Milestones: OB 1
EPAs: EPA 1
Learner Task: Obtain a complete history from this patient.
Educator Script: Provide the following patient history as asked by the learner:
Educator Checklist: HPI
Mark the appropriate column to indicate whether the learner included each element in his or her response. When completed, tally the “Included” column to calculate the learner’s score.
| Included =1 | Not included =0 | |
| Introduces her/himself appropriately (first name, last name, medical student) | ||
| Addresses patient as per patient preference | ||
| Clarifies purpose of visit, asks if patient has any other concerns | ||
| Washes hands correctly (before touching patient), uses sterile technique throughout visit | ||
| Obtains accurate obstetric history: number of deliveries, mode of delivery, gestational ages, any complications | ||
| Obtains accurate gynecologic history: menarche/duration/frequency, first coitus, STIs, abnormal Pap tests, gynecologic surgery or problems, sexual orientation, lifetime partners, problems with intercourse | ||
| Obtains accurate review of systems for chief complaint: typical pregnancy symptoms, contractions, leaking fluid, bleeding, fetal movement. Also includes the following pertinent review of systems: headache, edema, RUQ or epigastric pain, visual changes | ||
| Obtains accurate past medical history | ||
| Obtains accurate surgical history | ||
| Obtains accurate medication use, asks about over the counter and herbal supplements | ||
| Obtains accurate allergy history (ideally about food allergies, too) | ||
| Obtains accurate family history | ||
| Obtains accurate social history including smoking, alcohol use, drug use |
Milestones: OB 1
EPAs: EPA 1
Learner Task: Perform a focused physical exam on this patient.
Educator Script: Provide the following details of focused physical examination as asked by the learner:
Educator Checklist: Physical Examination
Mark the appropriate column to indicate whether the learner included each element in his or her response. When completed, tally the “Included” column to calculate the learner’s score.
| Included =1 | Not included =0 | |
| Vital signs: obtains vital signs and recognizes elevated blood pressure and elevated body mass index | ||
| Abdominal examination: checks for right upper quadrant tenderness, examines fundus and fundal height | ||
| Obstetric examination: checks fetal lie, presence of fetal heart tones | ||
| Extremity examination: checks for edema | ||
| Neurologic examination: checks reflexes, checks for clonus, recognizes abnormalities | ||
| Pelvic examination: performs external genital examination during group B beta streptococcus collection, examines cervix |
Milestones: OB 1
EPAs: EPA 2
Learner Task: Develop an initial problem list.
Educator Checklist: Patient Problem List
Mark the appropriate column to indicate whether the learner included each element in his or her response. When completed, tally the “Included” column to calculate the learner’s score.
| Included =1 | Not Included =0 | |
| Advanced maternal age: recognizes age >35 at delivery is advanced maternal age and carries increased risk to pregnancy | ||
| Poor prenatal care: recognizes that the patient’s lack of visit since 12-weeks gestation carries increased risk to pregnancy | ||
| Hypertension: recognizes current blood pressure is abnormal, and recognizes patient’s history of hypertension as a complication to the pregnancy | ||
| Obesity: recognizes the patient’s obesity; recognizes that the obesity increases the risk to the pregnancy | ||
| Fundal height less than expected: recognizes discrepancy in dating and fundal height |
Milestones: OB 1
EPAs: EPA 3, EPA 4
Learner Task: The nurse asks what tests you would like to order for the patient. Order the appropriate diagnostic tests.
Educator Checklist: Diagnostic Tests
Mark the appropriate column to indicate whether the learner included each element in his or her response. When completed, tally the “Included” column to calculate the learner’s score.
| Included =1 | Not included =0 | |
| Urinalysis or urine drip | ||
| Urine protein: creatinine ratio or 24 hour urine protein | ||
| Complete blood count | ||
| Metabolic profile/chemistry | ||
| Liver function tests | ||
| Blood type and antibody screen | ||
| Syphilis screening | ||
| HIV screening | ||
| Hepatitis screening | ||
| Gonorrhea/chlamydia screening | ||
| Group B strep screening | ||
| Rubella immunity testing | ||
| Diabetes screening | ||
| Nonstress test or biophysical profile | ||
| Ultrasound for fetal growth |
Milestones: OB 1
EPAs: EPA 10
Learner Task: Identify additional problems found in the patient based on the diagnostic test results.
Educator Script: Provide the following diagnostic tests results to the learner (if ordered in the previous task):
| Diagnostic Test | Result |
| Urinalysis or urine dip | 3+ protein |
| Urine protein: creatinine ratio or 24-hour urine protein | Ratio: 0.6 24-hour urine: 531 mg |
| Complete blood count | WBC=10.4, Hgb=8, HCT=25.1, platelets=101,000 |
| Metabolic profile/chemistry | Na=142, Cl=106, K+=3.5, BUN=12, Cr=0.7, glucose=112 |
| Liver function tests | AST=102, ALT=96 |
| Blood type and antibody screen | A+, negative screen |
| Syphilis screening | negative |
| HIV screening | negative |
| Hepatitis screening | negative |
| Gonorrhea/chlamydia screening | negative |
| Group B strep screening | negative |
| Rubella immunity testing | immune |
| Diabetes screening (GCT or A1C) | GCT=122 A1C=5.6 |
| Nonstress test or biophysical profile | reactive |
| Ultrasound for fetal growth | EFW=2183 g (<10%ile), cephalic, AFI=13 cm |
Educator Checklist: Interpret Diagnostic Tests
Mark the appropriate column to indicate whether the learner included each element in his or her response. When completed, tally the “Included” column to calculate the learner’s score.
| Included =1 | Not included =0 | |
| Anemia: recognizes low Hemoglobin/HCT | ||
| Proteinuria: recognizes the protein, creatinine, or 24-hour urine collections are abnormal | ||
| Fetal growth restriction: recognizes the growth restriction | ||
| Elevated liver function tests: recognizes elevated liver function tests |
EPAs: EPA 10, EPA 2
Learner Task: What is the diagnosis for this patient?
Correct Diagnosis: Pre-eclampsia with severe features
Milestones: OB 1
EPAs: EPA 10
Learner Task: Identify risk factors for pre-eclampsia.
Educator Checklist: Risk Factors for Pre-Eclampsia
Mark the appropriate column to indicate whether the learner included each element in his or her response. When completed, tally the “Included” column to calculate the learner’s score.
| Included =1 | Not Included =0 | |
| Advanced maternal age | ||
| Chronic hypertension | ||
| History of pre-eclampsia | ||
| Obesity |
Milestones: OB 1
Learner Task: Develop a management plan for a patient with pre-eclampsia with severe features.
Educator Checklist: Management of Pre-Eclampsia with Severe Features
Mark the appropriate column to indicate whether the learner included each element in his or her response. When completed, tally the “Included” column to calculate the learner’s score.
| Included =1 | Not Included =0 | |
| Admits to hospital | ||
| Plans induction, delivery | ||
| Plans seizure prophylaxis | ||
| Recognizes importance of gestational age |
Milestones: OB 3, OP 1
Learner Task: The patient ultimately delivers vaginally and returns for postpartum examination. Identify the components of her postpartum care that are important to address at the postpartum visit.
Educator Checklist: Postpartum Care of Patient with Pre-Eclampsia
Mark the appropriate column to indicate whether the learner included each element in his or her response. When completed, tally the “Included” column to calculate the learner’s score.
| Included =1 | Not Included =0 | |
| Depression screening: asks about signs or symptoms of depression | ||
| Contraception: asks about sexual activity and contraception. Appropriately counsels patient about at least four appropriate contraception options, including sterilization and long-acting reversible contraception. Can include side effects, risks, and contraindications for all four. | ||
| Liver function tests: assesses for persistent elevated liver function tests | ||
| Breastfeeding concerns: asks about breastfeeding | ||
| Physical recovery: asks about pain, vaginal bleeding, return of sexual activity | ||
| Domestic violence: screens for domestic violence and safety | ||
| Future pregnancy: discusses timing of future pregnancy, importance of appropriate spacing of pregnancies | ||
| Blood pressure screening: assesses for persistent elevated blood pressures |
