cultural diversity

◦ Practice quality care and advocate for patients

Teach the basics◦ Assume they know nothing◦ Learn differently: oral/auditory/written◦ 3 times a charm rule of learning

Role modeling◦ Your technique◦ Your nurses◦ Your breastfeeding counselor◦ Your lactation counselor

◦ Make them watch/ provide the opportunity/ protect the time

One power point presentation

Daily sit down rounds

Daily bedside rounds

Patient consult with a lactation consultant

www.wellstart.org online course

The AAP pretest exam

www2.aap.org/breastfeeding/curriculum/

The curriculum is flexible and can be implemented over 1 rotation, or entire length of residency

Planning tools: data collection Evaluation tools: pre and post test Teaching tools: case study, presentations

http://www2.aap.org/breastfeeding/curriculum/tools.html

www.wellstart.org/Self-Study-Module.pdf

Online Free of charge Printed certificate of completion quite thorough Likely mode of tracking for Baby Friendly

◦ after residency

Newborn care is always family centered?

Cincinnati Children’s Hospital

The challenges of breastfeeding

Part of daily rounds and care plan

Examine mother’s breast development

Examine baby oral patterns and explain

stages of post partum recovery

Weight and output

Observe feeding daily

The stages of postpartum recovery in the newborn and mother and its effect on breastfeeding◦ Initial period of vigilance for 4 hour◦ Second stage of recovery for 1-3 days◦ Third stage of emergence on day 3 and the chemical

markers

The effects of iatrogenic interference: Type of delivery , induction, IVF Maternal illness and meds Gestational age Painful procedures

Scripts at sit down rounds

◦ “How is feeding?”◦ “Are you feeling any pain?”-”May I examine your breast as

well?”◦ “How do you know when your baby is ready to feed?”◦ “How many poop and pee diapers have you changed?”◦ “What is your feeding plan for the day?”◦ “Why did your baby stay in the nursery overnight last night?”

Bedside teaching

Role modeling◦ Attending◦ Nursing◦ Breast feeding counselor◦ Lactation consultant

Role modelingProtected timePractice and reinforcement

Expectations

Protected session with LC, BFC

◦ Arrange, insist, follow up

Different patients-different problems-different solutions

◦ Gestational age

◦ Cultural differences Caucasian African -American, Hispanic indigenous Africans, Indian, Middle eastern, Muslim

Feed back session after LC and at the end of rotation

◦ Written◦ Verbal

Multiple sitesMultiple opportunityMultiple teachers

Medical school rotations◦ Obstetrics 1 month◦ Pediatrics 1 month

N.I.C.U. ◦ 4-6 month rotation

Normal newborn◦ 1 month rotation

Continuity clinic◦ weekly for 3 years

Inpatient◦ General pediatric medicine : 6 months

Wellstart International’s Lactation Management Self-Study Modules, Level 1, Third Edition 2009

◦ For official designation as a Baby Friendly®* Hospital by Baby-Friendly USA, Inc. (BFUSA)

◦ physicians involved in care of either mothers or babies in candidate hospitals, they must have at least 3 hours of acceptable breastfeeding management training.”

◦ by using current evidence-based self-study modules.

◦ Meets JACHO certification

To facilitate record keeping,

◦ has developed a Certificate of Completion process.

◦ A “final exam” is available without charge. May be taken multiple times

◦ A Certificate is available for a passing score of 80% or greater free downloading and print Includes the name of the candidate and the date of achievement

◦ This Certificate can be printed and given to the staff or faculty member who is maintaining the records

Does not currently give CME for completion

If certificate is lost, must retake the test

Does not require the study module to complete the test

Must have computer and printer access

Governing body who will enforce certification

rnewman@northwestern.edu

Keep on smilin’